Dose: 1.43 to 2.86 mg/kg
Single Dose: 2.1 (2.145)
Frequency: 3 hourly
Route: IM
Instructions:

Quinidine (Bisulphate and Sulphate), Quinidine (Bisulphate and Sulphate) are the derivatives of Quinidine. It is of Natural origin and belongs to Alkaloid. It belongs to Na-Channel Antiarrhythmic antagonist pharmacological group on the basis of mechanism of action and also classified in Anti arrhythmic agents pharmacological group.The Molecular Weight of Quinidine is 324.43. Its pKa is 4.2,8.8.

Quinidine is contraindicated in conditions like Heart failure,Myasthenia gravis,Thrombocytopenia,Heart block,Sick sinus syndrome,Atrioventricular block,Hypersensitivity,Torsade de pointes.

The severe or irreversible adverse effects of Quinidine, which give rise to further complications include Hepatitis, Myasthenia gravis, Hemolysis, QT prolongation.Quinidine produces potentially life-threatening effects which include Cardiac arrhythmia, Heart block, Heart failure. which are responsible for the discontinuation of Quinidine therapy.The signs and symptoms that are produced after the acute overdosage of Quinidine include Quinidine poisoning.The symptomatic adverse reactions produced by Quinidine are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Vomiting, Anorexia, Diarrhea, Fever, Tinnitus, Abdominal pain, Blurred vision, Urticaria, Arthralgia, Esophagitis, Anemia, GI irritation, Exacerbation of psoriasis, Atrial fibrillation.

Quinidine is primarily indicated in conditions like Atrial fibrillation, Atrial flutter, Extrasystolic atrial tachycardia, Extrasystolic nodal tachycardia, Suppression of supraventricular tachycardias and ventricular arrhythmias, Ventricular tachycardia.

Quinidine is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAcetazolamide (Na)Acetazolamide reduce urinary excretion and enhance pharmacological effectAdrenalineCoadministration increase risk of Cardiac ArrythmiasAfatinibmay increase the level of afatinibuse alternative or reduced doseAlcuronium (Cl)Amantadine (HCl)Amiloride (HCl)Amiloride (HCl)Quinidine associated prolongation of QRS segment is enhance by amiloride.This combination act synergistically to block soium channel.MajorThiazide like diuretics can be used as an alternative therapy or QRS segment length should be monitor if use this combination.Amiodarone (HCl)Quinidine may enhance the QTc-prolonging effect of Amiodarone. Amiodarone may increase the metabolism, via CYP isoenzymes, of Quinidine. MajorRapidIncreased risk of ventricular arrhythmias when amiodarone given with quinidine: avoid combined administration of these two drugs (or only undertaken with caution and appropriate monitoring).Amitriptyline (HCl)By inhibting CYP450 3A4 2D6 metabolism quinidine increase serum levels of amitriptyline and both these drugs can prolong QT interval.ModerateThis combination should be avoided and monitor patient for drowsiness,confusion,weakness and seizures.Amlodipine (Besylate)Amlodipine may decrease the serum concentration of Quinidine. ModerateMonitor for decreased Quinidine effects if Amlodipine is initiated/dose increased or increased effects/toxicity if Amlodipine is discontinued/dose decreased. AmprenavirAmprenavir possibly increases plasma concentration of quinidine; increased risk of ventricular arrhythmias. ADVICE: Avoid concomitant use.MajorArtemisininAtracurium (Besylate)BaclofenEffects of muscle relaxants enhanced by Quinidine.MajorBendrofluazideBethanechol (Cl)Biperiden (HCl)Chlorpheniramine (Maleate)It increases effects of chlotpheniramine. as it is is a CYP3A4 inhibitorCholestyramineCiclonium (Br)Cimetidine (HCl)Dabigatranconcomitant quinidine administration increases AUC and Cmax of dabigatran by 53% and 56% respectively.DextromethorphanDigoxinSerum digoxin levels are increased by quinidine due to reduced renal and biliary clearance.ModerateRapidUpon initiation of quinidine, an empiric reduction (25% to 50%) in the digoxin dose seems warranted, with continued monitoring of digoxin serum concentrations until the quinidine reaches steady state (5-10 days). Monitor for toxic effects of digoxin if quinidine is initiated or the dose is increased.Onset Rapid (Sequence Important)DisopyramideDistigmine (Br)Edrophonium (Cl)Ephedrinetheir is risk of arrythmias when ephedrine co administered with cardiac glycosides such as quinidine or TCAsFelodipineHalofantrine (HCl)Homatropine (HBr)HydrocortisoneHydroflumethiazideImipramine (HCl)ItraconazoleKetoconazoleCo-administration increases the plasma concentration of quiniddine by inhibiting the hepatic enzyme responsible for metabolic clearance of quinidine.Quinidine also prolongate the QT interval thus potentiate the risk of ventricular arrhythmias as well as cardiac arrest.MajorCo-administration should be avoided.If co-administration is necessary pharmacological response and Quinidine plasma levels should be monitored more closely and adjust the dose.Lercanidipine (HCl)Levobunolol (HCl)LoratadineMefloquine (HCl)Metformin (HCl)Quinidine reduces the excretion of metformin by competing for renal tubular transport results in increased level of metformin may lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Closely monitor the blood glucose level. Patient should notify to physician if experience signs of lactic acidosis.MetipranololInfrequent reports of METIPRANOLOL [EYE] increasing the NEGATIVE CHRONOTROPIC effect of QUINIDINE. May need to avoid combinationMetoprolol (Tartrate)Quinidine increases the serum level of metoprolol by inhibiting first-pass metabolism and by decreasing hepatic clearence.Quinidine and metoprolol have negative inotropic effect on heart so this combination may become beneficial when used to treat atrial fbrillation.ModerateClosely monitor for orthostatic hypotension, cardiac arrythmia, bradycardia and heart failure. Dose of metoprolol should be decreased accordingly.MexiletineMibefradil (Di HCl)MoxifloxacinConcomitant use of moxifloxacin and antiarrythmics (e.g quinidine, procaineamide, satolol, ibutilide, amiodarone, erythromycin, tricyclic antidepressants) can cause marked QTc prolongation.NelfinavirNevirapineNifedipineNimodipineNitrendipineMay increase the levels/effects of nitrendipine.Oxethazaine An increase in the plasma level of quinidine and possible toxicity may result if alkalization of the urine occurs during antacid therapy.ParoxetinePentobarbitone (Na)PericyazineThese drugs shouldnot be taken concurrently without doctors prescription.PhenobarbitonePhenytoin (Na)PipercuroniumQuinidine may enhance the effect of pipercuronium.PolythiazideProcyclidine (HCl)Propafenone (HCl)Pseudoephedrine (HCl)Pyridostigmine (Br)Antiarrythmic drugs such as quinidine block the acetylcholine receptorQuinagolide (HCl)Rauwolfia ReserpineReserpineRifabutinRifampicinRifampicinRitonavirRivastigmineRocuronium (Br)Sodium BicarbonateSodium CitrateSodium Citrate may decrease the excretion and increase the serum levels of Quinidine, possibly increasing their pharmacologic effects.Sodium PhosphateShould not be use concurrently without doctors prescription.Sotalol (HCl)SucralfateSulfapyridineConcurrent use with sulfapyridine may increase the potential for toxic side effectsSuxamethonium (Cl)Thioridazine (HCl)Tramadol (HCl)Verapamil (HCl)VORICONAZOLEVoriconazole may increase the serum concentration of quinidine likely by inhibiting its metabolism. Consider alternate therapy or monitorVortioxetineincreases the level of vortioxetineuse alternative or reduce dose by 50% These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Fluorometric Estimation of Urinary Catecholamines Measurement of Urinary 17-OH-Corticosteroids

Drug should not be given to Paediatrics, Pregnant Mothers, patients suffering from Kidney dysfunction, patients suffering from Liver Malfunction, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Inj Store at room temperature. Do not Freeze. Protect from Sunlight. Tab Store in a well closed container, Below 40°C. Protect from Sunlight.

Perform periodic blood counts and liver or kidney tests. If there is blood dyscrasias or any sign of liver or kidney disorders then discontinue the use of quinidine. Continuously monitor ECG & determine plasma quinidine level, when large doses are used.