Quinidine

Хинидин Drug photo

The description is actual on 05.05.2016

  • Latin name: Chinidinum
  • ATH code: C01BA01
  • Active ingredient: Quinidine (Quinidine)
  • Producer: Polfa S.A. (Poland)

Structure

1 powder or 1 tablet may contain sulfate quinidine quantity 100 or 200 mg. Data on excipients are not provided.

Release form

10 tablets in the blister, 2 blisters in a pack from a cardboard.

Pharmacological action

Antiarrhytmic action.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

The drug Quinidine belongs to antiarrhytmic means of an IA class. Slows down transfer of ions of sodium through fast channels of a cell wall of cardiomyocytes, lowers the speed limit of depolarization, increases duration of action potential and an effective refractory interval of time. Weakens excitability of a myocardium, conductivity and automatism in an AV node, auricles, a ventriculonector and other structures. Has vagolytic action, reduces sokratitelny activity of heart, it is capable to cause lowering of blood pressure, renders also m-holinoblokiruyushchy effect.

Negative inotropic effect – result of braking of transformation of energy in mitochondrions. Antiarrhytmic action is caused by existence in structure to a molecule of amide group. Reduction of speed of spread of activation is connected by impact on depolarization process. Suppression of conductivity is shown on an ECG by increase in a piece of QRS, braking of repolarization is expressed in increase in a piece of QT. In toxic dosages the drug Quinidine strengthens function of automatism of fibers of Purkinye.

Suppressing m-holinoretseptory, stimulates AV conductivity. In medical doses renders hypotensive effect because of lowering of a tone of peripheral arteries and veins and negative inotropic action. Shows local irritative action. Has also anesthetizing and febrifugal effects that is connected with the oppressing influence on a brain.

Pharmacokinetics

After intake the greatest concentration drug in blood is reached later an hour and a half. Reaction with proteins makes 75-80%. It Biotransformirutsya in a liver. Some derivatives possess cardiotonic action. Time of semi-removal makes about 6 hours. It is evacuated mainly by kidneys. Release of drug amplifies at acidulation of urine and is slowed down at its alkali reaction.

Indications to use

Use of Quinidine is proved at the following states:

  • atrial tachycardia, ventricular and supraventricular ekstrasistoliya, AV tachycardia, attacks of trembling and atrial fibrillation;
  • for preservation of a sinoatrial rate after carrying out cardioversion;
  • for the prevention of attacks of supraventricular tachycardia and ventricular tachycardia, the prevention of fibrillation of ventricles.

Contraindications

  • AV blockade 2-3 degrees;
  • Werlhof's disease after Quinidine reception;
  • heavy disorders of intra ventricular conductivity;
  • intoxication glycosides with conductivity disturbance;
  • cardiogenic shock;
  • blockade of legs of a ventriculonector;
  • allergy to Quinidine or quinine;
  • myasthenia.

Side effects

  • Reactions from blood circulation: arterial thromboembolism, expansion of a piece of QRS, ventricular ekstrasistoliya of ectopic type, increase in a piece of QT at an ECG, Bouveret's ventricular disease, asystolia, fibrillation of ventricles, lowering of blood pressure, sinus bradycardia.
  • Reactions from digestion: appetite loss, bitter smack in a mouth, pains of spastic character in epigastric area, a gastralgia, vomiting, nausea, hepatitis, diarrhea.
  • Reactions from a nervous system: confusion of consciousness, headache, dizziness.
  • Reactions from touch bodies: hearing loss, sonitus, vision disorders.
  • Reactions from a hemopoiesis: thrombocytopenia, hemolitic anemia.
  • Allergic reactions: volchanochnopodobny syndrome, fever, small tortoiseshell, skin rash, dermahemia, itch.
  • Other reactions: myasthenia, adynamy.

Quinidine, application instruction (Way and dosage)

Pill is taken orally for an hour to or 2 hours later after food, washing down with a glass of water (or milk in need of weakening of an irritant action on digestive organs); it is not necessary to chew or get to the core of the prolonged tablets.

Quinidine sulfate in standard cases is accepted on 200–300 mg to 4 times a day. At treatment of attacks of supraventricular tachycardia each 3 hours before stopping of a paroxysm accept 400–600 mg. At treatment of attacks of a ciliary arrhythmia accept 200 mg every 3 hour (and so to 5–8 times a day), the maintenance dose is equal to 200-300 mg to 4 times a day.

The prolonged pill is taken on 300–600 mg 2-3 times a day.

Overdose

Overdose signs: oppression of cordial function, an atrial flutter against ventricular tachycardia, hinidinovy shock (an asystolia and the expressed disturbances of a rhythm), a diplopia, lowering of blood pressure, a ring in ears, dizziness, a hearing loss is not excluded.

Overdose treatment: gastric lavage, reception of hypertensive means, oxygen supply, use of electrocardiostimulation, IVL, administration of intravenous solutions, hemodialysis.

Interaction

At joint reception with antiarrhytmic means strengthening of cardiodepressive action is not excluded.

At combined use weakening of effect of antikholinesterazny drugs is not excluded; with kaliysoderzhashchy means strengthening of effects of Quinidine comes to light.

At simultaneous use with anticonvulsants decrease in content of Quinidine in blood and reduction of its efficiency, because of stimulation of its metabolism is possible.

At a concomitant use with purgatives concentration of Quinidine in blood and its efficiency decrease; with drugs, alkaliziruyushchy urine (for example, hydrosodium carbonate, Acetazoleamide) the probability of emergence of toxic reactions of Quinidine increases.

At combined use action of the means suppressing a neuromuscular transmission is stimulated.

When sharing with tricyclic antidepressants removal from Nortriptilin's organism, Desipramine, Imipraminum, Trimipramin is slowed down that leads to increase in their content in blood and risk of emergence of toxic reactions.

At joint reception with Amiloride efficiency of the described drug decreases; with Amiodaronum — QT piece because of the additive effect of drugs is extended and there is an increased probability of developing of ventricular arrhythmia "pirouette". Also concentration of active agent in blood increases and its undesirable effects amplify.

At simultaneous use with acetylsalicylic acid increase in term of bleeding, emergence of petechias and bleedings from digestive organs is possible.

At a concomitant use with Warfarin its anticoagulating effect amplifies; with Verapamil – the speed of removal of Quinidine goes down and the probability of emergence of side effects increases.

At combined use the maintenance of the Haloperidol in blood increases and the probability of development of side reactions increases.

At a concomitant use with Hydroxyzinum the probability of heavy arrhythmias increases; with Dextromethorphan – its content in blood because of braking of a metabolism in a liver under the influence of Quinidine increases.

At combined use with Digoxin its concentration in blood increases; with Disopyramidum – increase of content of Quinidine in blood and increase in a piece of QT at an ECG is not excluded.

At joint reception with Dikumarol it is reported about decrease in its efficiency; with Itrakonazol, Ketokonazol – increase in concentration of Quinidine in blood; with Codeine – the analgeziruyushchy effect of codeine decreases; with Metoclopramidum – change of concentration of sulfate of quinidine in blood; with Meflokhin – increase of an interval of QT on an ECG.

At joint reception use with Nifedipine change of concentration of Quinidine and Nifedipine in blood is not excluded.

At combined use with Propranolol work of an isoenzyme of CYP2D6 is suppressed that causes braking of a metabolism of Propranolol and to decrease in its removal. Also strengthening of beta and adrenoceptor blocking effect and development of orthostatic hypotension is not excluded.

At combined use to Rifampicin there is a decrease in concentration of Quinidine in blood and, therefore, its efficiency; with Fluvoksamin – blocking of biotransformation of Quinidine and delay of its removal is possible.

At a concomitant use with Erythromycin concentration of Quinidine in blood increases and QT piece on an ECG is a little extended.

Terms of sale

According to the recipe.

Storage conditions

To store at the room temperature. To protect from children.

Period of validity
2 years.

Special instructions

It is recommended to apply with care the described medicine at a ventricular tachyarrhythmia with lengthening of a piece of QT, AV blockade of the first degree, at heart failure of chronic type 2-3 of a stage, weakness of a sinus node, bronchial asthma, arterial hypotension, a thyrotoxicosis, emphysema, a hypopotassemia, thrombocytopenia, acute infectious diseases, a hyperplasia of a prostate, a liver failure, closed-angle glaucoma, a chronic renal failure, psoriasis, at pregnancy and a lactation.

Persons with myocarditis or other serious diseases of a myocardium when using drug need constant medical control. Before therapy it is necessary to make correction of symptoms of insufficiency of cardiac performance and hypopotassemia.

In the course of treatment it is regularly necessary to control an ECG, indicators of a hemodynamics and analysis findings of peripheral blood.

To children

The standard dose of sulfate of quinidine for children makes 6 mg/kg of weight of 5 times a day.

Analogs

Coincidence on the ATH code of the 4th level:

Novokainamid, Lidocaine, Propanorm, Verapamil, Amiodaronum, Kinidinum Durules, Propranolol, Ritmonorm, Bretilat, Amiokordin, Etatsizin.

Section: Cardiological Cardiovascular
in more detail

Education: Graduated from the Vitebsk state medical university majoring in "Surgery". At university headed Council of students' scientific society. Professional development in 2010 - in "Oncology" and in 2011 - in "A mammology, visual forms of oncology".

Experience: Work in an all-medical network 3 years the surgeon (The Vitebsk hospital of an emergency medical service, Lioznensky TsRB) and in combination the regional oncologist and the traumatologist. Work farm the representative within a year in the Rubicon company.

Provided 3 improvement suggestions on the subject "Optimization of an Antibioticotherapia depending on Species Composition of Microflora", 2 works took prizes in a republican competition review of student's scientific works (1 and 3 categories).
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