Procainamide Ciprofloxacin

T Pancreatic insulin release Metformin Peripheral insulin sensitivity hepatic glucose output/production i intestinal glucose absorption Dose Ist-line (naive pts), 1.25/250 mg PO daily-bid 2nd-line, 2.5/500 mg or 5/500 mg bid (max 20/2000 mg) take w/ meals, slowly T dose hold before 48 h after ionic contrast media Caution [C, -] Contra SCr >1.4 mg/dL in females or >1.5 mg/dL in males hypoxemic conditions (sepsis, recent MI) alcoholism metabolic acidosis liver Dz Disp Tabs SE HA, hypoglycemia, lactic acidosis, anorexia, N/V, rash Additional Interactions T Effects W/ amiloride, ciprofloxacin cimetidine, digoxin, miconazole, morphine, nifedipine, procainamide, quinidine, quinine, ranitidine, triamterene,... 

Clinically important, potentially hazardous interactions with abacavir, amiodarone, bretylium, chlorpromazine, ciprofloxacin, disopyramide, enoxacin, fluphenazine, gatifloxacin, lomefloxacin, mesoridazine, moxifloxacin, norfloxacin, ofloxacin, phenothiazines, procainamide, prochlorperazine, promethazine, quinidine, quinolones, sotalol, sparfloxacin, thioridazine, trifluoperazine... 

Procainamide is converted to A/-acetylprocainamide (active metabolite) in the horse (p 2 = 6.3 h), but this metabolite is not formed in the dog. d Enrofloxacin is converted to ciprofloxacin, both of which have antimicrobial activity. 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, ampicil-lin, carbamazepine, cefamandole, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftizoxime, cephalexin, cephalothin, cephapirin, chloramphenicol, ciprofloxacin, clonazepam, (yclosporine, desipramine, digoxin, disopyramide, ethosuximide, gentamicin, haloperidol, imipramine, kanamycin, lidocaine, mezlocillin, netilmicin, nortriptyline, phenobarbital, phenytoin, primidone, procainamide, propranolol, quinidine, salicylic acid, streptomycin, sulfamethoxazole, theophylline, thiamphenicol, ticarcillin, tobramycin, trimethoprim, vancomycin... 

Ofloxacin and levofloxacin cause moderate increases in the serum levels of procainamide, whereas ciprofloxacin has a lesser effect However, the ECG appears to be unaltered in studies in healthy subjects given these quinolones with procainamide. An increased risk of torsade de pointes would be expected if procainamide is used with gatifloxacin, moxifloxacin, or sparfloxacin, and possibly levofloxacin. 

The probable reason for the interaction is that levofloxacin, ofloxacin and to a lesser extent ciprofloxacin, inhibit the secretion of unchanged procainamide by the kidney tubules via renal drug transporters. Levofloxacin also appears to inhibit the secretion ofV-acetylprocainamide. 

Bauer LA, Black DJ, Lill JS, Garrisc J, Raisys VA, Hootc TM. Levofloxacin and ciprofloxacin decrease procainamide and N-acetylprocainamide renal clearances. Antimicrob Agents ChemoOter (2005) 49,1649-51. 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, amlodi-pine, carbamazepine, cefotaxime, ceftazidime, chloramphenicoL ciprofloxacin, cisapride, clindamycin, clonidine, codeine, cyclosporine, digoxin, diphenhydramine, disopyramide, ethosuximide, fluconazole, gentamicin, gentamicin, heparin, labetalol, levothyroxine, li-docaine, lithium, methotrexate, metronidazole, minoxidil, nafdllin, nifedipine, phenobar-bital, phenobarbital, phenytoin, phenytoin, primidone, procainamide, propranolol, quini-dine, ranitidine, salicylic acid, theophylline, tobramycin, tobramycin, valproic acid, warfarin... 

Drugs implicated 3-Lactams other antibacterials NMBDs some NSAIDs quinolones mAbs proton pump inhib s P-Lactams quinine quinidine sulfonamides NSAIDs procainamide gold carbamazepine propylthiouracil ticlopidine P-Lactams ciprofloxacin sulfonamides lincomycin tetracycline NSAIDs carbamazepine allopurinol gold methyldopa mAbs NSAIDs p-lactams othCT antibiotics anti-convulsants antimalarials local anesthetics barbiturates quinolones dapsone... 

Noninterfering amikacin, aztreonam, carbamazepine, cephalosporins, ciprofloxacin, clavulanic acid, difloxacin, digitoxin, digoxin, fleroxacin, fosfomycin, furosemide, gentamicin, imipenem, lidocaine, netilmicin, norfloxacin, ofloxacin, pefloxacin, penicillins, phenobarbital, phenytoin, primidone, procainamide, quinidine, rifampin, salicylic acid, teicoplanin, theophylline, tobramycin, valproic acid, vancomycin... 

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