Procainamide with amiodarone

Clinically important, potentially hazardous interactions with amiodarone, procainamide, quinidine, sotalol... 

Clinically important, potentially hazardous interactions with amiodarone, bepridil, cisapride, disopyramide, droperidol, erythromycin, flecainide, levodopa, pentamidine, procainamide, quinidine, sotalol, sparfloxacin, terfenadine, thioridazine... 

Clinically important, potentially hazardous interactions with amiodarone, azithromycin, bepredil, bosentan, bretylium, cisapride, clarithromycin, disopyramide, erythromycin, erythromycin fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ketoconazole, metronidazole, miconazole, nefazodone, nilotinib, paroxetine, pimozide, probucol, procainamide, quinidine, quinine, ritonavir, saquinavir, sertraline, sotalol, SSRIs, terfenadine, troleandomycin, voriconazole, zileuton, ziprasidone... 

Clinically important, potentially hazardous interactions with amiodarone, amisulpride, amitriptyline, amoxapine, arsenic, bepridil, bretylium, calcium, chlorpromazine, clomipramine, desipramine, disopyramide, doxepin, erythromycin, fluphenazine, imipramine, iron salts, magnesium, mesoridazine, nortriptyline, pentamidine, perphenazine, phenothiazines, pimozide, procainamide, prochlorperazine, promazine, promethazine, protriptyline, quinidine, sotalol, sucralfate, thioridazine, tricyclic antidepressants, trifluoperazine, trimipramine, zinc salts... 

Patients with Wolff-Parkinson-White (WPW) syndrome may have several different tachycardias that are treated acutely by different strategies orthodromic reentry (adenosine), antidromic reentry (adenosine or procainamide), and atrial fibrillation (procainamide or amiodarone). AV nodal blocking drugs are contraindicated with WPW syndrome and atrial fibrillation. 

Comparative studies Intravenous amiodarone and procainamide have been compared in 37 children with supraventricular tachycardia (40 episodes) [27 ]. Amiodarone was the initial therapy in 26 cases and procainamide in 14 cases. Procainamide was successful in 71% compared with 34% for amiodarone. Success was achieved in 5 of 8 amiodarone-to-procainamide crossovers compared with 1 of 2 procainamide-to-amiodarone crossovers. Adverse events did not differ significantly. The most serious occurred after procainamide-to-amiodarone crossover, with profound bradycardia and hypotension after a large dose of amiodarone (10 mg/kg over 1 hour). Hypotension and bradycardia were the most common minor adverse events among amiodarone recipients. 

With pulse If hemodynamically stable with monomorphic QRS complexes, administration of procainamide, sotalol, amiodarone, or lidocaine (follow ACLS protocol) if drugs are ineffective, cardioversion. 

Concurrent use of the fluoroquinolones with theophylline causes an increase in serum theophylline levels. When used concurrently with cimetidine, the cimetidine may interfere with the elimination of the fluoroquinolones. Use of the fluoroquinolones with an oral anticoagulant may cause an increase in the effects of the oral coagulant. Administration of the fluoroquinolones with antacids, iron salts, or zinc will decrease absorption of the fluoroquinolones. There is a risk of seizures if fluoroquinolones are given with the NSAIDs. There is a risk of severe cardiac arrhythmias when the fluoroquinolones gatifloxacin and moxifloxacin are administered with drains that increase the QT interval (eg, quini-dine, procainamide, amiodarone, and sotalol). 

Patients with mild or no symptoms can be treated initially with antiarrhythmic drugs. IV amiodarone is now recommended as first-line therapy in this situation. Procainamide or lidocaine given IV is a suitable alternative. Synchronized DCC should be delivered if the patient s status deteriorates, VT degenerates to VF, or drug therapy fails. 

Congenital or acquired QTprolongation Patients with congenital QT prolongation and those taking Class lA (eg, quinidine, procainamide) or Class III (eg, amiodarone, sotalol) antiarrhythmic medications should avoid using vardenafil. 

According to recent ACC/AHA/ESC Guidelines (see Zipes et al., 2006), in patients with sutained VT, direct-current cardioversion is appropriate and most effective, and also intravenous procainamide (or ajmaline in some European countries) is recommended as a reasonable choice for initial treatment for sustained monomorphic VT in patients with acute coronary syndrome. Intravenous amiodarone or lidocaine may be reasonable chose as alternative treatment. 

Procainamide is effective against most atrial and ventricular arrhythmias. However, many clinicians attempt to avoid long-term therapy because of the requirement for frequent dosing and the common occurrence of lupus-related effects. Procainamide is the drug of second or third choice (after lidocaine or amiodarone) in most coronary care units for the treatment of sustained ventricular arrhythmias associated with acute myocardial infarction. 

A systematic review of randomized controlled trials in patients with newly detected AF identified a number of antiarrhythmic drugs for which there was statistically significant evidence of benefit (I). In a limited number of comparative studies, flecainide was more effective than propafenone and procainamide, propafenone was superior to amiodarone, amiodarone was superior to quinidine, and quinidine was superior to sotalol. 

ATOMOXETINE 1. ANTIARRHYTHMICS - amiodarone, disopyramide, procainamide, propafenone 2. ANTIBIOTICS — macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/dalfopristin 3. ANTICANCER AND IMMUNOMODU-LATING DRUGS - arsenic trioxide 4. ANTIDEPRESSANTS - TCAs, venlafax-ine 5. ANTIEMETICS - dolasetron 6. ANTIFUNGALS-fluconazole, posaconazole, voriconazole 7. ANTIHISTAMINES-terfenadine, hydroxyzine, mizolastine 8. ANTIMALARIALS -artemether with lumefantrine, chloro-quine, hydroxychloroquine, mefloquine, quinine 9. ANTIPROTOZOALS-pentamidine isetionate 10. ANTIPSY-CHOTICS - atypicals, phenothiazines, pimozide 11. BETA-BLOCKERS - sotalol 12. BRONCHODILATORS - parenteral bronchodilators Risk of ventricular arrhythmias, particularly torsades de pointes Additive effect these drugs cause prolongation of the Q-T interval Avoid co-administration... 

Pharmacodynamic interactions. Many TCAs cause sedation and therefore co-prescription with other sedative agents such as opioid analgesics, antihistamines, anxiolytics, hypnotics and alcohol may lead to excessive drowsiness and daytime somnolence. The majority of TCAs can have undesirable cardiovascular effects, in particular prolongation of the QT interval. A similar risk of QT prolongation arises with many other cardiovascular drugs including amiodarone, disopyramide, procainamide, propa-... 

The effects of procainamide on the QT interval may be potentiated by other drugs with this action, for example amiodarone (62). 

The pharmacokinetics of procainamide are altered by amiodarone, with a reduction in clearance of about 25% due to changes in both renal and non-renal clearances (62). 

Miller B, Skupin A, Rubenfire M, Bigman O. Respiratory failure produced by severe procainamide intoxication in a patient with pre-existing peripheral neuropathy caused by amiodarone. Chest 1988 94(3) 663-5. 

A Sotalol has nonselective beta-blocking properties that may cause bronchospasm in patients with asthma and COPD. Although amiodarone has beta-blocking activity, this effect is specific to the heart and therefore is not contraindicated in patients with asthma. Also, the patient has not taken amiodarone for a long enough period to develop pulmonary fibrosis. Procainamide, quinidine, and lidocaine are unlikely to cause bronchospasm. 

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