Antiarrhythmic activity of quinine in humans.
BACKGROUND
Quinine is the diastereomer of quinidine. In dogs, it has similar effects on conduction time but does not prolong epicardial repolarization time or ventricular refractoriness. It has antiarrhythmic effects in both cats and dogs. We assessed the antiarrhythmic potential of quinine in suppressing ventricular arrhythmias in humans.


RESULTS
Patients underwent open-label, dose-ranging trials of quinine with daily doses of 600, 1200, and 1800 mg in a twice-daily dosing regimen. In 17 patients with frequent spontaneous ventricular ectopy, oral quinine suppressed arrhythmia in 11 of 12 patients who finished the study and was not tolerated by 4 patients, and 1 patient withdrew from the study. The mean effective daily dosage was 927 mg, the mean effective trough serum level was 11 mumol/L (range, 4 to 17 mumol/L), and the half-life was 20 +/- 7 hours. In a second open-label, dose-ranging trial in 10 patients with inducible ventricular tachycardia and reduced left ventricular systolic function (left ventricular ejection fraction, 35 +/- 16%), quinine suppressed inducibility of ventricular tachycardia in 3 of 10 patients. At a basic pacing cycle length of 500 milliseconds, ventricular effective refractory period was prolonged (279 +/- 21 versus 247 +/- 10 milliseconds, quinine versus drug free, P = .003). In the remaining patients, ventricular tachycardia cycle length was prolonged (373 +/- 48 versus 253 +/- 30 milliseconds, quinine versus drug free, P < .001). The corrected QT interval was not prolonged.


CONCLUSIONS
Quinine is an effective and convenient antiarrhythmic drug for the suppression of ventricular arrhythmias in humans.
Sheldon
R
R
Cardiovascular Research Group, University of Calgary, Alberta, Canada.
Duff
H
H
Koshman
M L
ML
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000494:pharmacology*; D002304:Cardiac Pacing, Artificial; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011803:Quinine / Q000008:administration & dosage / Q000494:pharmacology*; D015222:Sodium Channels / Q000187:drug effects; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000517:prevention & control*; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000517:prevention & control*
D000889:Anti-Arrhythmia Agents; D015222:Sodium Channels; D011803:Quinine