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Quinidex

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Quinidex

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

Indications
Dosage
How Supplied

INDICATIONS

Conversion of Atrial Fibrillation/Flutter

In patients with symptomatic atrial fibrillation/flutter whose symptoms are not adequately controlled by measures that reduce the rate of ventricular response, Quinidex (quinidine) is indicated as a means of restoring normal sinus rhythm. If this use of Quinidex (quinidine) does not restore sinus rhythm within a reasonable time (see DOSAGE AND ADMINISTRATION), then Quinidex (quinidine) should be discontinued.

Reduction of Frequency of Relapse into Atrial Fibrillation/Flutter

Chronic therapy with Quinidex (quinidine) is indicated for some patients at high risk of symptomatic atrial fibrillation/flutter; generally patients who have had previous episodes of atrial fibrillation/flutter that were so frequent and poorly tolerated as to outweigh, in the judgment of the physician and the patient, the risks of prophylactic therapy with Quinidex (quinidine) . The increased risk of death should specifically be considered. Quinidex (quinidine) should be used only after alternative measures (e.g., use of other drugs to control ventricular rate) have been found to be inadequate.

In patients with histories of frequent symptomatic episodes of atrial fibrillation/flutter, the goal of therapy should be an increase in the average time between episodes. In most patients, the tachyarrhythmia will recur during therapy, and a single recurrence should not be interpreted as therapeutic failure.

Suppression of Ventricular Arrhythmias

Quinidex (quinidine) is also indicated for the suppression of recurrent documented ventricular arrhythmias, such as sustained ventricular tachycardia, that in the judgment of the physician are life-threatening. Because of the proarrhythmic effects of quinidine, its use with ventricular arrhythmias of lesser severity is generally not recommended, and treatment of patients with asymptomatic ventricular premature contractions should be avoided. Where possible, therapy should be guided by the results of programmed electrical stimulation and/or Holter monitoring with exercise.

Antiarrhythmic drugs (including Quinidex (quinidine) ) have not been shown to enhance survival in patients with ventricular arrhythmias.

 

DOSAGE AND ADMINISTRATION

Conversion of Atrial Fibrillation/Flutter to Sinus Rhythm

Especially in patients with known structural heart disease or other risk factors for toxicity, initiation or dose-adjustment of treatment with Quinidex (quinidine) should generally be performed in a setting where facilities and personnel for monitoring and resuscitation are continuously available.

Patients with symptomatic atrial fibrillation/flutter should be treated with Quinidex (quinidine) only after ventricular rate control (e.g., with digitalis or (beta)-blockers) has failed to provide satisfactory control of symptoms. Adequate trials have not identified an optimal regimen of Quinidex (quinidine) for conversion of atrial fibrillation/flutter to sinus rhythm. Therapy with Quinidex should begin with one tablet (300 mg; 249 mg of quinidine base) every 8 to 12 hours. If this regimen is well tolerated, if the serum quinidine level is still well within the laboratory's therapeutic range, and if this regimen has not resulted in conversion, then the dose may be cautiously raised. If, at any point during administration, the QRS complex widens to 130% of its pre-treatment duration; the QT c interval widens to 130% of its pre-treatment duration and is then longer than 500 ms; P waves disappear; or the patient develops significant tachycardia, symptomatic bradycardia, or hypotension, then Quinidex (quinidine) is discontinued, and other means of conversion (e.g., direct-current cardioversion) are considered.

Reduction of Frequency of Relapse into Atrial Fibrillation/Flutter

In a patient with a history of frequent symptomatic episodes of atrial fibrillation/flutter, the goal of therapy with Quinidex (quinidine) should be an increase in the average time between episodes. In most patients, the tachyarrhythmia will recur during therapy with Quinidex (quinidine) , and a single recurrence should not be interpreted as therapeutic failure.

Especially in patients with known structural heart disease or other risk factors for toxicity, initiation or dose-adjustment of treatment with Quinidex (quinidine) should generally be performed in a setting where facilities and personnel for monitoring and resuscitation are continously available.

Monitoring should be continued for two or three days after initiation of the regimen on which the patient will be discharged.

Therapy with Quinidex should begin with one tablet (300 mg; 249 mg of quinidine base) every eight to twelve hours. If this regimen is well tolerated, if the serum quinidine level is still well within the laboratory's therapeutic range, and if the average time between arrhythmic episodes has not been satisfactorily increased, then the dose may be cautiously raised. The total daily dosage should be reduced if the QRS complex widens to 130% of its pre-treatment duration; the QT c interval widens to 130% of its pre-treatment duration and is then longer than 500 ms; P waves disappear; or the patient develops significant tachycardia, symptomatic bradycardia, or hypotension.

Suppression of Ventricular Arrhythmias

Dosing regimens for the use of quinidine sulfate in suppressing life-threatening ventricular arrhythmias have not been adequately studied.

Described regimens have generally been similar to the regimen described just above for the prophylaxis of symptomatic atrial fibrillation/flutter. Where possible, therapy should be guided by the results of programmed electrical stimulation and/or Holter monitoring with exercise.

 

HOW SUPPLIED

Quinidex Extentabs® Tablets (quinidine sulfate extended-release tablets, USP) are 300 mg, white, sugar-coated, round tablets marked with "QUINIDEX (quinidine) " and "AHR". The tablets are available in bottles and in DIS-CO® unit-dose packages as follows:

bottle of 100                       NDC 0031-6649-63

bottle of 250                       NDC 0031-6649-67

unit-dose pack of 100         NDC 0031-6649-64

Store at controlled room temperature, 20°-25°C (68°-77°F). Dispense in well-closed, light-resistant container.

Caution:   Federal law prohibits dispensing without prescription.

Manufactured by:
Pharmaceutical Division
A.H. Robins Company
Richmond, VA 23220

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

Indications
Dosage
How Supplied
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