SOME INCOMPATIBILITIES
Acidified sodium chlorite could provide a powerful new opportunity to improve or to restore sensitivity to quinolines by virtue of its oxidative power. However, quinolines contain secondary or tertiary amino groups which react with chlorine dioxide in such a way that both could destroy each other. Some possible strategies to resolve this
incompatibility are suggested below.
1) Acidified sodium chlorite could be used as explained above only as a solo therapy.
2) Quinoline administration could be withheld until after the acidified sodium chorite has completed its action.
3) Patients already preloaded with a quinoline could stop this, wait a suitable period of time for this to wash out, then administer the acidified sodium chlorite.
4) The quinoline could remain in use and while the less active sodium chlorite is administered without acid. This should retain plenty of oxidant effectiveness without destroying any quinoline or wasting too much oxidant.
5) Switch from a quinoline to an endoperoxide (such as artemisinin) or to a quinone (such as atovaquone) before using acidified sodium chlorite, as these may be less sensitive toward destruction by chlorine dioxide.
Similar problems apply to methylene blue and many other drugs if they have an unoxidized sulfur atom, a phenol group, a secondary amine or a tertiary amine. Such are also very reactive with the chlorine dioxide component. [58a]