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| Interactions: | Acetazolamide
Adverse Effect: quinidine toxicity (ventricular arrhythmias, hypotension, aggravated CHF) Clinical Management: If initiating, discontinuing, or changing the dose of acetazolamide in patients taking quinidine, monitor quinidine levels and adjust quinidine dose as required.
Amiloride
Adverse Effect: an increased risk of arrhythmias in patients with ventricular tachycardia Clinical Management: Patients receiving quinidine therapy should avoid the use of amiloride.
Amiodarone
Adverse Effect: quinidine toxicity (diplopia, giddiness, hypotension) Clinical Management: In patients receiving amiodarone therapy, the initial dose of quinidine should be approximately one-half the usual recommended dose. During conversion from quinidine to amiodarone, the dose levels of quinidine should be reduced by 30% to 50% several days after the addition of amiodarone. If concurrent use is deemed necessary, monitor the patient for conduction disturbances and exacerbation of tachyarrhythmias.
Amitriptyline
Adverse Effect: Amitriptyline toxicity (dry mouth, urinary retention, sedation) and an increased risk of cardiotoxicity Clinical Management: Monitor for increased antidepressant side effects with concomitant therapy with quinidine; lower doses of the Amitriptyline may be required. Conversely, if quinidine is discontinued from therapy, monitor for antidepressant efficacy. Amitriptyline serum levels might be considered in some clinical situations. Also monitor the patient for signs and symptoms of additive cardiac effects, including any changes in the EKG.
Amoxapine
Adverse Effect: Amoxapine toxicity (dry mouth, sedation) and an increased risk of cardiotoxicity Clinical Management: Monitor for increased antidepressant side effects with concomitant therapy with quinidine; lower doses of the Amoxapine is required. Conversely, if quinidine is discontinued from therapy, monitor for antidepressant efficacy. Amoxapine serum levels might be considered in some clinical situations. Also monitor the patient for signs and symptoms of additive cardiac effects, including any changes in the EKG.
Antacids Comb.
Adverse Effect: quinidine toxicity (ventricular arrhythmias, hypotension, exacerbation of heart failure) Clinical Management: Concurrent administration of quinidine and antacids is not recommended. If concurrent use cannot be avoided, monitor for signs of quinidine toxicity (tinnitus, blurred vision, headache, nausea, delirium, psychosis). Monitor quinidine plasma levels and decrease the dose as necessary.
Aspirin
Adverse Effect: prolonged bleeding times Clinical Management: Monitor patient for clinically significant signs of bleeding (petechiae, occult blood in stools). Consider alternative antiarrhythmic agents which do not have antiplatelet effects.
Atenolol
Adverse Effect: Bradycardia, hypotension Clinical Management: If concurrent therapy is required, monitor cardiac function carefully (ie, blood pressure, heart rate). It may be necessary to lower the initial dose of each drug.
Atracurium
Adverse Effect: atracurium toxicity (respiratory depression, apnea) Clinical Management: Quinidine should be avoided if possible in the immediate postoperative period when the effects of neuromuscular blockers may be present. If quinidine is utilized, the need for respiratory support should be anticipated.
Cimetidine
Adverse Effect: Quinidine toxicity (ventricular arrhythmias, hypotension, exacerbation of heart failure) Clinical Management: Monitor for signs of quinidine toxicity (tinnitis, blurred vision, headache, nausea, delirium, psychosis). Monitor quinidine plasma levels and adjust dose accordingly; usual therapeutic range 2-6 mg/L. If concurrent use cannot be avoided, select another H2-antagonist (eg, ranitidine or famotidine) that has less potential to alter drug metabolism.
Cisapride
Adverse Effect: cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: The concurrent use of cisapride and Quinidine is contraindicated.
Clomipramine
Adverse Effect: Clomipramine toxicity (dry mouth, sedation) and an increased risk of cardiotoxicity Clinical Management: Monitor for increased antidepressant side effects with concomitant therapy with quinidine; lower doses of the Clomipramine may be required. Conversely, if quinidine is discontinued from therapy, monitor for antidepressant efficacy. Clomipramine serum levels might be considered in some clinical situations. Also monitor the patient for signs and symptoms of additive cardiac effects, including any changes in the EKG.
Codeine
Adverse Effect: reduced analgesia Clinical Management: If analgesia is needed while receiving quinidine, an alternative to codeine is suggested.
Diclofenac Preps.
Adverse Effect: Reduced partial clearance of quinidine Clinical Management: While the clinical significance of this interaction is unknown, monitor patients for an altered response to quinidine.
Digoxin
Adverse Effect: Digoxin toxicity (nausea, vomiting, cardiac arrhythmias) Clinical Management: A decrease in digoxin dosage will probably be necessary when quinidine is added to therapy. Monitor serum digoxin levels and be alert for signs of digoxin toxicity, including neurotoxicity.
Diltiazem
Adverse Effect: Quinidine toxicity (ventricular arrhythmias, hypotension, exacerbation of heart failure) Clinical Management: Monitor patients closely for symptoms of quinidine toxicity, including laboratory confirmation of alterations in serum quinidine levels. Dose adjustments may be required.
Disopyramide
Adverse Effect: Disopyramide toxicity and decreased quinidine effectiveness Clinical Management: Dosage adjustment for both drugs may be necessary. When concurrent therapy is required, monitor for disopyramide toxicity especially in patients already taking higher doses of disopyramide.
Dothiepin
Adverse Effect: Dothiepin toxicity (dry mouth, sedation) and an increased risk of cardiotoxicity Clinical Management: Monitor for increased antidepressant side effects with concomitant therapy with quinidine; lower doses of the Dothiepin may be required. Conversely, if quinidine is discontinued from therapy, monitor for antidepressant efficacy. Dothiepin serum levels might be considered in some clinical situations. Also monitor the patient for signs and symptoms of additive cardiac effects, including any changes in the EKG.
Doxepin
Adverse Effect: Doxepin toxicity (sedation, dry mouth, urinary retention) and an increased risk of cardiotoxicity Clinical Management: Monitor for symptoms of Doxepin ; a decrease in doxepin dosage may be required. Also monitor the patient for signs and symptoms of additive cardiac effects, including any changes in the EKG.
AErythromycin
Adverse Effect: An increased risk of quinidine toxicity Clinical Management: Monitor patients receiving quinidine and erythromycin concurrently for signs and symptoms of quinidine toxicity, including ventricular arrhythmias, hypotension, and exacerbation of heart failure. A quinidine serum concentration may be useful if quinidine toxicity is suspected.
Fluoxetine
Adverse Effect: An increased risk of fluoxetine and quinidine toxicity Clinical Management: Caution should be used if these agents are to be coadministered. Monitor the patient for evidence of elevated fluoxetine and/or quinidine serum concentrations.
Frusemide
Hypokalaemia induced by diurectic
Haloperidol
Adverse Effect: Increased haloperidol plasma concentrations resulting in possible increased extrapyramidal effects or somnolence Clinical Management: Monitor patients for extrapyramidal effects or somnolence and consider alternative therapy.
Imipramine
Adverse Effect: Imipramine toxicity (dry mouth, sedation) and an increased risk of cardiotoxicity Clinical Management: Monitor for increased Imipramine side effects with concurrent therapy; lower doses of the Imipramine may be required in some cases. Also monitor the patient for signs and symptoms of additive cardiac effects, including any changes in the EKG.
Itraconazole
Adverse Effect: an increased risk of quinidine toxicity (ventricular arrhythmias, hypotension, exacerbation of heart failure) Clinical Management: The concomitant administration of itraconazole and quinidine is contraindicated.
Ketoconazole
Adverse Effect: Increased quinidine serum levels and toxicity (ventricular arrhythmias, hypotension, aggravated CHF) Clinical Management: Concurrent use of ketoconazole and quinidine should include careful monitoring of quinidine plasma concentrations and observation for clinical signs of quinidine toxicity (tinnitis, diplopia, headache, nausea, delirium, psychosis, hypotension); toxicity is more likely with plasma levels above 6 mg/L.
Metformin
Adverse Effect: An increased risk of lactic acidosis Clinical Management: In patients receiving metformin and Quinidine, closely monitor serum glucose levels and metformin plasma concentrations. Metformin doses may need to be reduced.
Metoprolol
Adverse Effect: Bradycardia, fatigue, shortness of breath Clinical Management: If concurrent therapy is required, monitor cardiac function carefully (ie, blood pressure, heart rate). A dosage adjustment may be required for both drugs.
Mexiletine
Adverse Effect: Increased mexiletine bioavailability Clinical Management: Although quinidine and mexiletine coadministration has proven effective in some patients, mexiletine serum concentrations should be monitored, along with electrophysiologic changes, when quinidine therapy is also present.
Nifedipine
Adverse Effect: Decreased quinidine effectiveness and/or an increased risk of nifedipine adverse effects (headache, peripheral edema, hypotension, tachycardia) Clinical Management: Monitor patient closely for symptoms of quinidine therapeutic failure, including laboratory confirmation of alterations in serum quinidine levels. Dose adjustments may be required.
Nortriptyline
Adverse Effect: Nortriptyline toxicity (dry mouth, sedation) and an increased risk of cardiotoxicity Clinical Management: Monitor for increased side effects such as dry mouth, drowsiness, and problems with urination. Lower doses of nortriptyline may be required in some cases. Also monitor the patient for signs and symptoms of additive cardiac effects, including any changes in the EKG.
Oxyphenonium Br.
Excessive cholinergic blockade occurs with Quinidine, TCAs, antihistamines and Phenothiazides
Pancuronium
Adverse Effect: pancuronium toxicity (respiratory depression, apnea) Clinical Management: Quinidine should be avoided if possible in the immediate postoperative period when the effects of neuromuscular blockers may be present. If quinidine is utilized, the need for respiratory support should be anticipated
Phenobarbitone
Adverse Effect: Decreased quinidine effectiveness Clinical Management: Monitor quinidine concentration for one to three weeks after starting or discontinuing phenobarbital. A dosage adjustment for quinidine may be required in order to maintain a therapeutic effect.
Phenytoin
Adverse Effect: Decreased quinidine effectiveness Clinical Management: Monitor quinidine levels when phenytoin is added or discontinued from therapy; increased quinidine dosage may be needed with concomitant therapy.
Pimozide
Adverse Effect: Increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: Pimozide is contraindicated in individuals with congenital QT syndrome, patients with a history of cardiac arrhythmias, or patients taking other drugs which may prolong the QT interval.
Pipecuronium
Adverse Effect: Pipecuronium toxicity (respiratory depression) Clinical Management: Quinidine should be avoided if possible in the immediate postoperative period when the effects of neuromuscular blockers may be present. If quinidine is utilized, the need for respiratory support should be anticipated.
Procainamide
Adverse Effect: excessive prolongation of conduction time or depression of cardiac contractility and hypotension Clinical Management: Monitor blood pressure and ECG in patients receiving procainamide and another class IA antiarrhythmic agent. Procainamide doses may need to be reduced. Closely observe patients for signs of procainamide toxicity, especially in patients with cardiac decompensation.
Propafenone
Adverse Effect: propafenone toxicity (blurred vision, CNS depression, tachycardia) Clinical Management: If concurrent therapy is required, monitor cardiac function carefully. A dosage adjustment for propafenone may be required.
Propranolol
Adverse Effect: Hypotension, bradycardia, arrhythmias, and heart failure Clinical Management: Use caution when administering propranolol and quinidine concomitantly. Monitor patients for hypotension, bradycardia, arrhythmias, and heart failure.
Rifampicin
Adverse Effect: Decreased quinidine effectiveness Clinical Management: Combination therapy will probably require an increase in the quinidine dosage: usual therapeutic range 2-6 mg/L. It is also important to consider the possibility of quinidine toxicity after withdrawing concomitant rifampin therapy.
Sotalol
Adverse Effect: Increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: The concurrent administration of sotalol and Quinidine is not recommended. The Quinidine should be withheld for at least three half-lives prior to dosing with sotalol.
Sparfloxacin
Adverse Effect: prolongation of the QTc interval and/or torsades de pointes Clinical Management: Sparfloxacin is contraindicated in individuals with known QTc prolongation or in patients being treated concurrently with drugs that are known to increase the QTc interval and/or cause torsades de pointes.
Succinyl Choline
Adverse Effect: succinylcholine toxicity (respiratory depression, apnea) Clinical Management: Monitor patients for respiratory depression and prolonged neuromuscular blockade.
Sucralfate
Adverse Effect: Decreased quinidine effectiveness Clinical Management: Concurrent administration of quinidine and sucralfate is not recommended. If concurrent use cannot be avoided, sucralfate should be taken at least four hours after quinidine.
Timolol
Adverse Effect: Enhanced beta-blockade (hypotension, bradycardia) Clinical Management: Clinicians should be aware that ophthalmic administration of timolol may result in systemic side effects and enhanced beta-blockade during coadministration with quinidine. If coadministration of these two agents is necessary, monitor patients closely for signs of timolol toxicity (hypotension, bradycardia).
Tramadol
Adverse Effect: The possibility of altered tramadol concentrations and efficacy Clinical Management: Closely monitor patient response and adjust doses accordingly.
Trimipramine
Adverse Effect: Trimipramine toxicity (dry mouth, urinary retention, sedation) and an increased risk of cardiotoxicity Clinical Management: Monitor for increased antidepressant side effects with concomitant therapy with quinidine; lower doses of the Trimipramine may be required. Conversely, if quinidine is discontinued from therapy, monitor for antidepressant efficacy. Trimipramine serum levels might be considered in some clinical situations. Also monitor the patient for signs and symptoms of additive cardiac effects, including any changes in the EKG.
Vecuronium
Adverse Effect: Vecuronium toxicity (respiratory depression, apnea) Clinical Management: Quinidine should be avoided if possible in the immediate postoperative period when the effects of neuromuscular blockers may be present. If quinidine is utilized, the need for respiratory support should be anticipated.
Verapamil
Adverse Effect: Hypotension, counteraction by verapamil of quinidines effect on AV conduction, and possible quinidine toxicity (ventricular arrhythmias, hypotension, exacerbation of heart failure) Clinical Management: Monitor blood pressure closely for hypotension, and also monitor for quinidine toxicity, including laboratory confirmation of alterations in serum quinidine levels. Avoid use of this combination in patients with hypertrophic cardiomyopathy.
Warfarin
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving oral anticoagulant therapy with warfarin, the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with quinidine, and should be reassessed periodically during concurrent therapy. Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation. |
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