Quinidine / Idiopathic VF

Hi all - I’ve had an interesting experience with medication changes and figured it would be worth sharing. 

I was first started on propranolol after multiple episodes of syncope and polymorphic VT. Then flecainide was added after more episodes of PVT. This combination was terrible in that it made me feel very unstable and I started having panic-attacks. I had never had problems with anxiety or panic attacks prior to starting this medication combination. (Even after getting shocked 17 times and having an ICD placed, I didn’t have panic attacks.) I also started feeling like I had asthma for the first time since I was a kid.

After doing some research, I asked if I could switch to a selective beta blocker (metoprolol) because it doesn’t impact the lungs like non-selective beta blockers. This switch immediately resolved the panic-like feelings I was having after almost every dose of the medications.

I still struggled with regular fatigue and palpitations on metoprolol and flecainide. The symptoms seemed to be worst about 2 hours after taking these medications. While on this combination, I had various episodes of pre-syncope, syncope and VFib. 

After the latest episode of syncope and VFib, my doctor suggested we try eliminating both the beta blocker and flecainide, and switch to the anti-arrhythmic Quinidine. Quinidine is an old anti-arrhythmic, not readily available in North America. The modern use case for Quinidine seems to be in patients with Brugada and people with malaria.

The medication switch was done in the hospital at a large research institution. None of the doctors or pharmacists had first-hand experience with Quinidine. The most notable side effect was significant nausea, which dissipated after the 3rd dose. 

When getting ready to discharge me, I was told they may need to keep me for another 5-7days because they couldn’t find a pharmacy that had the medication. Fortunately, they were able to get the inpatient pharmacy to dispense to me. We also later found out that Costco had the medication in stock.

It’s been a week since starting the medication, and I feel….normal. As in, the daily fatigue and palpitations are gone. It’s certainly still early and I expect to have some ups and downs, but generally things are good!

Anyone else out there taking this medication?


4 Comments

Quinidine

by AgentX86 - 2022-04-20 23:29:19

Flecainide can be proarrhythmic in some people and where it works, it often switchs from antiarrhymic to proarrhythmic overnight. It's an odd drug.  It's one of the lesser antiarrhythmics but it works in some people.  It seems that it may be a proarrhytmic for you, right out of the gate.

Metoprolol isn't a selective beta blocker at all.  It's about as general as you can get.  It's one of the most common drugs out there.  Snipers take it to calm nerves.  As such, it's been banned from several sports.

Quinidine seems to be readily available, well, it may not be in stock but all of the normal players dispense it. No, I've never been on it.

Anti arrhythmic medication

by Gemita - 2022-04-21 06:45:40

Jaykay,

Like AgentX86, I have never tried Quinidine, but thank you so much for sharing your success with this med.  It is always interesting to hear what works for others.  Like with many other meds, it does come with a few warnings, so please take care.

Anti arrhythmic medication can be very hit and miss, trial and error for so many of us.  As a long time arrhythmia sufferer, I have tried many remedies.  In my experience I found going in too aggressively to try to treat an arrhythmia may work against us sometimes and make the arrhythmia worse.  I was on Flecainide and Digoxin for several years and found them to be pro arrhythmic, particularly Digoxin which needed frequent blood checks to see that the drug was being adequately cleared.

Providing we are anticoagulated if we have a stroke risk and the heart rate during an arrhythmia is well controlled, there may be little else that needs to be done for the majority of us with uncomplicated arrhythmias, so clearly fewer meds can be better than more.  Your Ventricular Fibrillation however cannot be classified as uncomplicated and I am glad to see you have an ICD to protect you. 

I am now on minimal meds for both atrial and ventricular arrhythmias and I am steadier this way.  I only take low dose Bisoprolol (an extremely cardio selective beta blocker) and anticoagulant Edoxaban.  Previously I was taking Flecainide, Digoxin and Bisoprolol in fairly high doses which made my arrhythmias more active and difficult to control.  By reducing Bisoprolol and eliminating Flecainide and Digoxin, my arrhythmias are well controlled now, the opposite of what one might expect, so I have no difficulty in fully appreciating your message.  Thank you again for sharing this with us and I hope you continue to do well

Quinidine

by IAN MC - 2022-04-22 13:45:35

Glad to hear how well you have done on quinidine . It is a fascinating drug and seems to work EXCEPTIONALLY well on a small percentage of arrhythmia patients ( probably depends on your genes ! ).

Unfortunately , because it is such low-cost  and because  the oral form is only used for arrhythmias ,manufacturers cannot make much profit from it so are discontinuing its production.

The major manufacturer of quinidine for the IV anti-malaria version has recently discontinued making it.

If I were you I would stockpile in-date supplies for future use as availability is likely to become more and more diffiicult.  It is no longer available in most countries..

Ian

Beta Blocker Selectivity and Quinidine Availability

by JayKay - 2022-04-23 10:51:21

Thanks AgentX86, Gemita, and Ian for sharing your experiences and insights. I'm incredibly happy to be doing so well at the moment!

AgentX86 -

Regarding the cardio-selectivity of metoprolol, I believe it is selective:  https://www.goodrx.com/classes/beta-blockers/beta-blocker-comparison. What are you referencing regarding whether or not metoprolol is selective?

Regarding Quinidine availability, this is just one article that draws attention to this issue: https://pubmed.ncbi.nlm.nih.gov/23583244/ . 

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