Quinine and Quinidine

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Abstract
We recorded electrocardiograms from 31 patients receiving quinine and 14 patients receiving quinidine for the treatment of Plasmodium falciparum malaria. Despite plasma quinine concentrations of up to 20 mg/L, there was no evidence of cardiotoxicity. QT prolongation was considerably greater in the quinidine-treated patients. The mean ratio of change in corrected QT interval to change in plasma concentration (delta QTc%/delta CQ) was 3.2% . mg-1 . L-1 for quinidine, compared to 0.74% . mg-1 . L-1 for quinine (p less than 0.001). T-wave flattening was observed in both groups. Plasma concentrations of quinine cannot be predicted from the EKG, because concentrations within the therapeutic range produced only minor and unpredictable abnormalities.

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