Quinidine Sulfate

This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This drug may also be used for malaria.

Before starting this drug, the manufacturer recommends that you take a test dose (usually a smaller amount than your regular dose) to determine whether you are allergic to it. Consult your doctor or pharmacist for details.

Take this medication by mouth with or without food with a full glass of liquid (8 ounces/240 milliliters) as directed by your doctor. This medication is best taken on an empty stomach, but taking it with food may help decrease stomach upset. Do not lie down for at least 10 minutes after taking this medication.

Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Swallow the tablets whole.

There are different brands and forms of this medication available. Not all have identical effects. Do not change quinidine products without talking to your doctor or pharmacist.

Dosage is based on your medical condition and response to treatment. If you are taking regular-release quinidine for an irregular heartbeat, the manufacturer recommends that you take no more than 4 grams daily.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.

Avoid large changes in your dietary salt intake while being treated with this medication unless your doctor instructs you otherwise. The amount of salt in your diet may affect the amount of quinidine absorbed by your system. Consult your doctor or pharmacist for more details.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

Tell your doctor if your condition does not improve or if it worsens.

Diarrhea, nausea, vomiting, loss of appetite, stomach pain/cramps, or a burning feeling in throat or chest (such as heartburn) may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: nausea/vomiting that doesn't stop, vision changes, eye pain, muscle pain, signs of low blood sugar (such as unusual sweating, shakiness), signs of infection (such as sore throat that doesn't go away, fever, chills), easy bruising/bleeding, extreme tiredness, dark urine, yellowing eyes/skin, aching/swollen joints.

Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, sudden change in heartbeat (faster/slower/more irregular).

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

One type of reaction (cinchonism) can occur after even a single dose of this drug. Contact your doctor of pharmacist promptly if you notice symptoms such as ringing in the ears, sudden hearing problems, headache, blurred vision, confusion. Your dosage may need to be adjusted.

Certain long-acting brands of quinidine may appear as a whole tablet in the stool. This is the empty shell left after the medicine has been absorbed by the body. It is harmless.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before taking quinidine, tell your doctor or pharmacist if you are allergic to it; or to quinine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: certain types of heart disease (such as incomplete or complete heart block without an artificial pacemaker, torsades-type irregular heartbeats, digitalis toxicity), very low blood pressure, history of easy bruising/bleeding (thrombocytopenic purpura) with use of quinine or quinidine, severe muscle weakness (myasthenia gravis), kidney disease, liver disease, a certain blood disorder (G6PD deficiency), asthma, current infection with fever.

Quinidine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that require immediate medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using quinidine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using quinidine safely.

This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Before having surgery, tell your doctor that you are using this medication.

Older adults may be more sensitive to the side effects of this drug, especially dizziness and QT prolongation (see above).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication passes into breast milk. Consult your doctor before breast-feeding.

See also the How to Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: large amounts of antacids (such as sodium bicarbonate), arbutamine, aripiprazole, atomoxetine, etravirine, fingolimod, fosamprenavir, loperamide, certain macrolide antibiotics (such as erythromycin, clarithromycin), phenytoin, propafenone, quinupristin/dalfopristin, rifamycins (such as rifampin, rifabutin).

Other medications can affect the removal of quinidine from your body, which may affect how quinidine works. Examples include cobicistat, mifepristone, ritonavir, certain azole antifungals (including fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole), certain protease inhibitors (such as nelfinavir, tipranavir), among others.

This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include aliskiren, codeine, digoxin, mefloquine, tricyclic antidepressants (such as desipramine, imipramine), among others.

Many drugs besides quinidine may affect the heart rhythm (QT prolongation), including artemether/lumefantrine, ranolazine, toremifene, antiarrhythmic drugs (such as amiodarone, disopyramide, dofetilide, dronedarone, ibutilide, procainamide, sotalol), antipsychotics (such as pimozide, thioridazine, ziprasidone), certain quinolone antibiotics (grepafloxacin, sparfloxacin), among others.

Quinidine is very similar to quinine. Do not use medications containing quinine while using quinidine.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness/fainting, hallucinations, seizures.

Do not share this medication with others.

Lab and/or medical tests (such as complete blood count, liver/kidney function, quinidine blood levels, EKG) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).