title: Quinidine, a life-saving medication for Brugada syndrome, is inaccessible in many countries.
abstract: OBJECTIVE
  The aim of this study was to determine the availability of quinidine throughout the world.
  
  
  BACKGROUND
  Quinidine is the only oral medication that is effective for preventing life-threatening ventricular arrhythmias due to Brugada syndrome and idiopathic ventricular fibrillation. However, because of its low price and restricted indication, this medication is not marketed in many countries.
  
  
  METHODS
  We conducted a survey of the availability of quinidine by contacting professional medical societies and arrhythmia specialists worldwide. Physicians were e-mailed questionnaires requesting information concerning the quinidine preparation available at their hospital. We also requested information concerning cases of adverse arrhythmic events resulting from unavailability of quinidine.
  
  
  RESULTS
  A total of 273 physicians from 131 countries provided information regarding the availability of quinidine. Quinidine was readily available in 19 countries (14%), not accessible in 99 countries (76%), and available only through specific regulatory processes that require 4 to 90 days for completion in 13 countries (10%). We were able to gather information concerning 22 patients who had serious arrhythmias probably related (10 cases) or possibility related (12 cases) to the absence of quinidine, including 2 fatalities possibly attributable to the unavailability of quinidine.
  
  
  CONCLUSIONS
  The lack of accessibility of quinidine is a serious medical hazard at the global level.
authors.affiliation: Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. samiviskin@gmail.com
authors.forename: Sami
authors.initials: S
authors.lastname: Viskin
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
authors.forename: Milton E
authors.initials: ME
authors.lastname: Guevara-Valdivia
authors.forename: Amin
authors.initials: A
authors.lastname: Daoulah
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Zipes
authors.forename: Amir
authors.initials: A
authors.lastname: Halkin
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.forename: Noel G
authors.initials: NG
authors.lastname: Boyle
authors.forename: Arnon
authors.initials: A
authors.lastname: Adler
authors.forename: Bernard
authors.initials: B
authors.lastname: Belhassen
authors.forename: Edgardo
authors.initials: E
authors.lastname: Schapachnik
authors.forename: Farhan
authors.initials: F
authors.lastname: Asrar
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosso
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000600:supply & distribution / Q000627:therapeutic use; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D014943:Global Health; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D020380:Needs Assessment; D011802:Quinidine / Q000600:supply & distribution* / Q000627:therapeutic use*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality
chemical_list: D000889:Anti-Arrhythmia Agents; D011802:Quinidine