CardioExchange Archive

Recently in the Journal of the American College of Cardiology Viskin et al published the results of a survey  looking at the worldwide availability of quinidine. They found that the drug — the only effective oral antiarrhythmic in Brugada syndrome and idiopathic ventricular fibrillation — is readily available in only 19 countries and is unavailable or requires special procedures to obtain it in 99 countries. One country where quinidine is unavailable is Ireland. CardioExchange’s John Ryan asked Dr. Gerry Fahy, a cardiac electrophysiologist from Cork University Hospital, and Niamh O’Hanlon, a pharmacist at St. Vincent’s University Hospital, to discuss their experiences with quinidine in Ireland.

Fahy: Quinidine is rarely used in Ireland. For the past two years I have had only one patient on quinidine because of Brugada syndrome and a history of polymorphic VT and atrial fibrillation. Brugada syndrome appears to be rare in Ireland. My patient lives in West Cork but is originally from Sri Lanka.

Although quinidine is not marketed in Ireland it can be acquired from suppliers in the United Kingdom within 24 hours. On the rare occasions that it has been needed at short notice, such as for a patient with electrical storm, we have acquired it without undue delay from other hospital pharmacies who happened to have a supply. I think it is important to have a reliable supply available at short notice for the occasional patient who may need it. I will be contacting our hospital pharmacy to ensure that we will have a supply at all times. In the past ten years we have several times had a similar problem with the supply of isoproterenol.

O’Hanlon: We are able to obtain an unlicensed source for oral quinidine sulfate 200mg for inpatient use at our hospital though there may be some delay. Kinidin durules (quinidine bisulphate 250mg modified release preparation), which in the past was available, has been discontinued. The Irish Medicines Board does not list a licensed quinidine preparation.

Community pharmacists are able to order quinidine sulfate 200mg, but because it is unlicensed it is not directly reimbursable, so there would be an additional cost to the patient, although some patients may be eligible for reimbursement due to hardship.

It should be noted that there is a real Sound Alike Look Alike Drug (SALAD) issue with quinidine, which can be confused with quinine tablets (quinidine is an isomer of quinine). Quinine is prescribed in primary care for the relief of night cramps and is available as 200mg and 300mg quinine sulphate/sulfate oral preparations.