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quinidine (Rx)Brand and Other Names:Quinaglute, Quinidex, more...quinidine gluconate

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet, controlled-release

  • 300mg
  • 324mg

tablet

  • 200mg
  • 300mg

syrup

  • 10mg/mL

injectable solution

  • 80mg/mL
more...

Arrhythmias

Quinidine Sulfate

  • Test Dose: 200 mg PO quinidine sulfate several hr before full dosage
  • AFib: 300-400 mg PO q6hr
  • PSVT: 400-600 mg PO q2-3hr until paroxysm terminated
  • Atrial/Ventr Premature Contractions: 200-300 mg PO TID/QID
  • Maint: 200-400 mg PO TID/QID or 600 mg of SR PO q8-12hr
  • No more than 3-4 g/d

Quinidine Gluconate

  • 324-660 mg PO q8-12hr
  • Maint: 648 mg PO q12hr OR 324-660 mg PO q8hr
  • PSVT:400 - 600 mg PO q2-3hr until paroxysm is terminated
  • IV: usu <5 mg/kg (but may need up to 10 mg/kg) at 0.25 mg/kg/min

Malaria

Quinidine Sulfate: 300-600 mg OR 10 mg/kg PO q8hr x 5-7 days

Quinidine Gluconate

  • Load: 10 mg/kg diluted in 5 mL/kg NS IV over 1-2 hr, THEN continuous IV infusion of 0.02 mg/kg/min for 72 hr or until parasitemia is reduced to 1% or until oral therapy can be started OR 
  • Load: 24 mg/kg diluted in 250 mL NS IV infusion over 4 hours
  • Maint: after another 4 hr, 12 mg/kg IV infusion over 4 hours q8hr x3 & parasitemia is reduced to less than 1% & oral therapy can be started
  • PO: 324-972 mg PO q8-12hr x5-7 days

Pseudobulbar Affect (Off-Label)

Excessive laughing or crying, or involuntary emotional expression affects 20-50% of patients with ALS

30 mg PO bid (administer with dextromethorphan)

Other Indications & Uses

Cardioversion or chronic therapy for atrial fib/flutter, PSVT, malaria

Off-label: prevention of atrial, AV junctional & ventricular premature complexes in adults; paroxysmal atrial tach or AV junctional rhythm, paroxysmal VTach, pseudobulbar affect

Dosage Forms & Strengths

syrup

  • 10mg/mL

tablet

  • 200mg
  • 300mg

tablet, controlled-release

  • 300mg
  • 324mg

injectable solution

  • 80mg/mL
more...

Arrhythmias

Quinidine Gluconate: 2-10 mg/kg IV q3-6hr PRN

Quinidine Sulfate: 30 mg/kg/day or 900 mg/sq. meter/day PO given in 5 divided doses OR 15-60 mg/kg/day divided q6hr PO

Test Dose: 2 mg/kg PO quinidine sulfate

Malaria

CDC recommends same wt-based dosing as for adults

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Interactions

Interaction Checker

quinidine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Diarrhea (35%)

            Stomach cramping (22%)

            Lightheadedness (15%)

            QTc prolongation (modest prolongation common; excessive prolongation rare & indicates toxicity) (>10%)

            Anorexia (>10%)

            Bitter taste (>10%)

            Diarrhea (>10%)

            Upper GI distress (>10%)

            Nausea (>10%)

            Vomiting (>10%)

            1-10%

            Syncope (1-8%)

            Palpitation (7%), new or worsened arrhythmias (proarrhythmic effect),

            Headache (7%)

            Fatigue (7%)

            Angina (6%)

            Rash (5%)

            Weakness (5%)

            Sleep disturbance (3%)

            Nervousness (2%)

            Tremor (2%)

            Incoordination (1%)

            Blurred vision

            Tinnitus

            Wheezing

            Frequency Not defined

            Hypotension

            Hepatotoxicity

            Arthralgia

            Diplopia

            Night blindness

            Hypersensitivity rxns (eg, fever, hemolytic/aplastic anemia, respiratory arrest, agranulocytosis)

            Systemic lupus erythematosus may occur if taking quinidine for prolonged period of time

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            Warnings

            Black Box Warnings

            Antiarrhythmic drugs have not been shown to enhance survival in non-life-threatening ventricular arrhythmias and they may increase mortality. The mortality risk increases with structural heart disease.

            Quinidine may increase mortality in treatment of atrial fibrillation or atrial flutter

            Contraindications

            Hypersensitivity to quinidine or cinchona alkaloids

            Absence of atrial activity, aberrant impulses or abnormal rhythm due to escape mechanisms, complete AV block or AV dissociation, digoxin tox, wide QRS, history of torsades, long QT syndrome, thrombocytopenia, myasthenia gravis, contraindicated w/pregnancy (neonatal thrombocytopenia) and lactation

            Drugs or conditions that prolong QT interval

            Cautions

            In non-life-threatening ventricular arrhythmias, mortality associated with quinidine was consistently greater than that associated with any of a variety of alternative antiarrhythmics

            Acute rheumatic fever, acute thyrotoxicosis, bradycardia, CHF, hypoK or hypoMg, hypotension, incomplete AV block, sick sinus syndrome, subacute bacterial endocarditis, syncope, concomitant use of digoxin, liver dz, renal impairment, pregnancy/lactation

            Electrolyte imbalances d/t severe N/V, diarrhea, eating disorders

            IV admin requires continuous cardiac & blood pressure monitoring

            Low salt diet may incr blood concs

            Dose should be adjusted within range to achieve desired therapeutic effects within therapeutic plasma concentration and in absence of toxic SE

            Avoid grapefruit juice

            Very high dosages may induce abortion in pregnant women d/t oxytocic effect

            Ext rel not recommended in children

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: crosses into breast milk, use extreme caution (AAP Committee states compatible w/ nursing)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Half-Life: 6-8 hr

            Onset: PO: 1-3 hr

            Duration: 6-8 hr

            Peak Plasma Time: PO, conv: 1-2 hr PO, ext rel: 3-5 hr

            Bioavailability: sulfate 70%; gluconate 70-80%

            Protein Bound: ~80%

            Vd: 2-3 L/kg

            Metabolism: liver via hepatic P450 enzyme CYP3A4

            Metabolites: 3-hydroxyquinidine & 2-quinidinone (some have antiarrhythmic effects)

            Excretion

            Urine 10-50%

            Feces 5%

            Other Information

            Dialyzable: HD: yes; PD: no

            Enzymes inhibited: CYP2D6

            Mechanism of Action

            Class IA (membrane stabilizing) antiarrhythmic agent; inhibits recovery after repolarization resulting in decreasing myocardial excitability & conduction velocity

            Direct membrane depressant that decreases conduction velocity, prolongs refractoriness, decreases automaticity and reduces repolarization abnormalities

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            Administration

            IV Compatibilities

            Additive: diazepam, ranitidine, verapamil

            IV Incompatibilities

            Additive: alkalines, amiodarone, furosemide, iodide

            IV Preparation

            Dilute 800 mg quinidine gluconate (10 mL) to 50 mL w/ D5W

            Minimize use of PVC tubing

            Other Information

            IV Administration: see dosing

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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