Ivermectin Cream and Quinidine Sulfate

• Generic Name: ivermectin topical
• Dosage Forms: n.a.
• Other Brand Names: Soolantra

• It is used to treat rosacea.

• Generic Name: quinidine
• Dosage Forms: n.a.
• Other Brand Names: Quin-G, Cardioquin, Quinora, Quinidex Extentabs, Quinaglute Dura-Tabs, Quin-Release

Comparably effective to procainamide for atrial or ventricular arrhythmias; choice based on pharmacokinetics and adverse effect profile.

Used for conversion of atrial fibrillation or flutter in patients whose symptoms are not adequately controlled by measures to reduce ventricular rate; also may be used to maintain normal sinus rhythm after conversion. However, used infrequently because of adverse effects (e.g., QT-interval prolongation, torsades de pointes, increased mortality) and considered an alternative to other antiarrhythmic agents.

Has been used for treatment of other supraventricular tachycardias (e.g., paroxysmal atrial tachycardia, paroxysmal AV junctional rhythm); however, other therapies preferred.

Suppression and prevention of recurrent ventricular arrhythmias (e.g., sustained VT) that in the judgment of the clinician are life-threatening. Because of arrhythmogenic potential and lack of evidence for improved survival for class I antiarrhythmic agents, not recommended for less severe arrhythmias; avoid treatment in asymptomatic VPCs. (See Boxed Warning.)

Parenteral lidocaine is considered drug of choice for treatment of VPCs because quinidine can decrease myocardial contractility.

Like other antiarrhythmic drugs, not shown to decrease mortality rate in VPCs associated with acute MI.

Treatment of severe malaria caused by Plasmodium falciparum or other Plasmodium species.

Severe malaria usually caused by P. falciparum; P. knowlesi also can cause severe disease. Can be rapidly progressive and fatal (most deaths occur within first 24–48 hours of illness); initial aggressive treatment with a parenteral antimalarial regimen indicated as soon as possible after diagnosis (regardless of Plasmodium species involved) and whenever suspected based on possible exposure and symptoms.

For initial treatment of severe malaria in adults or children, CDC recommends a regimen of IV quinidine gluconate in conjunction with doxycycline, tetracycline, or clindamycin (oral or IV as tolerated). After at least 24 hours and when parasitemia is reduced to <1% and an oral regimen can be tolerated, IV quinidine gluconate can be discontinued and oral quinine sulfate initiated to complete 7 or 3 days of total quinidine and quinine therapy as determined by geographic origin of infecting parasite (7 days if acquired in Southeast Asia or 3 days if acquired elsewhere). Oral antimalarials not recommended for initial treatment of severe malaria.

Because of potentially fatal consequences of delays in initiating treatment of severe malaria, institutional pharmacy services should be aware of the essential role of ready availability of IV quinidine gluconate. (See Availability for Use in Treatment of Severe Malaria under Cautions.)

If IV quinidine gluconate is unavailable locally and cannot be obtained quickly or cannot be used because of adverse effects or contraindications or if parasitemia is high and has not responded to quinidine gluconate, IV artesunate is available from CDC under an investigational new drug (IND) protocol for initial treatment of severe malaria. WHO recommends IV artesunate as the drug of choice for treatment of severe malaria.

Although oral quinidine sulfate has been used for treatment of malaria, including uncomplicated malaria caused by multidrug-resistant P. falciparum, oral quinine sulfate is not included in CDC recommendations for treatment of uncomplicated or severe P. falciparum malaria.

Assistance with diagnosis or treatment of malaria or assistance obtaining IV quinidine gluconate or IV artesunate for treatment of severe malaria is available by contacting CDC Malaria Hotline at 770-488-7788 or 855-856-4713 from 9:00 a.m. to 5:00 p.m. Eastern Standard Time or CDC Emergency Operation Center at 770-488-7100 after hours and on weekends and holidays.