Quinidine can be called the progenitor of antiarrhythmics. This active ingredient belongs to class A1 and is derived from quinine. It is referred to as alkaloids, which is contained in the bark of a cinchona tree. And today we will talk in more detail about the features and analogues of quinidine sulfate, instructions for its use, prices and reviews about it.
Features of the preparation
The dose is selected individually, but before that the patient takes a trial dose of the drug( 0.2 g).
Due to the penetration of the active ingredient into breast milk, it is not possible to use a medicament during lactation. In the elderly, the minimum doses of quinidine are selected, since it accumulates in the tissues.
Composition
Excipients and quinidine sulfate in an amount of 0.1 or 0.2 grams.
Forms of release of quinidine
Tablet form in usual and prolonged form. Since the drug does not produce and does not release in pharmacies in Russia, the average price for quinidine is formed with a reference to European ones. So, it is about 3-4 thousand rubles.
Further, the mechanism of action of quinidine, its pharmacological group and similar data will be considered.
Pharmacological action
Antiarrhythmic, hypotensive.
Farmakodinamika
- Helps reduce the rate of impulse transmission and excitability of the myocardium, which is possible due to the blocking of sodium channels.
- Inhibits the vagus nerve and oxidation processes.
- May lower heart rate and blood pressure, has m-cholinoblock effect.
- Brakes inflammation in the heart muscle.
- The medication reduces conduction in the bundles of the His-Purkinje and AV-node.
Features of the impact:
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The opinion of doctors. .. & gt; & gt;
- An antiarrhythmic effect occurs due to the presence of an amide tertiary group in the molecule.
- Inotropic action develops as a result of oppression of energy production in the mitochondria.
- Hypotensive effect occurs when taken in therapeutic doses. This is due to alpha-adrenoblocking and inotropic effects.
- Quinidine has an antipyretic and analgesic effect, depresses the central nervous system.
Pharmacokinetics
The drug is absorbed in the small intestine. In prolonged forms, the effect of the drug is longer( up to 12 hours), the usual tablets show their effectiveness about 6-8 hours.
Bioavailability up to 80%.The toxic effect appears at a concentration in the blood of more than 9 μg / l, therapeutic - 6 μg / l. Up to 90% of the drug is able to bind to plasma proteins.
The drug is biotransformed in the liver under the influence of active metabolites and with the help of an oxidase system. Half-life is 10 hours, but usually no more than 6 hours( increased in old age).Most of Quinidine is excreted by the kidneys, if there is an alkaline reaction of urine, excretion is reduced. Peak effect is observed after 2-3 hours.
Indications
Required for prevention and therapy with:
- atrial paroxysm,
- extrasystole,
- ventricular fibrillation,
- tachycardia,
- atrial fibrillation.
With caution, the drug is prescribed for children. It is completely forbidden to use prolonged forms. Data, which with accuracy would have spoken about the negative effect during pregnancy on the fetus, have not been identified. However, quinidine is avoided appointing women in the position, since it is capable of increasing the risk of miscarriage.
In addition, quinine, which is its isomer, can slow the development of the fetus, worsen the development of the skull and limbs, and also develops deafness in the fetus. Doctors fear that quinidine can cause a similar reaction, so it is recommended to replace the drug with safe analogs.
Instructions for use
Ingestion. Tablets can not be broken or chewed to avoid irritating effects on the stomach. Together with food the medicine is not taken, only 2 hours after the meal or an hour before it.
- The individual dosage depends on the severity, type and form of the disease. The optimal dose is 0.2-0.6 g after a certain period of time( usually about 12 hours).Not more than 8.25 mg / 1 kg of weight per day can be administered to children.
- When ventricular arrhythmia is used up to 4 grams of funds per day. If the attacks are frequent, then take the pill every 3 hours for 0.6 g. For individual dose selection, a study of the concentration of the drug in the plasma.
Contraindications
- Aberrant rhythms;
- hypersensitivity;
- hypotension;
- cardiogenic shock;
- atrial-ventricular blockade( complete);
- blockade of the branch of the bundle;
- thrombocytopenic purpura resulting from the administration of quinine or quinidine( in anamnesis);
- conduction abnormalities inside the ventricles.
With extreme caution, the dosage should be selected in the presence of the following pathologies:
- glaucoma;
- hyperthyroidism;
- heart failure( decompensated);
- impaired renal or hepatic function;
- myocarditis;
- asthma is bronchial;
- psoriasis;
- fever in combination with infectious diseases;
- myopathy;
- extended interval Q-T;
- emphysema;
- intoxication;
- adenoma of the prostate.
For side effects of quinidine read below.
Side effects of
- Heart and vessels : pirouette arrhythmia, arterial thromboembolism, lowering of blood pressure( often accompanied by syncope), increase in Q-T interval, sinus bradycardia, QRS complex expansion, ventricular ectopic extrasystole, paroxysmal tachycardia.
- Digestive system : bitterness in the mouth, nausea, gastralgia, hepatitis, decreased appetite, epigastric pain, diarrhea.
- Nervous system : confused consciousness, headache, dizziness.
- Allergic reactions : rash, fever, itching, lupus-like syndrome, urticaria, hyperemia.
- Sensory organs : visual and hearing impairments, tinnitus.
- Hemostatic : thrombocytopenia, hemolytic anemia.
- Other : myasthenia gravis, asthenia.
Overdose
- At the time of an overdose, a person may experience a seizure.
- Decreased BP, there is ventricular tachycardia and atrial flutter.
- Along with photophobia, ringing in the ears and confusion, there are also more dangerous phenomena arising from using too much of the drug. This is the stopping of breathing, coma, the cessation of the heart, quinidine shock.
Treatment includes rinsing, urine oxidants, oxygen, IVL, taking hypertensive medications. The condition is controlled by ECG.If the condition worsens, the doctor makes a decision about cardiostimulation, hemodialysis, detoxification therapy.
Special instructions
- Quinidine should be taken constantly at a certain time. If a pass was found, the medicine is drunk as soon as possible, and the dose is not doubled.
- Regular ECG and laboratory tests are required for prolonged therapy, as quinidine has hepatotoxic and cardiotoxic effects. This dictates the need to monitor the indicators of renal and hepatic functions.
- Quinidine was previously available in injectable form, but currently it is not used, since after intravenous administration, the risk of severe arterial hypotension is much higher.
- The drug is not recommended to combine with the use of erythromycin, antidepressants of the tricyclic group, haloperidol. Such therapy with a greater degree will cause arrhythmogenic influence. When combined with quinine, the risk of quinidine intoxication rises.
Reviews
At the moment, the drug is difficult to find in Russian pharmacies. Sometimes it is possible to find its analogs, in other cases, patients are forced to take either other drugs, or buy quinidine in foreign pharmacies. It is worth noting that this is difficult to do, since a local doctor's prescription for quinidine sulfate drugs is needed.
People who applied the drug noted its effectiveness. But still its toxicity is very high, so many chose not to apply it and give preference to other medicines.
Analogs
- Kinidin Durules,
- Hinipec,
- Kinilentin,
- Quinidine sulfate,
- Quinadine.
About the experience of Israeli doctors in the treatment of quinidine will tell this video: