Drug interactions
Perhexiline + Quinidine
Severity: Major
Perhexiline and Quinidine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Perhexiline is mainly cleared by CYP2D6 and has a narrow therapeutic range. Quinidine strongly inhibits CYP2D6, which can cause perhexiline accumulation, leading to hepatotoxicity, neuropathy, hypoglycemia and QT prolongation.
What this interaction means in plain words
Perhexiline and Quinidine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Quinidine potently inhibits CYP2D6, reducing perhexiline metabolism.
What to do
Avoid the combination where possible. If used, reduce the perhexiline dose and monitor plasma perhexiline levels, liver function and ECG.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Quinidine
- Adagrasib + Quinidine Contraindicated
- Arsenic trioxide + Quinidine Contraindicated
- Artemether / lumefantrine + Quinidine Contraindicated
- Chloroquine + Quinidine Contraindicated
- Dofetilide + Quinidine Contraindicated
- Dronedarone + Quinidine Contraindicated
Frequently asked questions
Can I take Perhexiline with Quinidine?
MediHelp rates the interaction as major. Perhexiline and Quinidine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Perhexiline is mainly cleared by CYP2D6 and has a narrow therapeutic range. Quinidine strongly inhibits CYP2D6, which can cause perhexiline accumulation, leading to hepatotoxicity, neuropathy, hypoglycemia and QT prolongation.
How serious is the interaction between Perhexiline and Quinidine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible. If used, reduce the perhexiline dose and monitor plasma perhexiline levels, liver function and ECG.
What other medicines interact with Quinidine?
MediHelp also lists interactions of Quinidine with, for example, Adagrasib, Arsenic trioxide, Artemether / lumefantrine. The full list is on the Quinidine page.
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