Details About Generic Salt ::  Quinidin

Main Medicine Class:: Antipsychotic   

(KWIN-ih-deen)
Quinidine Sulfate
Quinidex Extentabs, Quinora,  Apo-Quinidine
Quinidine Gluconate
Quinaglute Dura-Tabs, Quinalan,  Quinate
Quinidine Polygalacturonate
Cardioquin
Class: Antipsychotic

 

Drugs Class ::

 Action Depresses myocardial excitability, conduction velocity and contractility; prolongs effective refractory period and increases conduction time; indirect anticholinergic effects; may decrease vagal tone at low doses paradoxically increasing conduction through the AV node.

Indications for Drugs ::

 Indications Treatment of premature atrial, atrioventricular junctional, and ventricular contractions; treatment of paroxysmal supraventricular tachycardia, paroxysmal atrioventricular junctional rhythm, atrial flutter, paroxysmal and chronic atrial fibrillation, and paroxysmal ventricular tachycardia not associated with complete heart block; maintenance therapy after electrical conversion of atrial fibrillation or flutter.

Quinidine gluconate (IV administration): Treatment of life-threatening Plasmodium falciparum malaria.

Drug Dose ::

 Route/Dosage

The following oral doses are expressed as quinidine sulfate salt:

Premature Atrial and Ventricular Contractions

ADULTS: PO 200 to 300 mg tid/qid. CHILDREN: PO 30 mg/kg/day or 900 mg/m 2/day in 5 divided doses.

Paroxysmal Supraventricular Tachycardia

ADULTS: PO 400 to 600 mg q 2 to 3 hr until event is abated.

Atrial Flutter

Administer after digitalization and individualize dose.

Conversion of Atrial Fibrillation

ADULTS: PO 200 mg q 2 to 3 hr for 5 to 8 doses, then maintain with 200 to 300 mg tid to qid (immediate-release tablets) or 300 to 600 mg bid to tid (sustained-release tablets); do not exceed 3 to 4 g/day.

QUINIDINE GLUCONATE

ADULTS: PO 324 to 648 mg (1 to 2 tablets) q 8 to 12 hr.

Quinidine Polygalacturonate

ADULTS: PO Maintenance dose: 275 mg q 8 to 12 hr.

PARENTERAL QUINIDINE GLUCONATE

ACUTE TACHYCARDIA: ADULTS: IM 600 mg initially, then 400 mg prn up to q 2 hr. CHILDREN: IV 2 to 10 mg/kg/dose q 3 to 6 hr prn. P. FALCIPARUM MALARIA: ADULTS: IV 15 mg/kg infused over 4 hr initially, then 7.5 mg/kg over 4 hr q 8 hr for 7 days or until oral therapy can be instituted or 10 mg/kg over 1 to 2 hr initially, then 0.02 mg/kg/min for up to 72 hr or until oral therapy can be instituted.

Contraindication ::

 Contraindications Myasthenia gravis; history of thrombocytopenic purpura associated with quinidine administration; digitalis intoxication; complete heart block; left bundle branch block; complete atrioventricular (AV) block with AV nodal or idioventricular pacemaker; aberrant ectopic impulses and abnormal rhythms because of escape mechanisms; history of drug-induced torsade de pointes; history of long QT syndrome.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Atrial flutter or fibrillation: Pretreat these patients with digitalis preparation. Bioequivalency: Different salts have different amounts of quinidine base. Do not interchange without taking this into consideration. Cardiotoxicity: May occur; immediately discontinue drug. Hepatotoxicity (including granulomatous hepatitis): Has occurred. Consider possibility if unexplained fever or elevated hepatic enzymes develop. Hypersensitivity reactions: May occur; administer single 200 mg tablet of quinidine sulfate or 200 mg IM injection of quinidine gluconate before starting therapy to determine if patient has idiosyncrasy to quinidine. Malaria: Dose schedules may result in hypotension, ECG changes, and cinchonism. Parenteral therapy: Use only when oral therapy is not possible or when rapid therapeutic effect is required. Potassium balance: Effect of quinidine is enhanced by potassium and reduced if hypokalemia is present. Renal, hepatic, or cardiac impairment: Use drug with caution because of potential for toxicity. Syncope: Occasionally occurs in patients on long-term therapy; may be fatal. Often caused by torsades de pointes. Vagolytic effects: May antagonize vagal maneuvers or administration of cholinergic drugs used to terminate paroxysmal supraventricular tachycardia.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Widening of QRS complex; cardiac asystole; ventricular ectopy; hypotension; paradoxical tachycardia. CNS: Headache; fever; vertigo; excitement; confusion; delirium; syncope. DERM: Rash; urticaria; pruritus; flushing; photosensitivity. EENT: Mydriasis; blurred vision; photophobia, diplopia, night blindness; tinnitus. GI: Nausea; vomiting; anorexia; abdominal pain; diarrhea. GU: Lupus nephritis. HEPA: Hepatitis. HEMA: Acute hemolytic anemia; agranulocytosis; thrombocytopenic purpura. OTHER: Lupus erythematosus-like syndrome; cinchonism (headache, tinnitus, nausea, disturbed vision, deafness, dizziness, vertigo, lightheadedness); hypersensitivity reactions; arthralgia; myalgia.

Drug Mode of Action ::  

 Action Depresses myocardial excitability, conduction velocity and contractility; prolongs effective refractory period and increases conduction time; indirect anticholinergic effects; may decrease vagal tone at low doses paradoxically increasing conduction through the AV node.

Drug Interactions ::

 Interactions

Amiodarone, antacids, cimetidine, verapamil: May increase quinidine levels. Anticoagulants: May increase effect of anticoagulant; may cause hemorrhage. Barbiturates, nifedipine, primidone, sucralfate: May decrease quinidine levels. Beta-blockers: May increase effect of beta-blocker. Dextromethorphan: May increase plasma dextromethorphan concentrations. Digitoxin, digoxin: May increase digoxin plasma levels. Hydantoins: May reduce therapeutic effect of quinidine. Nondepolarizing neuromuscular blocking agents, succinylcholine: May increase neuromuscular blockade effect. Propafenone: Increased propafenone levels. Rifampin: May increase quinidine metabolism.

Drug Assesment ::

 Administration/Storage

  • Use IV route only when rapid response is needed or oral route is not feasible.
  • Give test dose of 200 mg as ordered to evaluate intolerance/sensitivity.
  • Position patient supine during IV administration to minimize hypotension.
  • For direct IV push, administer slowly at 1 ml/min.
  • For intermittent IV infusion, dilute 800 mg/50 ml or more with D5W; give at a rate of 16 mg/min or less. Use infusion device for accuracy/safety.
  • Administer IM injection in deltoid muscle.
  • Give oral preparation with full glass of water on empty stomach (1 hr before or 2 hr after other medication) to enhance absorption; if GI distress develops, administer with or just after meal.
  • Instruct patient to report these symptoms to health care provider immediately: Visual disturbances (eg, blurring), tinnitus, bleeding, bruising, fever, headache, dizziness, severe diarrhea, or skin rash/eruption.
  • Advise patient that drug causes dizziness and blurred vision and to use caution while driving or performing other tasks requiring mental alertness.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Instruct patient not to take otc medications without consulting health care provider.

Drug Storage/Management ::

 Administration/Storage

  • Use IV route only when rapid response is needed or oral route is not feasible.
  • Give test dose of 200 mg as ordered to evaluate intolerance/sensitivity.
  • Position patient supine during IV administration to minimize hypotension.
  • For direct IV push, administer slowly at 1 ml/min.
  • For intermittent IV infusion, dilute 800 mg/50 ml or more with D5W; give at a rate of 16 mg/min or less. Use infusion device for accuracy/safety.
  • Administer IM injection in deltoid muscle.
  • Give oral preparation with full glass of water on empty stomach (1 hr before or 2 hr after other medication) to enhance absorption; if GI distress develops, administer with or just after meal.
  • Instruct patient to report these symptoms to health care provider immediately: Visual disturbances (eg, blurring), tinnitus, bleeding, bruising, fever, headache, dizziness, severe diarrhea, or skin rash/eruption.
  • Advise patient that drug causes dizziness and blurred vision and to use caution while driving or performing other tasks requiring mental alertness.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Instruct patient not to take otc medications without consulting health care provider.

Drug Notes ::

 Administration/Storage

  • Use IV route only when rapid response is needed or oral route is not feasible.
  • Give test dose of 200 mg as ordered to evaluate intolerance/sensitivity.
  • Position patient supine during IV administration to minimize hypotension.
  • For direct IV push, administer slowly at 1 ml/min.
  • For intermittent IV infusion, dilute 800 mg/50 ml or more with D5W; give at a rate of 16 mg/min or less. Use infusion device for accuracy/safety.
  • Administer IM injection in deltoid muscle.
  • Give oral preparation with full glass of water on empty stomach (1 hr before or 2 hr after other medication) to enhance absorption; if GI distress develops, administer with or just after meal.
  • Instruct patient to report these symptoms to health care provider immediately: Visual disturbances (eg, blurring), tinnitus, bleeding, bruising, fever, headache, dizziness, severe diarrhea, or skin rash/eruption.
  • Advise patient that drug causes dizziness and blurred vision and to use caution while driving or performing other tasks requiring mental alertness.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Instruct patient not to take otc medications without consulting health care provider.

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