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Uses

Comparably effective to procainamide for atrial or ventricular arrhythmias; choice based on pharmacokinetics and adverse effect profile.

Supraventricular Tachyarrhythmias

Used principally for prophylactic therapy to maintain normal sinus rhythm after conversion of atrial fibrillation and/or flutter by other means.

Abnormal ventricular rate and CHF should first be controlled by administration of digoxin. Electrical cardioversion usually is considered the treatment of choice for conversion of atrial fibrillation or flutter.

Prevention of recurrence of atrial fibrillation or flutter is controversial because mortality may increase despite recurrence suppression.

May maintain normal sinus rhythm for long periods in recent onset of atrial fibrillation or flutter without CHF, atrial enlargement, or left ventricular hypertrophy, but long-standing atrial fibrillation is likely to recur even with quinidine maintenance therapy.

Generally, quinidine should not be used prophylactically for atrial fibrillation if the ventricular rate is adequately controlled by digoxin and the patient is asymptomatic.

Treatment of paroxysmal atrial tachycardia or paroxysmal AV junctional rhythm.

Atrial Premature Complexes

Treatment of atrial premature complexes; however, these arrhythmias usually are treated with digoxin.

Ventricular Premature Complexes (VPCs)

Treatment of VPCs; however, parenteral lidocaine is considered the drug of choice because quinidine can decrease myocardial contractility.

Like other antiarrhythmic drugs, not shown to decrease mortality rate in VPCs associated with AMI.

Avoid in treatment of asymptomatic VPCs.

Not for treatment of cardiac glycoside-induced ventricular arrhythmias.

VT

Treatment of paroxysmal VT that is not associated with complete heart block; however, treatment with cardioversion or lidocaine usually is preferred.

Suppression and prevention of recurrent ventricular arrhythmias (e.g., sustained VT) that in the judgment of the clinician are life-threatening.

Because of arrhythmogenic potential and the lack of evidence for improved survival for class I antiarrhythmic agents, not recommended for less severe VTs; avoid treatment in asymptomatic VPCs.

Malaria

Treatment of severe, life-threatening malaria (e.g., cerebral malaria) caused by Plasmodium falciparum. Drug of choice for initial treatment; there are no alternatives commercially available in US for parenteral treatment of severe malaria.

CDC recommends an initial regimen of IV quinidine gluconate in conjunction with a 7-day regimen of doxycycline, tetracycline, or clindamycin (oral or IV as tolerated) for severe P. falciparum malaria. After at least 24 hours and when parasitemia is reduced to <1% and an oral regimen can be tolerated, oral quinine sulfate is substituted for IV quinidine gluconate to complete 3 or 7 days of total quinidine and quinine therapy as determined by the geographic origin of the infecting parasite (3 days if malaria acquired in Africa or South America or 7 days if acquired in Southeast Asia).

Because of potentially fatal consequences of delays in initiating treatment of severe malaria, institutional pharmacy services should be aware of the essential role of ready availability of IV quinidine gluconate. (See Availability for Use in Treatment of Severe Malaria under Cautions.)

Assistance with diagnosis or treatment of malaria or in obtaining IV quinidine gluconate for treatment of severe P. falciparum malaria is available from CDC Malaria Epidemiology Branch by contacting CDC Malaria Hotline at 770-488-7788 from 8:00 a.m. to 4:30 p.m. Eastern Standard Time or CDC Emergency Operation Center at 770-488-7100 after hours, on weekends, and holidays. CDC also recommends consultation with a cardiologist regarding use of quinidine gluconate.

Has been used (oral quinidine sulfate) for treatment of uncomplicated malaria† caused by multidrug-resistant P. falciparum. However, oral quinine sulfate (not oral quinidine sulfate) is recommended by CDC and others for treatment of uncomplicated P. falciparum malaria.