Quinidine, a life-saving medication for Brugada syndrome, is inaccessible in many countries

J Am Coll Cardiol. 2013 Jun 11;61(23):2383-7. doi: 10.1016/j.jacc.2013.02.077. Epub 2013 Apr 10.

Abstract

Objectives: The aim of this study was to determine the availability of quinidine throughout the world.

Background: Quinidine is the only oral medication that is effective for preventing life-threatening ventricular arrhythmias due to Brugada syndrome and idiopathic ventricular fibrillation. However, because of its low price and restricted indication, this medication is not marketed in many countries.

Methods: We conducted a survey of the availability of quinidine by contacting professional medical societies and arrhythmia specialists worldwide. Physicians were e-mailed questionnaires requesting information concerning the quinidine preparation available at their hospital. We also requested information concerning cases of adverse arrhythmic events resulting from unavailability of quinidine.

Results: A total of 273 physicians from 131 countries provided information regarding the availability of quinidine. Quinidine was readily available in 19 countries (14%), not accessible in 99 countries (76%), and available only through specific regulatory processes that require 4 to 90 days for completion in 13 countries (10%). We were able to gather information concerning 22 patients who had serious arrhythmias probably related (10 cases) or possibility related (12 cases) to the absence of quinidine, including 2 fatalities possibly attributable to the unavailability of quinidine.

Conclusions: The lack of accessibility of quinidine is a serious medical hazard at the global level.

Publication types

  • Comparative Study

MeSH terms

  • Anti-Arrhythmia Agents / supply & distribution
  • Anti-Arrhythmia Agents / therapeutic use
  • Brugada Syndrome / complications
  • Brugada Syndrome / diagnosis
  • Brugada Syndrome / drug therapy*
  • Cross-Sectional Studies
  • Drug Utilization
  • Female
  • Global Health*
  • Health Services Accessibility*
  • Humans
  • Male
  • Needs Assessment
  • Quinidine / supply & distribution*
  • Quinidine / therapeutic use*
  • Risk Assessment
  • Surveys and Questionnaires
  • Survival Analysis
  • Ventricular Fibrillation / drug therapy*
  • Ventricular Fibrillation / etiology
  • Ventricular Fibrillation / mortality

Substances

  • Anti-Arrhythmia Agents
  • Quinidine