Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
BRAND NAME: Pronestyl, Procan-SR, Procanbid (These brands no longer are
available in the U.S.)
DRUG CLASS AND MECHANISM: Procainamide is an injectable drug that is used to
correct disturbances in the heart's rhythm; it is an antiarrhythmic drug. Three
actions are responsible for its ability to correct disturbances of rhythm and
prevent their recurrence. Procainamide decreases the speed of electrical
conduction through the heart muscle, prolongs the electrical phase during which
the heart's muscle cells can be electrically stimulated, and prolongs the
recovery period during which the heart muscle cells cannot be stimulated.
Procainamide was approved for use by the FDA in 1950.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Injection: 100 and 500 mg/ml.
STORAGE: Procainamide may be kept at room temperature. If diluted it is
stable for 24 hours at room temperature or seven days if refrigerated at 2 to 8
C (35 to 46 F).
PRESCRIBED FOR: Procainamide is an antiarrhythmic drug used in the treatment
of abnormal heart rhythms such as:
early (premature) atrial and ventricular beats;
intermittent rapid rhythms (tachycardias) involving the atria and
atrio-ventricular (AV) junction as well as abnormal pathways (bypass tracts)
between the atria and ventricles;
after conversion from atrial fibrillation or flutter to prevent recurrence;
and
ventricular tachycardia.
DOSING: An intravenous dose of 500-600 mg over may be administered over 25-30
minutes to adults. The initial dose is followed with a maintenance dose of 1-6
mg/min.
DRUG INTERACTIONS:Amiodarone (Cordarone) increases the blood concentrations
of procainamide by either decreasing the kidneys or the liver's abilities to
remove procainamide. Combining procainamide with thioridazine (Mellaril),
pimozide (Orap), quinolones for example, levofloxacin
(Levaquin), tricyclic
antidepressants for example, amitriptyline
(Endep, Elavil), and ziprasidone (Geodon) may
increase the risk of abnormal heart beats because these drugs may also prolong
the recovery period of the heart. Concurrent administration of procainamide with
other antiarrhythmics can result in additive or antagonistic effects on the
heart.
PREGNANCY: Procainamide crosses the placenta. Adequate studies have not been
performed in humans to determine if there are any effects of procainamide on the
fetus. Therefore, procainamide should be avoided in
pregnant patients unless the
physician feels that the potential benefits outweigh the unknown risks.
NURSING MOTHERS: There are no adequate studies in
nursing mothers. Available
information suggests that there is minimal risk of adverse effects to the
infant.
SIDE EFFECTS: Common reactions include diarrhea, nausea, vomiting, rash,
low
blood pressure, itching, flushing, and slow heart beat. Severe reactions include
abnormal heart beats, seizures,
heart arrest, and blood disorders. A severe
reduction in white blood cell count occurs relatively rarely with procainamide
therapy and is more common with the sustained-release preparations. This side
effect has caused death. For this reason, patients on sustained-release
procainamide get a complete blood count every 2 weeks for the first 3 months of
treatment. A syndrome resembling lupus erythematosus, including fever, chills,
joint pain, chest pain, and/or skin rash can occur with procainamide. The
lupus-like syndrome is reversible after stopping the drug. Rarely, procainamide
can cause confusion, hallucinations, and depression.
An arrhythmia is an abnormal heart rhythm. With an arrhythmia, the heartbeats may be irregular or too slow (bradycardia), to rapid (tachycardia), or too early. When a single heartbeat occurs earlier than normal, it is called a prmature contraction.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Premature ventricular contractions (PVCs) are premature heartbeats originating from the ventricles of the heart. PVCs are premature because they occur before the regular heartbeat. There are many causes of premature ventricular contractions to include: heart attack, high blood pressure, congestive heart failure, mitral valve prolapse, hypokalemia, hypoxia, medications, excess caffeine, drug abuse, and myocarditis.
Neutropenia is a marked decrease in the number of neutrophils, neutrophils being a type of white blood cell (specifically a form of granulocyte) filled with neutrally-staning granules, tiny sacs of enzymes that help the cell to kill and digest microorganisms it has engulfed by phagocytosis.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
Paroxysmal supraventricular tachycardia (PSVT) is an abnormal conduction of electricity in particular areas of the heart. PSVT was referred to at one time as paroxysmal atrial tachycardia or PAT, however, the term PAT is reserved for as specific heart condition. Symptoms of PSVT include weakness, shortness of breath, chest pressure, lightheadedness, and palpitations. PSVT is treated with medications or procedures that return the heart to its normal electrical pattern.
Atrial fibrillation (AF) is the most common, abnormal rhythm of the
heart.
The heart contracts (beats) and pumps blood with a regular rhythm, for example,
at a rate of 60 beats per minute there is a beat every second. The heart may
beat faster or slower with a shorter or longer interval between beats, but at
any one rate the interval between beats is constant. This regular rhythm occurs
as a result of regular electrical discharges (currents) that travel through the
heart and cause the muscle of the heart to contract. In atrial fibrillation, the electrical
discharges are irregular and rapid and, as a result, the heart beats irregularly
and, usually, rapidly.
Atrial fibrillation is common; half a million new cases are diagnosed yearly
in the U.S., and billions of dollars are spent annually on its diagnosis and
treatment.
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