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Quinidine

Chinidin


Presentation

  • Although this therapy was effective and diminished her peripheral blood parasitemia from 3% at presentation to almost undetectable at the time of delivery, vast numbers of P. falciparum-infected erythrocytes were present in the maternal sinusoids of the[ncbi.nlm.nih.gov]
  • Abstract We present the case of a 14-year-old female with early repolarization syndrome who presented with recurrent ventricular fibrillation and ICD shocks which were refractory to multiple drugs and catheter ablation.[ncbi.nlm.nih.gov]
  • Keywords: Biological processes, Cell signaling, Diseases, Hormones, Ligands, Neurotransmitters HPLC Analysis of Alkaloids on Discovery RP-AmideC16 From our library of Articles, Sigma-Aldrich presents HPLC Analysis of Alkaloids on Discovery RP-AmideC16[sigmaaldrich.com]
  • Abstract We report an adolescent with a malignant form of Brugada syndrome who presented with 15 episodes of ventricular fibrillation (VF) over 10 days, shortly after implantation of an implantable cardioverter defibrillator.[ncbi.nlm.nih.gov]
Congestive Heart Failure
  • Heart a factor with levels No/Mild, Moderate, and Severe indicating congestive heart failure for the subject.[stat.ethz.ch]
  • Before you take quinidine, tell your doctor if you have a slow heart rate , congestive heart failure , a serious heart condition such as "sick sinus syndrome," kidney or liver disease , low levels of potassium or magnesium in your blood, a history of[drugs.com]
  • It is contra-indicated in patients with acute infection, complete heart block or extensive myocardial disease such as valvular disease, auricular fibrillation of long standing, congestive heart failure, cardiac enlargement, mitral stenosis, recent coronary[home.intekom.com]
  • Before you take quinidine, tell your doctor if you have a slow heart rate, congestive heart failure, a serious heart condition such as "sick sinus syndrome," kidney or liver disease, low levels of potassium or magnesium in your blood, a history of "Long[uofmhealth.org]
Diarrhea
  • Abstract The effective use of quinidine as an antiarrhythmic agent is frequently curtailed by one of its most common side effects-relentless diarrhea.[ncbi.nlm.nih.gov]
  • A 62-y-old male with a past medical history of atrial flutter and adult onset diabetes was admitted to the hospital with a 3-d history of diarrhea, nausea, fever, chills and palpitations.[ncbi.nlm.nih.gov]
  • The most frequently reported treatment-related AEs (TRAEs) were nausea (11.8%), dizziness (10.5%), headache (9.9%), somnolence (7.2%), fatigue (7.1%), diarrhea (6.5%), and dry mouth (5.1%).[ncbi.nlm.nih.gov]
  • Nausea, vomiting, diarrhea, and skin rash are common reactions to the use of quinidine.[britannica.com]
Vomiting
  • Nausea, vomiting, diarrhea, and skin rash are common reactions to the use of quinidine.[britannica.com]
  • Non-specific symptoms, such as lightheadedness, chills, fever, nausea, and vomiting, can precede or occur with thrombocytopenia. NUEDEXTA should be discontinued immediately if thrombocytopenia occurs.[nuedextahcp.com]
  • Overdose symptoms may include vomiting, diarrhea, ringing in your ears or hearing problems, dizziness or spinning sensation, blurred vision, irregular heartbeat, confusion, or feeling like you might pass out.[drugs.com]
Nausea
  • A 62-y-old male with a past medical history of atrial flutter and adult onset diabetes was admitted to the hospital with a 3-d history of diarrhea, nausea, fever, chills and palpitations.[ncbi.nlm.nih.gov]
  • Nineteen patients discontinued treatment due to adverse effects, chiefly nausea. LIMITATIONS: Because this was a retrospective chart review with no control group, conclusions about causation cannot be made.[ncbi.nlm.nih.gov]
  • The most frequently reported treatment-related AEs (TRAEs) were nausea (11.8%), dizziness (10.5%), headache (9.9%), somnolence (7.2%), fatigue (7.1%), diarrhea (6.5%), and dry mouth (5.1%).[ncbi.nlm.nih.gov]
  • Nausea, vomiting, diarrhea, and skin rash are common reactions to the use of quinidine.[britannica.com]
Tachycardia
  • Nine-month follow-up was uneventful, without recurrence of ventricular tachycardia at ICD controls.[ncbi.nlm.nih.gov]
  • Abstract Holter monitoring in a 75-year-old man with a VVI pacemaker with rate hysteresis and concomitant quinidine treatment documented the occurrence of several episodes of non-sustained polymorphous ventricular tachycardia, triggered by each first[ncbi.nlm.nih.gov]
  • Abstract Torsades de pointes is a polymorphic ventricular tachycardia characterized by marked QT prolongation on the electrocardiogram. It can be induced by both antiarrhythmic and nonantiarrhythmic drugs, such as quinidine and erythromycin.[ncbi.nlm.nih.gov]
  • RESULTS: We report the case of a patient with vasospastic angina and J-wave pattern in inferior and lateral leads associated with polymorphic ventricular tachycardia which was effectively treated only with quinidine-vasodilating drugs were not able to[ncbi.nlm.nih.gov]
  • Quinidine is used by the 1920s, as an antiarrhythmic agent to maintain sinus rhythm after the conversion from atrial flutter or atrial fibrillation and to prevent recurrence of ventricular tachycardia or ventricular fibrillation.[doi.org]
Hypotension
  • Abstract We report the use of extracorporeal membrane oxygenation (ECMO) to establish and maintain cardiovascular stability in a 16 month old with refractory bradydysrrhythmias and hypotension after an acute overdose of quinidine.[ncbi.nlm.nih.gov]
  • Four (17%) patients had hypotension possibly attributed to the quinidine. CONCLUSIONS: A continuous intravenous infusion of quinidine gluconate may be effective in patients in whom other agents are contraindicated or have failed.[ncbi.nlm.nih.gov]
  • Hypotension. Renal or hepatic dysfunction. Monitor blood, liver and kidney function in long-term use. Monitor ECG and serum levels if dose is over 2.5g/day. Pregnancy (Cat.C). Nursing mothers. Pharmacologic Class: Class I antiarrhythmic.[empr.com]
  • Clinically observed hypotension after quinidine plus verapamil can be explained by their synergistic inhibitory effects on human alpha1ARs.[ncbi.nlm.nih.gov]
  • Prolongation of the QT interval as indicated by an electrocardiogram, ventricular arrhythmia, hypotension, and hypoglycemia can result from the use of this drug at treatment doses.[doi.org]
Orthostatic Hypotension
  • hypotension, fainting spells or blackouts Chronic or relevant acute infections History of relevant allergy/hypersensitivity (including allergy to drug or its excipients) Intake of drugs with a long half-life ( 24 hours) within at least one month or less[clinicaltrials.gov]
Tinnitus
  • Adverse effects include cinchonism (headaches and tinnitus), diarrhea. Quinidine is also associated with torsades de pointes, a ventricular arrhythmias associated with marked QT prolongation.[pharmacology2000.com]
  • Symptoms of toxicity (cinchonism) include tinnitus, light-headedness, premature ventricular contractions, and atrioventricular block.[mayomedicallaboratories.com]
  • Cinchonism is a collection of symptoms that includes tinnitus, blurred vision, lightheadedness, tremor, giddiness, and altered hearing which decreases in severity with lower quinidine concentrations.[mhmedical.com]

Workup

Wide QRS Complex
  • Other ECG effects include a wide notched P wave, wide QRS complex, depressed ST segment, and U waves. These are the results of both slowed depolarization and repolarization.[en.wikipedia.org]
Prolonged QT Interval
  • OBJECTIVE: To report a case of Plasmodium falciparum malaria in which intravenous quinidine was used, resulting in a prolonged QT interval. CASE SUMMARY: P. falciparum malaria was diagnosed in a woman visiting from Nigeria.[ncbi.nlm.nih.gov]
  • A prolonged QT interval, development of torsades de pointes, and a serum quinidine concentration of 3.1 micrograms/ml contributed to a decision favoring permanent pacemaker implantation.[ncbi.nlm.nih.gov]
  • Cardiovascular: NUEDEXTA is contraindicated in patients with a prolonged QT interval, congenital long QT syndrome, history suggestive of torsades de pointes, heart failure, patients receiving drugs that both prolong QT interval and are metabolized by[nuedextahcp.com]
  • At the same time, hypokalemia induces a decrease in potassium conductance and traps potassium in the cardiac cells making them depolarized and increasing the action potential duration and hence the prolonged QT interval.[forums.studentdoctor.net]
  • 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,[reference.medscape.com]
Torsades De Pointes
  • Abstract Torsades de pointes is a polymorphic ventricular tachycardia characterized by marked QT prolongation on the electrocardiogram. It can be induced by both antiarrhythmic and nonantiarrhythmic drugs, such as quinidine and erythromycin.[ncbi.nlm.nih.gov]
  • Abstract Right ventricular endocardial monophasic action potential recordings were obtained in a patient with a qunidine-induced long QTU interval and polymorphic ventricular tachycardia of the torsade de pointes type.[ncbi.nlm.nih.gov]
  • A prolonged QT interval, development of torsades de pointes, and a serum quinidine concentration of 3.1 micrograms/ml contributed to a decision favoring permanent pacemaker implantation.[ncbi.nlm.nih.gov]
  • CONCLUSION: Serum quinidine concentrations, electrocardiograms, and other factors that may predispose patients to torsades de pointes, such as hypokalemia and hypomagnesemia, should be monitored closely if quinidine is coadministered with erythromycin[ncbi.nlm.nih.gov]
  • She developed "quinidine syncope," and the Q-Tc was unchanged despite stopping administration of the drug; however, electrophysiologic studies demonstrated reproducibly inducible "torsade de pointes" while the patient was being rechallenged with quinidine[ncbi.nlm.nih.gov]
Flattened T Wave
  • T waves (without dysrhythmia), have occurred frequently and hypotension and ventricular tachycardia have occurred occasionally in patients receiving IV quinidine gluconate for the treatment of Plasmodium falciparum malaria. 102 104 108 124 Use with caution[drugs.com]
Notched T Wave
  • BACKGROUND: Congenital long QT syndrome type 2 (abnormal hERG potassium channel) patients can develop flat, asymmetric, and notched T waves. Similar observations have been made with a limited number of hERG-blocking drugs.[ncbi.nlm.nih.gov]

Treatment

  • Outcome was measured on the basis of patient self-report, treatment team evaluation, and physical examination by psychiatrists and primary care physicians.[ncbi.nlm.nih.gov]
  • No changes were made to the pre-existing drug regimen during the course of treatment with DMQ. The primary outcome measure was the Clinical Global Impression-Improvement (CGI-I) score after 90 days of treatment.[ncbi.nlm.nih.gov]
  • Four clinical trials have evaluated the use of DM/Q for the treatment of PBA. Although the therapeutic outcomes with DM/Q have been positive, interpretation of the published evidence is limited by small sample size and short treatment duration.[ncbi.nlm.nih.gov]
  • Pending approval of the data from the FDA, AVP-923 would be the first FDA-approved treatment for PBA.[ncbi.nlm.nih.gov]
  • Sermoneta, Italy) and quinidine polygalacturonate (Ritmocor; Malesci, Bagno A Ripoli, Italy) has been causing clinical problems to many cardiologists and patients, frequently leading to discontinuance of an effective and well-tolerated pharmacological treatment[ncbi.nlm.nih.gov]

Prognosis

  • Abstract Epilepsy of infancy with migrating focal seizures {a.k.a malignant migrating partial seizures of infancy (MMPSI)} is an uncommon epileptic encephalopathy with a poor prognosis.[ncbi.nlm.nih.gov]
  • Prognosis for seizure control, neurological or psychomotor skill development or even survival beyond the first few years is poor in these patients. Most MPSI patients do not respond to the available antiepileptic drugs.[cainlabs.texaschildrens.org]

Etiology

  • Quinidine was considered an etiologic agent and was discontinued after administration of 1 dose. The patient became afebrile within 48 h, liver enzyme levels gradually decreased, and the patient was discharged on day 6 of hospitalization.[ncbi.nlm.nih.gov]
  • If improvement does not occur, drug resistance or inadequate drug delivery, complications of malaria, or other etiologies for the illness should be investigated.[cdc.gov]

Epidemiology

  • No clinical or epidemiologic studies have, however, been done. Quinidine should be used during pregnancy only when clearly indicated. Lactation: Quinidine is present in breast milk at levels slightly lower than those in maternal serum.[rxmed.com]
Sex distribution
Age distribution

Pathophysiology

  • Useful For Suggests clinical disorders or settings where the test may be helpful Assessing and adjusting dosage for optimal therapeutic level Assessing toxicity Clinical Information Discusses physiology, pathophysiology, and general clinical aspects,[mayomedicallaboratories.com]

Prevention

  • […] the arrhythmia although they were effective in preventing ischemic events.[ncbi.nlm.nih.gov]
  • Quinidine prevented recurrence of VAs in nine patients.[ncbi.nlm.nih.gov]
  • BACKGROUND: To prevent the recurrence of ventricular arrhythmias (VA) in Brugada syndrome (BrS), only quinidine has been consistently reported to have a beneficial effect. Recommended doses are 1 g/d.[ncbi.nlm.nih.gov]
  • Subsequently, we treated the patient with oral quinidine and the drug suppressed the electrical storm and prevented VF episodes during a follow-up period of 3 years.[ncbi.nlm.nih.gov]
  • Quinidine is used by the 1920s, as an antiarrhythmic agent to maintain sinus rhythm after the conversion from atrial flutter or atrial fibrillation and to prevent recurrence of ventricular tachycardia or ventricular fibrillation.[doi.org]

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