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Straka RJ, Marshall PS. The Clinical Significance of the Pharmacogenetics of Cardiovascular Medications. J Pharm Pract 2016. [DOI: 10.1177/089719009200500606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inter-individual variability in the response to numerous drugs can be traced to a number of sources. One source of variability in drug response is the variability associated with the metabolic capacity of an individual. The component of metabolic capacity that will be the focus of this article is that determined by heredity. Pharmacogenetics is frequently referred to as the study of the effects of heredity on the disposition and response to medications. This article will review the pharmacokinetic and pharmacodynamic significance of pharmacogenetics as it pertains to a select number of cardiovascular agents. The enzyme systems responsible for drug metabolism discussed in this article will be limited to the P-450IID6 and N-acetylation pathways. Given the extensive use of cardiovascular agents in clinical practice that are affected by this genetic polymorphism, it is important for the practicing pharmacist to be aware of this phenomenon and its implications. Hopefully, the knowledge gained from this article will help practicing pharmacists to appreciate the clinical significance of polymorphic drug metabolism and provide a basis for the application of this knowledge to a variety of practice settings.
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Affiliation(s)
- Robert J. Straka
- Section of Clinical Pharmacy, St Paul-Ramsey Medical Center, 640 Jackson St, St Paul, MN 55101
| | - Peter S. Marshall
- Section of Clinical Pharmacy, St Paul-Ramsey Medical Center, St Paul, Department of Pharmacy Practice, College of Pharmacy, University of Minnesota, Minneapolis, MN
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Marill KA, deSouza IS, Nishijima DK, Senecal EL, Setnik GS, Stair TO, Ruskin JN, Ellinor PT. Amiodarone or procainamide for the termination of sustained stable ventricular tachycardia: an historical multicenter comparison. Acad Emerg Med 2010; 17:297-306. [PMID: 20370763 DOI: 10.1111/j.1553-2712.2010.00680.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The objective was to compare the effectiveness of intravenous (IV) procainamide and amiodarone for the termination of spontaneous stable sustained ventricular tachycardia (VT). METHODS A historical cohort study of consecutive adult patients with stable sustained VT treated with IV amiodarone or procainamide was performed at four urban hospitals. Patients were identified for enrollment by admissions for VT and treatment with the study agents in the emergency department (ED) from 1993 to 2008. The primary measured outcome was VT termination within 20 minutes of onset of study medicine infusion. A secondary effectiveness outcome was the ultimate need for electrical therapy to terminate the VT episode. Major adverse effects were tabulated, and blood pressure responses to medication infusions were compared. RESULTS There were 97 infusions of amiodarone or procainamide in 90 patients with VT, but the primary outcome was unknown after 14 infusions due to administration of another antidysrhythmic during the 20-minute observation period. The rates of VT termination were 25% (13/53) and 30% (9/30) for amiodarone and procainamide, respectively. The adjusted odds of termination with procainamide compared to amiodarone was 1.2 (95% confidence interval [CI]=0.4 to 3.9). Ultimately, 35/66 amiodarone patients (53%, 95% CI=40 to 65%) and 13/31 procainamide patients (42%, 95% CI=25 to 61%) required electrical therapy for VT termination. Hypotension led to cessation of medicine infusion or immediate direct current cardioversion (DCCV) in 4/66 (6%, 95% CI=2 to 15%) and 6/31 (19%, 95% CI=7 to 37%) patients who received amiodarone and procainamide, respectively. CONCLUSIONS Procainamide was not more effective than amiodarone for the termination of sustained VT, but the ability to detect a significant difference was limited by the study design and potential confounding. As used in practice, both agents were relatively ineffective and associated with clinically important proportions of patients with decreased blood pressure.
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Affiliation(s)
- Keith A Marill
- Department of Emergency Medicine, Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA.
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Geelen P, O'Hara GE, Roy N, Talajic M, Roy D, Plante S, Turgeon J. Comparison of propafenone versus procainamide for the acute treatment of atrial fibrillation after cardiac surgery. Am J Cardiol 1999; 84:345-7, A8-9. [PMID: 10496451 DOI: 10.1016/s0002-9149(99)00292-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A prospective, randomized, double-blind study to compare the efficacy in terminating postoperative atrial fibrillation of the class Ic drug propafenone versus class Ia drug procainamide was conducted. Intravenous propafenone was superior to procainamide in achieving rapid cardioversion and a better rate control with a lower incidence of symptomatic hypotension.
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Affiliation(s)
- P Geelen
- Quebec Heart Institute, Laval Hospital, Sainte-Foy, Canada
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Tisdale JE, Rudis MI, Padhi ID, Borzak S, Svensson CK, Webb CR, Acciaioli J, Ware JA, Krepostman A, Zarowitz BJ. Disposition of procainamide in patients with chronic congestive heart failure receiving medical therapy. J Clin Pharmacol 1996; 36:35-41. [PMID: 8932541 DOI: 10.1002/j.1552-4604.1996.tb04149.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Dosage reduction of procainamide has been recommended in patients with congestive heart failure (CHF). However, these recommendations are based primarily on studies with unmatched control groups, suboptimal blood sampling, and in patients not receiving angiotensin-converting enzyme (ACE) inhibitors. These agents increase renal blood flow, which theoretically may offset alterations in drug disposition in patients with CHF. The pharmacokinetics of procainamide in patients with chronic CHF and in matched controls were compared. A single intravenous dose of 750 mg of procainamide was administered to 9 patients with chronic New York Heart Association (NYHA) class II or III CHF (mean +/- SD left ventricular ejection fraction 22 +/- 9%) receiving medical therapy and 7 control subjects matched for age and gender. Blood and urine samples were collected at intervals over a period of 48 and 72 hours, respectively. Patients with CHF and control subjects were demographically similar, with the exception of concomitant medications, including ACE inhibitors (8/9 versus 1/7, respectively). There were no significant differences between patients with CHF and control subjects in mean +/- SD peak serum concentrations (Cmax), area under the serum concentration-time curve (AUC0-infinity), total clearance, renal clearance, half-life (t1/2), or volume of distribution (Vd) of procainamide. Similarly, there were no significant differences between patients with CHF and control subjects in the mean +/- SD Cmax, AUC0-infinity, renal clearance, or t1/2 of N-acetylprocainamide (NAPA). Procainamide dosage reduction may not be necessary in patients with chronic stable CHF who are receiving medical therapy.
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Affiliation(s)
- J E Tisdale
- College of Pharmacy and Allied Health, Wayne State University, Detroit, MI 48202, USA
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Chamberlain D, Vincent R, Baskett P, Bossaert L, Robertson C, Juchems R, Lindner K. Management of peri-arrest arrhythmias. A statement for the Advanced Cardiac Life Support Committee of the European Resuscitation Council, 1994. Resuscitation 1994; 28:151-9. [PMID: 7846375 DOI: 10.1016/0300-9572(94)90088-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
Continuous infusion of potent, often short-acting drugs particularly affecting the cardiovascular system is becoming more common in the operating room and intensive care unit. Accuracy and, hence, safety are always important in drug therapy, and never more so than when using the potent vasoactive and cardioactive drugs, yet the multiplicity of methods for preparing these drugs for infusion creates a situation in which mistakes may easily occur. A series of decimally related dilutions for drug preparation is presented, which has been in use for the past 5 years in the cardiac intensive care units at this hospital. It is believed that this system is easy to understand and remember and it thereby simplifies the process. This system may enhance the accuracy of dosage and improve the safety for patients.
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Affiliation(s)
- R Burtles
- Cardiology Department, Military Hospital, Riyadh, Saudi Arabia
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Bauman JL, Schoen MD, Hoon TJ. Practical optimisation of antiarrhythmic drug therapy using pharmacokinetic principles. Clin Pharmacokinet 1991; 20:151-66. [PMID: 2029806 DOI: 10.2165/00003088-199120020-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The optimisation of antiarrhythmic drug therapy is dependent on the definitions and methods of short term efficacy testing and the characteristics of those drugs used for rhythm disturbances. The choice of an initial antiarrhythmic drug dosage is highly empirical, and will remain so until the measurement of free concentrations, enantiomeric fractions and genetic phenotyping becomes routine. However, the clinician can devise an efficient initial dosage for efficacy testing procedures based on pharmacokinetic principles and disposition variables in the literature. In this regard, a nomogram for commonly used agents and dosages was constructed and is offered as a guide to accomplish this goal. Verification of the accuracy and usefulness of this nomogram in a prospective manner in patients with symptomatic tachyarrhythmias is still required. On a long term basis, dosage regimens can be modified by the use of pharmacokinetic principles and patient-specific target concentrations, in accordance with the methods used to monitor arrhythmia recurrence and drug-related side effects.
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Affiliation(s)
- J L Bauman
- Department of Pharmacy Practice, University of Illinois, Chicago
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Abstract
The pathophysiologic changes occurring in cardiovascular disease can affect the kinetics of drugs in several different ways. The present review examines these modifications and the underlying mechanisms. The kinetics of specific agents, such as antiarrhythmic, antihypertensive, cardiotonic, and other drugs are considered, and the clinical implications are outlined. The clinician should be aware of these modifications, because they require an adjustment of the dosage regimen. A rational basis for a correct therapeutic choice can be provided by adequate knowledge of these modifications.
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Affiliation(s)
- V Rodighiero
- Department of Pharmacology, University of Padova, Italy
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Jordaens LJ, Colardyn F, Clement DL. A comparison of sotalol and procainamide in symptomatic ventricular tachycardia. Cardiovasc Drugs Ther 1989; 3:155-61. [PMID: 2487531 DOI: 10.1007/bf01883859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED The effects of oral sotalol were compared with 1000 and 1500 mg of procainamide in 23 patients with sustained ventricular tachycardia. The predictive value of an induction study after procainamide was assessed. The mean age of the study group was 62 +/- 12 years, and the mean ejection fraction was 32 +/- 16%. The cycle length (CL) of the induced tachycardia, the coupling interval (CI) of the first extrastimulus (in ms), and the number of noninducible (NI) patients are given in the table below. (table; see text) One patient developed torsades during the loading period of sotalol and is included in the number requiring cardioversion (DC). Important proarrhythmic effects (spontaneous occurrence of tachycardia) were seen twice after procainamide. Induction suppression by procainamide predicted success with sotalol (p = 0.0013). CONCLUSION Ventricular tachycardia seems to be less often inducible after oral sotalol than after procainamide. The success of procainamide during programmed electrical stimulation predicts the same for sotalol. If ventricular tachycardia remains inducible after oral sotalol, it is faster than after procainamide but slower than the baseline tachycardia. Both drugs slightly prolong refractoriness.
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de Haas DD, Taliaferro EH, Amin NM. Intravenous procainamide for the conversion of new onset atrial fibrillation in the emergency department setting. J Emerg Med 1988; 6:185-7. [PMID: 3171117 DOI: 10.1016/0736-4679(88)90323-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A common problem seen by emergency physicians, that of new onset atrial fibrillation, and a unique approach to its emergency department management are discussed. In hemodynamically stable patients with new onset atrial fibrillation, an attempt at chemical cardioversion can be made in the emergency department with intravenous procainamide at a rate of 20 mg/min to a maximum dose of 20 mg/kg if accompanied with careful monitoring of blood pressure and cardiac rhythm. If cardioversion is successful, such individuals may not require hospitalization if they are less than 65 years of age and without evidence of organic heart, lung, or thyroid disease.
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Affiliation(s)
- D D de Haas
- Emergency Medicine and Internal Medicine, Kern Medical Center, Bakersfield, California
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Kessler KM, Kayden DS, Estes DM, Koslovskis PL, Sequeira R, Trohman RG, Palomo AR, Myerburg RJ. Procainamide pharmacokinetics in patients with acute myocardial infarction or congestive heart failure. J Am Coll Cardiol 1986; 7:1131-9. [PMID: 3958372 DOI: 10.1016/s0735-1097(86)80235-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abnormal procainamide pharmacokinetics (prolonged half-life and decreased volume of distribution) and pharmacodynamics (decreased threshold for the suppression of premature ventricular complexes) have been suggested in patients with acute myocardial infarction or congestive heart failure, or both. To better define procainamide kinetics, 37 patients in the acute care setting received intravenous procainamide (25 mg/min, median dose 750 mg) with peak and hourly blood samples taken over 6 hours. Compared with the 10 control patients, the 12 patients with acute myocardial infarction and the 15 patients with congestive heart failure had normal procainamide pharmacokinetics with respect to half-life (2.3 +/- 1.0, 2.5 +/- 0.9 and 2.6 +/- 0.8 hours, respectively), volume of distribution (1.9 +/- 0.7, 1.8 +/- 0.4 and 1.8 +/- 0.5 liters/kg, respectively), clearance (11.3 +/- 7.5, 9.3 +/- 3.6 and 9.1 +/- 3.5 ml/min per kg, respectively) and unbound drug fraction (66 +/- 9, 66 +/- 9 and 69 +/- 4%, respectively). Low thresholds for greater than 85% premature ventricular complex suppression were confirmed in these patients (median 4.7 micrograms/ml in patients with acute myocardial infarction and 3.3 micrograms/ml in patients with congestive heart failure). Thus, differences in the response of premature ventricular complexes to procainamide reflect electropharmacologic differences dependent on clinical setting rather than pharmacokinetic abnormalities. Furthermore, the reduction of procainamide dosing in patients with acute myocardial infarction or congestive heart failure, based solely on prior kinetic data, may result in inappropriate antiarrhythmic therapy.
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Pharmacologic Principles of Cardiovascular Drug Administration to the Critically Ill. Crit Care Clin 1985. [DOI: 10.1016/s0749-0704(18)30640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Coyle JD, Boudoulas H, Mackichan JJ, Lima JJ. Concentration-dependent clearance of procainamide in normal subjects. Biopharm Drug Dispos 1985; 6:159-65. [PMID: 2408690 DOI: 10.1002/bdd.2510060207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Four normal volunteers each received two intravenous doses of PA. The mean low dose was 3.30 mg kg-1 (infused over 20 minutes) while the mean high dose was 12.5 mg kg-1 (infused over 60 minutes). Blood samples were collected for 12 hours and urine was collected for 48 hours after each dose. PA concentrations were determined by both HPLC and fluorescent immunoassay methods. The reported concentrations and pharmacokinetic parameters are from the HPLC data unless otherwise indicated. The mean peak serum PA concentrations resulting from the low and high doses were 3.18 and 9.07 micrograms ml-1, respectively. Total PA clearance averaged 763 ml min-1 and 577 ml min-1 while renal clearance averaged 360 ml min-1 and 318 ml min-1 after the low and high doses, respectively. Concentration-dependent decreases in nonrenal PA clearance ranged from 31 to 43 percent (p less than 0.05) in the four subjects. Total clearance decreases ranged from 4.7 to 36 per cent (p less than 0.05). Differences between doses in renal clearance, elimination rate constant, and volume of distribution were not statistically significant. This study demonstrates that the nonrenal and total clearances of PA are concentration-dependent in normal subjects at therapeutic plasma PA concentrations and suggests that the total clearance changes are of sufficient magnitude to be clinically important.
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Higbee MD, Wood JS, Mead RA. Procainamide-cimetidine interaction: a potential toxic interaction in the elderly. J Am Geriatr Soc 1984; 32:162-4. [PMID: 6693705 DOI: 10.1111/j.1532-5415.1984.tb05860.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Christoff PB, Conti DR, Naylor C, Jusko WJ. Procainamide disposition in obesity. DRUG INTELLIGENCE & CLINICAL PHARMACY 1983; 17:516-22. [PMID: 6191939 DOI: 10.1177/106002808301700704] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The pharmacokinetics of intravenous procainamide (PA) were studied in seven obese and seven normal subjects. Serum concentrations and urinary excretion rates of PA and its active metabolite, NAPA, were measured by high performance liquid chromatography. Pharmacokinetic parameters were related to ideal body weight (IBW) and total body weight (TBW). The volume of distribution at steady state (Vssd) was similar for both groups when based per unit of IBW. Plasma clearance of PA, corrected for body surface area, was greater in obese subjects when adjusted for IBW, but similar on the basis of TBW. For its components, metabolic and renal clearance, the obese subjects showed similar metabolic clearances, but a significant increase was found in renal clearance per unit of body surface area based on both IBW (normal mean, 11.9 L/h/m2; obese, 19.0 L/h/m2) and TBW (normal mean, 11.7 L/h/m2; obese, 15.7 L/h/m2). This appears to be due to increased tubular secretion of PA in the obese group. In contrast, these subjects had lower renal clearances of NAPA. Variability in disposition of PA may, thus, be affected by patient physiology and method of parameter normalization.
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Bottorff MB, Kuo CS, Batenhorst RL. High-dose procainamide in chronic renal failure. DRUG INTELLIGENCE & CLINICAL PHARMACY 1983; 17:279-81. [PMID: 6839958 DOI: 10.1177/106002808301700408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A patient with chronic renal failure who experienced symptomatic ventricular tachycardia was treated successfully with procainamide (PA) after numerous dosage adjustments to optimize his clinical response and serum PA and NAPA concentrations. Efforts to maintain total combined serum levels at 20-30 micrograms/ml led to sustained ventricular ectopy whenever the serum PA levels decreased to less than 8 micrograms/ml.
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Roden DM, Woosley RL. Class I antiarrhythmic agents: quinidine, procainamide and N-acetylprocainamide, disopyramide. Pharmacol Ther 1983; 23:179-91. [PMID: 6199801 DOI: 10.1016/0163-7258(83)90012-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Gunnar RM, Lambrew CT, Abrams W, Adolph RJ, Chatterjee K, Cohn JN, Derryberry JS, Horowitz LN, Martin WB, Siciliano EG, Temple R, Tuckman J. Task force IV: pharmacologic interventions. Emergency cardiac care. Am J Cardiol 1982; 50:393-408. [PMID: 6125099 DOI: 10.1016/0002-9149(82)90196-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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MORRIS DOUGLASC. The Management of Arrhythmias in Acute Myocardial Infarction. Prim Care 1981. [DOI: 10.1016/s0095-4543(21)01470-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wyman MG, Goldreyer BN, Cannon DS, Ludden TM, Lalka D. Factors influencing procainamide total body clearance in the immediate postmyocardial infarction period. J Clin Pharmacol 1981; 21:20-5. [PMID: 7217340 DOI: 10.1002/j.1552-4604.1981.tb01727.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Fifteen acute myocardial infarction patients (only one of whom had evidence of significant renal dysfunction) received a constant-rate intravenous infusion of procainamide at one rate for a least 24 hours. Steady-state plasma levels achieved during these infusions were used to calculate total body clearance (C/B). Linear regression analysis of C/B versus a variety of clinical and laboratory patient characteristics yielded only body weight (or parameters derived from it) as a significant covariant (r = 0.713, P less than or equal to 0.005). Interestingly, the data from these 15 patients suggest that the presence of a significant degree of heart failure at the start of therapy did not result in a significant decrease in C/B (C/B = 5.9 ml/min/kg when class 0-I failure was present at the start of therapy and C/B = 5.5 ml/min/kg when class III-IV failure was present). If the data from five other patients who were studied previously are added to the group reported here, the conclusions reached would be the same. These data suggest that in patients with good renal and hepatic function, initial procainamide infusion rate could be selected on the basis of body weight and need not consider the initial presence of moderate heart failure. However, intense clinical monitoring for signs of impeding serious toxicity is strongly recommended since the observed regression line did not predict total body clearance accurately in 10-15 per cent of the patients studied.
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Geleris P, Boudoulas H, Schaal SF, Lewis RP, Lima JJ. Effect of procainamide on left ventricular performance in patients with primary myocardial disease. Eur J Clin Pharmacol 1980; 18:311-4. [PMID: 7439250 DOI: 10.1007/bf00561387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The effect of procainamide (P) on left ventricular function as measured by the systolic time intervals (STI) was studied in 14 patients with primary myocardial disease. P, 7.5 mg/kg body weight, was given intravenously at a rate of 100 mg per minute. Administration of P produced a decrease in left ventricular performance as manifest by a significant prolongation of the pre-ejection period corrected for heart rate (PEPI) and an increase of the PEP to the left ventricular ejection time (LVET) ratio. The peak effect on PEPI and PEP/LVET occurred at 2 minutes after P administration (delta PEPI + 14 +/- 1.9 ms, p < 0.001, delta PEP/LVET + 0.052 +/- 0.007, p < 0.001) with values returning towards baseline by 60 min. In 6 of the patients P blood levels were measured simultaneously with the STI measurements. Changes in PEPI and PEP/LVET directly parallel changes of P blood levels. It is concluded that P given intravenously at the usual therapeutic doses decreases left ventricular performance in patients with primary myocardial disease. These changes in left ventricular performance directly parallel procainamide blood levels.
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Greenspan AM, Horowitz LN, Spielman SR, Josephson ME. Large dose procainamide therapy for ventricular tachyarrhythmia. Am J Cardiol 1980; 46:453-62. [PMID: 6968154 DOI: 10.1016/0002-9149(80)90015-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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