Quinidine

When ATH:
C01BA01

Characteristic.

It refers to Division IA antiarrhythmics. The white crystalline powder. Soluble in water (about 1%).

Pharmacological action.
Antiarrhythmic.

Application.

Arrhythmias (Prevention and treatment): paroxysmal supraventricular tachycardia and ventricular (without a complete heart block), paroxysmal atrioventricular (nodular) rhythm, atrial fibrillation (paroxysmal and permanent form), auricular flutter, rarely - ventricular and atrial beats.

Contraindications.

Hypersensitivity, complete atrioventricular block (unless there is an artificial pacemaker), His bundle branch block, intraventricular conduction disorders, aberrant rhythms (due elusive mechanism of AV node or ventricles), cardiogenic shock, trombotsitopenicheskaya purpura FoNet quinidine or quinine accepted (history).

Restrictions apply.

Incomplete atrioventricular block, syndrome, congenital long QT, episodes of arrhythmia type «torsade de pointes» (history), digitalisnaya intoxication, decompensated heart failure, hypotension, miokardit, bronchial asthma, emphysema, myopathy, prostate adenoma, glaucoma, infectious diseases with fever, hyperthyroidism, psoriasis, pregnancy, lactation, the liver and kidneys, childhood (for prolonged forms).

Side effects.

Arrhythmogenic effects - arrhythmia type «torsade de pointes», ventricular tachycardia, ventricular fibrillation, blockade, lupus-like syndrome, gipotenziya, fainting, dizziness, bitter taste in the mouth, diarrhea, loss of appetite, nausea, vomiting, gastralgia, hepatitis, anemia, thrombocytopenia, allergic reactions (fever, skin rash, hives, itch, redness of the skin, shortness of breath or difficulty breathing).

Cooperation.

Increases effect of anticoagulants, muscle relaxants, It reduces - antimiastenicheskih funds, betanekola, bretiliya (ornida). Substances, alkalizing urine (Antacids, containing calcium or magnesium, carbonic anhydrase inhibitors, tsytratы, sodium bicarbonate), and increase the toxicity of drugs kalisodergaszczye, pimozid, others. antiarrhythmics - proaritmogennoe Activity, fenotiazinы and reserpine - kardiodepressiyu. Anticholinergic agents (atropyn, platifillin) weaken vagotoniziruyuschie properties; holinomimeticalkie (acetylcholine, pilocarpine, proserin) - Increase. Cimetidine reduces the overall kltrens and lengthens T_1/2 (inhibits microsomal liver enzymes), stimulants hepatic metabolism (phenobarbital, phenytoin, rifampicin) - Shorten. Ranitidine - induced PVCs (incl. type byhemynyy). The risk of poisoning is increased by quinidine quinine background.

Overdose.

Symptoms: oppression heart, atrial flutter with ventricular tachycardia, quinidine possible shock (asystole and severe ventricular arrhythmias), decrease in blood pressure, diplopia, dizziness, tinnitus, hearing loss.

Treatment: in the recent admission of the drug - gastric lavage or induction of vomiting; oxygen, hypertensive agents, preparations, acidifying the urine, IVL, pacing, in / in a liquid, hemodialysis.

Dosing and Administration.

Inside, for 1 hours before or after 2 h postprandial, with a full glass of water (if necessary, reduce irritation to the gastrointestinal mucosa - with milk); sustained-release tablets should not crush or chew. Quinidine sulfate (Tablets and capsules) - 200-300 mg 3-4 times a day. When paroxysms of supraventricular tachycardia - 400-600 mg, reapply every 2-3 hours until relief of paroxysm. In a paroxysm of mercatelʹnoj arrhythmias - 200 mg every 2-3 hours (only 5-8 times a day), maintenance dose - 200-300 mg 3-4 times a day. An alternative scheme: 400 mg, If the attack is not docked - on 200 mg every hour until the termination of an attack or a total dose 1 g. In the absence of side effects following the first dose of reception can be increased to 600 mg. The maximum dose 4 g per day.

Quinidine sulfate (sustained-release tablets) 300-600 Mg every 8-12 hours.

Quinidine gluconate (slow-release tablets) - Table 1-2. 8-12 hours, for the maintenance of sinus rhythm after conversion - 2 Table. every 12 or h 0,5 - 2 Table. through 8 no; maintenance dose - 1 Table. per day, as necessary every 6 no. Quinidine gluconate (for parenteral administration): / m, the initial dose 600 mg, hereinafter 400 mg every 2 no, when the effect of lower dose; I /, 800 mg 40 ml 5% solution of glucose at a speed 1 ml / min (be sure to monitor the ECG and blood pressure).

Quinidine polygalacturonate - Table 1-3. (pre-appointed reception 100 quinidine sulfate mg) 3-4 hours to 3-4 times per day. If necessary, the next day, every third or fourth single dose is increased by 0.5-1 Table. to restore sinus rhythm, or the appearance of toxic effects. Maintenance dose - 1 Table. 2-3 Times a day.

The usual dose for children: inside, in the form of conventional tablets: quinidine sulyfat - 6 mg / kg or 180 mg / m² 5 once a day; quinidine polygalacturonate - 8,25 mg / kg or 247,5 mg / m² 5 once a day.

Precautions.

Doses are selected individually based on clinical response. Before treatment, the dose should be appointed trial (200 mg) inside to check for portability.

Since quinidine has the potential cardiotoxic (particularly at doses above 2,4 g per day), with long-term appointment requires regular blood tests, ECG monitoring (lengthening of the QRS complex on 25% - The initial signs of intoxication, more 50% - Toxemia), liver and kidney function, FROM (especially when I / run), and the level of potassium in blood serum quinidine (If the daily dose exceeds inward 2 r and parenteral administration).

In elderly patients, in violation of liver and kidney function dose should be reduced because of the risk of cumulation.

Caution should be exercised when co-surgery. Absorption and efficiency while decreasing intake antidiarrheal and antacid (in addition to aluminum hydroxide gel), in patients with heart failure, when i / m administration, hypokalemia, hypoxia and acid-base balance disorders.

It will be appreciated, that anticholinergic properties (in particular - sialoschesis) may result (especially in elderly patients) the development of caries, periodontal tissue diseases, Oral candidiasis and the appearance of unpleasant sensations in the mouth.

Cooperation