Drug hypersensitivity quinidine

Quinine must be used with considerable caution, if at all, in patients who manifest drug hypersensitivity. Quinine should be discontinued immediately if evidence of hemolysis appears. The drug should not be used in patients with tinnitus or optic neuritis. In patients with cardiac dysrhythmias, the administration of quinine requires the same precautions as for quinidine. Quinine appears to be fairly safe and is used commonly for treatment of malaria during pregnancy, but caution must be used to avoid hypoglycemia. 

Hypersensitivity or idiosyncrasy to quinidine or other cinchona derivatives manifested by thrombocytopenia, skin eruption or febrile reactions myasthenia gravis history of thrombocytopenic purpura associated with quinidine administration digitalis intoxication manifested by arrhythmias or AV conduction disorders complete heart block left bundle branch block or other severe intraventricular conduction defects exhibiting marked QRS widening or bizarre complexes complete AV block with an AV nodal or idioventricular pacemaker aberrant ectopic impulses and abnormal rhythms due to escape mechanisms history of drug-induced torsade de pointes history of long QT syndrome. 

Hypersensitivity reactions Asthma, muscle weakness, and infection with fever prior to quinidine administration may mask hypersensitivity reactions to the drug. Pregnancy Category C. 

Hypersensitivity to any component of the product. Coadministration of nelfinavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events (eg, amiodarone, quinidine, ergot derivatives, pimozide, midazolam, triazolam, lovastatin, simvastatin see Drug Interactions). 

Quinine is a cinchona alkaloid that acts rapidly against all four species of Plasmodium. It is used to treat protozoal infections and leg cramps, and as a bitter and flavoring agent. However, the drug is not used prophylactically for malaria. Quinines are contraindicated in patients with a history of hypersensitivity to quinine or quinidine. They should not be used in the presence of hemolysis and should be used with caution in patients with atrial fibrillation, cardiac conduction defects, or heart block. Quinine administration in myasthenia gravis may aggravate the disease, hence it should be avoided. Quinine can be used in pregnancy.37 Intravenous infusion of quinine should be slow, and the patient should be monitored for cardiotoxicity.38 Cinchonism, which is characterized by tinnitus, GI disturbances, and impaired vision may occur with therapeutic doses of quinine.39... 

Cutaneous reactions are uncommon with quinidine they are more commonly associated with the optical isomer, quinine. Drug fever either occuring alone or in combination with other symptoms is a more frequent manifestation of hypersensitivity than the cutaneous signs (Sturnick 1942), but even quinidine fever is very unusual (Abrams 1973). 

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