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European Heart Journal Mar 1987
Review
Topics: Arrhythmias, Cardiac; Disopyramide; Humans; Kinetics; Procainamide
PubMed: 3556173
DOI: 10.1093/eurheartj/8.suppl_a.11 -
Heart Disease and Stroke : a Journal... 1993Procainamide remains one of the most widely used antiarrhythmic agents in clinical practice. Currently, it is widely used alone or in combination with class I agents... (Review)
Review
Procainamide remains one of the most widely used antiarrhythmic agents in clinical practice. Currently, it is widely used alone or in combination with class I agents (eg, mexiletine or tocainide) to prevent recurrent ventricular tachycardia or symptomatic nonsustained ventricular tachycardia. Procainamide is also used for short-term treatment of ventricular tachycardia and a variety of supraventricular tachycardias, primarily atrial flutter and atrial fibrillation. Long-term procainamide therapy is limited by a number of systemic side effects, primarily lupus-like syndrome, gastrointestinal disturbances, and autoimmune blood dyscrasias. Procainamide levels can be useful in initial dose titrations; however, QRS and QT interval measurements help prevent drug toxicity. It is recommended that patients being started on antiarrhythmic therapy with procainamide be admitted to the hospital for monitoring to ensure that their QT interval is not excessively prolonged.
Topics: Anti-Arrhythmia Agents; Electrocardiography; Humans; Procainamide; Tachycardia, Supraventricular; Tachycardia, Ventricular
PubMed: 8137053
DOI: No ID Found -
Clinical Pharmacokinetics 1978Procainamide is almost completely absorbed after oral administration and peak plasma concentrations are generally reached within 1 to 2 hours. Upon intravenous... (Review)
Review
Procainamide is almost completely absorbed after oral administration and peak plasma concentrations are generally reached within 1 to 2 hours. Upon intravenous administration there is a rapid initial distribution phase, which is completed after about 30 minutes. The pharmacokinetics can be described by a 2-compartment open model. The plasma half-life during the beta-phase averages 3 hours. The apparent volume of distribution is about 2L/kg body weight. At therapeutic plasma levels about 15% is bound to plasma proteins. Approximately 50% of administered procainamide is eliminated as unchanged drug via the kidneys. N-Acetylprocainamide is the main metabolite and is the main metabolite and is pharmacologically active, with a recovery in urine of about 15% (range 7 to 34% in healthy subjects). The acetylation of procainamide seems to be under the same monogenic control as that of isoniazid. At least 2 more metabolites have been found but are not yet identified. The renal clearance of procainamide ranges from 179 to 660ml/min. Glomerular filtration and active tubular secretion seem to be the most important mechanisms. In patients with low-output cardiac and/or renal impairment, the absorption, distribution and elimination of the drug may be significantly altered. Determination of plasma levels is of particular value in these cases and will contribute to more safe and effective therapy in the majority of patients. As N-acetylprocainamide seems to have pharmacological effects comparable with those of procainamide, both agents should be monitored simultaneously in order to optimise therapy.
Topics: Acute Kidney Injury; Age Factors; Aged; Biotransformation; Drug Interactions; Heart Diseases; Humans; Intestinal Absorption; Kinetics; Liver Diseases; Procainamide; Protein Binding; Tissue Distribution
PubMed: 346289
DOI: 10.2165/00003088-197803020-00001 -
The Annals of Pharmacotherapy Sep 1999To describe a case of procainamide-induced psychosis in an adult treated for atrial fibrillation. (Review)
Review
OBJECTIVE
To describe a case of procainamide-induced psychosis in an adult treated for atrial fibrillation.
CASE SUMMARY
A 45-year-old Native American woman developed acute psychosis within 72 hours of initiating procainamide for atrial fibrillation. Symptoms abated within 24 hours of discontinuing procainamide. Serum procainamide/N-acetylprocainamide concentrations were therapeutic throughout treatment. Sotalol was started without recurrence of symptoms.
DISCUSSION
Psychosis is a rare complication of treatment with procainamide, but the exact mechanism for this adverse event is not fully understood. Seven cases implicating procainamide as the cause of acute psychosis are reported in the literature. Cases of psychosis involving other antiarrhythmic agents have also been reported.
CONCLUSIONS
Healthcare personnel should be aware of this adverse event related to procainamide and other antiarrhythmic agents.
Topics: Adult; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Female; Humans; Male; Middle Aged; Procainamide; Psychoses, Substance-Induced
PubMed: 10492498
DOI: 10.1345/aph.18378 -
Cutis Nov 1988Dermatologists are often faced with the difficulty of evaluating drug reactions in patients receiving multiple medications. Unfortunately, few drugs produce distinctive...
Dermatologists are often faced with the difficulty of evaluating drug reactions in patients receiving multiple medications. Unfortunately, few drugs produce distinctive lesions; many types of medications can produce identical eruptions. One common drug-induced eruption is urticaria. We report a specific eruption due to procainamide: urticarial vasculitis.
Topics: Aged; Arrhythmias, Cardiac; Drug Eruptions; Humans; Male; Procainamide; Urticaria; Vasculitis, Leukocytoclastic, Cutaneous
PubMed: 2973973
DOI: No ID Found -
JAMA Sep 1978
Topics: Arrhythmias, Cardiac; Bipolar Disorder; Female; Humans; Male; Middle Aged; Placebos; Pregnancy; Procainamide; Psychiatric Status Rating Scales; Psychoses, Substance-Induced
PubMed: 567255
DOI: 10.1001/jama.240.12.1265 -
Annals of the New York Academy of... 1984Procainamide (PA) has been a mainstay of treatment against acute and chronic supraventricular and ventricular arrhythmias for more than 30 years. PA's clinical... (Review)
Review
Procainamide (PA) has been a mainstay of treatment against acute and chronic supraventricular and ventricular arrhythmias for more than 30 years. PA's clinical pharmacology has been studied extensively and its bioavailability (75-95%); volume of distribution (1.5-2.5 liters per kg), plasma protein-binding (15-25%), half-time for elimination (3-7 hours), and metabolism are known. PA's efficacy against acute ventricular arrhythmias and chronic stable VPDs is associated with plasma drug concentrations of 4 to 10 micrograms per ml; but much higher plasma concentrations may be required against sustained ventricular arrhythmias. From 30 to 60% of a PA dose is excreted as the metabolite, N-acetylprocainamide (NAPA), and PA's metabolism is determined genetically (fast or slow acetylation phenotype). Studies in patients with VPDs indicate that NAPA is also antiarrhythmic, although the contribution of NAPA to the antiarrhythmic effect after PA is not known. Studies in patients with the systemic lupus-like syndrome from PA show that NAPA is not associated with this. Investigations comparing efficacy and adverse effects of PA with those of new antiarrhythmic agents available for clinical trials are indicated in the future.
Topics: Acecainide; Administration, Oral; Animals; Arrhythmias, Cardiac; Electrocardiography; Heart; Humans; Injections, Intravenous; Kinetics; Lupus Erythematosus, Systemic; Procainamide
PubMed: 6084435
DOI: 10.1111/j.1749-6632.1984.tb14519.x -
The Practitioner Jan 1961
Topics: Procainamide
PubMed: 13790515
DOI: No ID Found -
American Journal of Hospital Pharmacy Sep 1974
Review
Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Computers; Half-Life; Humans; Infusions, Parenteral; Kinetics; Myocardial Infarction; Procainamide
PubMed: 4607729
DOI: No ID Found -
Archives of Internal Medicine Sep 1972
Topics: Acetazolamide; Animals; Bile; Blood Urea Nitrogen; Creatinine; Dogs; Furosemide; Humans; Hydrogen-Ion Concentration; Kidney Diseases; Metabolic Clearance Rate; Methods; Procainamide; Time Factors
PubMed: 5055693
DOI: No ID Found