Dangerous Drug: Quinidine(qwin’ i deen)
Quinidine GluconateDNC
Quinidine SulfateDNC
PREGNANCY CATEGORY C
Drug Classes
Antiarrhythmic
Antimalarial
Therapeutic Actions
Type IA antiarrhythmic: Decreases automaticity in ventricles, decreases height and rate of rise of action potential, decreases conduction velocity, increases fibrillation threshold.
Indications
Treatment of atrial arrhythmias, paroxysmal or chronic ventricular tachycardia without heart block
Maintenance therapy after electrocardioversion of atrial fibrillation or atrial flutter
Treatment of life-threat Plasmodium falciparum infections when IV therapy (quinidine gluconate) is indicated
Contraindications and Cautions
Contraindicated with allergy or idiosyncrasy to quinidine, second- or third-degree heart block, myasthenia gravis, pregnancy (neonatal thrombocytopenia), lactation, thrombocytopenic purpura, in patients with diseases that might be adversely affected by an anticholinergic agent.
Use cautiously with renal disease, especially renal tubular acidosis, HF, hepatic insufficiency.
Available Forms
Tablets—200, 300 mg; SR tabletsDNC—300, 324 mg; injection—80 mg/mL
Dosages
Quinidine gluconate contains 62% anhydrous quinidine alkaloid. Quinidine sulfate contains 83% anhydrous quinidine alkaloid.
Adults
Administer a test dose of 200 mg PO or 200 mg IV to test for idiosyncratic reaction. Maintenance therapy, 200–300 mg tid or qid PO or 300–600 mg every 8 hr or every 12 hr if SR form is used.
Paroxysmal supraventricular arrhythmias: 400–600 mg (sulfate) PO every 2–3 hr until paroxysm is terminated.
Conversion of atrial flutter/fibrillation: 648 mg (gluconate) PO every 8 hr; may increase after three to four doses if needed. Or 324 mg (gluconate) PO every 8 hr for 2 days, then 648 mg PO every 12 hr for 2 days, then 648 mg PO every 8 hr for up to 4 days. Or 5–10 mg/kg (gluconate) IV. For ER tablets, 300 mg (sulfate) PO every 8–12 hr; may increase dosage cautiously if serum levels are in therapeutic range. For immediate-release tablets, 400 mg (sulfate) PO every 6 hr; may increase dosage after four to five doses if conversion has not occurred.
Reduction of relapse: 324 mg (gluconate) PO every 8–12 hr. For ER tablets, 300 mg (sulfate) PO every 8–12 hr. For immediate-release tablets, 200 mg (sulfate) PO every 6 hr.
P. falciparum malaria: 24 mg/kg quinidine gluconate IV in 250 mL normal saline infused over 4 hr; then 12 mg/kg infused over 4 hr every 8 hr for 7 days (patients who are able can switch to same dosage of quinidine sulfate orally). Or, 10 mg/kg quinidine gluconate in 5 mL/Kg normal saline as a loading dose; then a maintenance infusion of 20 mcg/kg/min. Patient may switch to same oral dosage of quinidine sulfate every 8 hr for 72 hr or until parasitemia is decreased to 1% or less.
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