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quinidine and HIV
Aug 16, 2000

My restless leg syndrome seems to have gotten worse since starting variations on the cocktail. I've been on klonopin for years for panic attacks, so my M.D. is hesitant to up the dosage. Quinidine seems to be the next option, but my M.D. can't find an interaction chart that includes quinidine and the antivirals;hence the hesitation to prescribe that for me. Help.

Response from Dr. Feinberg

Quinidine is metabolized (broken down) in the liver by the same enzyme complex that both metabolizes and is affected by protease inhibitors and NNRTIs. You didn't say what antiretrovirals you are taking, and this is important because some interact with cytochrome p450-3A4 to a much lesser extent than others. So, depending on what you're taking, it may be possible to find a reasonable dose of quinidine, and quinidine levels can be monitored to make sure that you don't get a high (toxic) dose. Tell your doctor that there is useful information in the PDR and in standard pharmacology texts about quinidine metabolism, so that he/she can make a reasonable judgment about doses if you decide to proceed with this approach to symptom management.

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