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Drug management
Published in Gregory YH Lip, Atrial Fibrillation in Practice, 2020
Non-cardiac adverse effects of the Class la agents can include diarrhoea, nausea, vomiting and abdominal pain with quinidine. ‘Cinchonism’ is the term used to describe the cluster of neurological side-effects associated with quinidine, such as tinnitus, deafness, delirium, confusion. Procainamide is partly metabolized by acetylation in the liver and almost all patients on procainamide develop antinuclear antibodies; however in slow acetylators, 15-20% develop a lupus-like syndrome, which would require drug discontinuation.
Toxicology
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Clinical manifestations from quinine (‘cinchonism’) are dose related and include: Mild: flushed and sweaty skin, tinnitus, blurred vision, confusion, reversible high-frequency hearing loss, abdominal pain, vertigo, nausea and vomiting.Severe: hypotension, deafness, blindness, cardiac arrhythmias and cardiac arrest.
Catalog of Herbs
Published in James A. Duke, Handbook of Medicinal Herbs, 2018
Toxicity — Chronic use will lead to cinchonism (abdominal pain, disturbed vision, headache, nausea, skin rashes, tinnitus).11 Quinic wine may cause gastric intestinal irritation.16 Ground cinchona can cause contact dermatitis, urticaria, and other hypersensitive reactions in humans.29 Eight grams of quinine can kill an adult in one dose. Acute hemolytic anemia and fatality from uremia have followed taking quinine as an abortifacient.17 Cinchona barks approved for use in beverages only, not to exceed 83 ppm in the finished beverage (§ 172.510 and 172.575).29
Antimalarial drugs for treating and preventing malaria in pregnant and lactating women
Published in Expert Opinion on Drug Safety, 2018
Makoto Saito, Mary Ellen Gilder, Rose McGready, François Nosten
The adverse symptoms of quinine are collectively called cinchonism, which affects almost all patients [16]. This leads to poor adherence particularly among the pregnant women in the first trimester when morning sickness peaks. The actual adherence without supervision is thought to be poor [7]. The prevalence of tinnitus in pregnant patients on quinine is reported to be from 35% to 85% in > 450 patients assessed in seven studies [11–13,15,17–19]. A meta-analysis reported that the risks of tinnitus (pooled RR 4.70, 95% CI 1.20–18.39, five RCTs), vomiting (pooled RR 2.01, 95%CI 1.23–3.30, five RCTs) and dizziness (pooled RR 1.51, 95% CI 1.02–2.25, three RCTs) were higher than those of artemisinin-based treatment [10]. Nausea and anorexia are also more common with quinine than artemether-lumefantrine (AL) in an open-label RCT [12]. The risk of quinine related hypoglycemia is higher in pregnant women than the general population, particularly in cases with severe malaria [20,21]. For uncomplicated malaria, two studies reported that hypoglycemia was observed in 17% (4/24) [18] – 72% (21/29) [14], but symptomatic hypoglycemia was rare (0/246) [17]. To reduce side effects under-dosing treatment by prescribing twice daily dosing or only five days is potentially harmful and likely to induce resistance [7,18]. In a study in Uganda, QTc prolongation (Fridericia corrected QTc > 440 ms) was observed on day 2 in 1% (2/149) of the patients [12].
Brugada syndrome clinical update
Published in Hospital Practice, 2021
Rhadames Rojas, Risheek Kaul, Daniel Frenkel, Ethan G Hoch, Sei Iwai, Jason T Jacobson, Wilbert S. Aronow
Quinidine can also be used for the long-term treatment of children with BrS as an alternative to ICD, as well as in adults who have a contraindication to ICD implantation or are declining ICD implantation. In addition to preventing episodes of ventricular tachycardia and fibrillation [67], quinidine can also lead to normalization of the EKG [68]. Unfortunately, prolonged use of quinidine can lead to thrombocytopenia, cinchonism, diarrhea, esophagitis, aggravation of sinus node dysfunction, and QT prolongation leading to torsade de pointes. Quinidine also remains unavailable in many southeast Asian countries where BrS is endemic [69].