Quinidine Dihydrocodeine

A,codeine,morphine,dihydrocodeine,quinine, quinidine,caffeine, theophylline, ajmaline Various basic drugs Separation of basic drugs on silica gel with non-aqueous ionic eluents Spherisorb S5W Silica 250x4.9 Me0H-hexane(85 15)contai ni ng o.iox hcio4 66 ... 

Simultaneous dihydrocodeine, hydrocodone, 6-monoacetylmorphine, morphine, ojgrcodone Noninterfering acetylcodeine, amitriptyline, amphetamine, diamorphine, dieizepeun, doth-iepin, doxepin, ephedrine, ephedrine, hydromorphone, mesoridazine, methadone, meth-amphetamine, 3-monoacetylmorphine, nordiazepam, norpropo oq)hene, nortriptyline, oxazepam, propojg hene, pseudoephedrine, quinidine, quinine, sulfamethoxazole, sulfor-idazine, thioridazine... 

The analgesic effects of codeine, and probably also hydrocodone, are reduced or abolished by quinidine. Quinidine alters the pharmacokinetics of dihydrocodeine and oxycodone, but this does not appear to alter their effects. 

The interaction between codeine and quinidine is well established and clinically important. Codeine will be virtually ineffective as an analgesic in extensive metabolisers of CYP2D6 (most patients) taking quinidine. An alternative analgesic should be used (possibly dihydrocodeine, see below, or tramadol, see Opioids + Quinidine , p.l83). No interaction would be expected in poor metabolisers (about 7% of Caucasians), but codeine is probably unlikely to be effective in these patients in any case. Whether the antitussive effects of codeine are similarly affected is not established, but it seems likely. Note that this interaction has been used clinically in an attempt to treat codeine dependence. ... 

The available evidence suggests that the efficacy of dihydrocodeine, hydromorphone, or oxycodone may not be significantly affected by quinidine, but this needs confirmation. 

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