Parenteral Manual

QuiNIDine gluconate (SPECIAL ACCESS PROGRAM)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Classification: 
Antiarrhythmic agent; Antimalarial agent
Original Date: 
August 2005
Indications: 
  • Ventricular tachycardia and atrial arrhythmias
  • Prevention of reoccuring paroxysmal atrial tachycardia
  • To convert atrial flutter to normal sinus rhythm
  • Effective against Plasmodium falciparum (malaria)
Reconstitution and Stability: 
  • Available as an 80 mg/mL injection
  • Stable at room temperature
  • Protect from light
  • DO NOT use discoloured solutions
  • Solutions diluted in D5W are stable 24 hours at room temperature and 48 hours refrigerated
Compatibility: 

- Solutions Compatible: D5W, NS

- Additive/buretrol: no information

- Y-site Compatible: no information

- Incompatible: alkaline solutions, furosemide

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES
IV Push

NO
IV Intermittent Infusion YES
Usual dilution: 16 mg/mL
Infusion rate: do not exceed 10 mg/minute
IV Continuous Infusion YES

 

 

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

*Dose expressed in terms of quinidine gluconate

Pediatric:      

  • Test Dose: 2 mg/kg IM
  • 2-10 mg/kg/dose IV Q 3-6 hours PRN

Adult:    

  • 400 mg/dose IM Q 4-6 HOURS
  • 200-400 mg/dose IV 

DOSING ADJUSTMENT IN RENAL IMPAIRMENT:

  • CrCl <10 mL/minute: Administer 75% of normal dose
Potential hazards of parenteral administration: 
  • Hypotension with rapid IV administration
  • Circulatory collapse, shock
  • Bradycardia, heart block, ventricular fibrillation, asystole, congestive heart failure
  • Hypersensitivity reactions
  • Cinchonism (nausea, vomiting, visual disturbances, impaired hearing, syncope, headache, confusion)
  • Respiratory depression
  • Blood dyscrasias, thrombocytopenia purpura (rare)
  • Hepatotoxicity
Notes: 
  • Try to minimize tubing length- quinidine may be significantly adsorbed to PVC tubing
  • Monitor CBC with differential, platelet count, liver and renal function tests
  • Amiodarone, verapamil or cimetidine increase serum quinidine concentrations
  • Barbiturates, phenytoin, or rifampin decrease serum quinidine concentrations
  • Quinidine may increase plasma digoxin concentrations
  • May enhance coumarin anticoagulants
  • 267 mg of quinidine gluconate is equivalent to 200 mg of quinidine sulfate
  • Hemolysis may occur in patients with G-6-PD deficiency

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