A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Pronestyl Side Effects, and Drug Interactions - Procainamide
Pronestyl Side Effects, and Drug Interactions - Procainamide
SIDE EFFECTS
Cardiovascular System
Hypotension and serious disturbances of cardiorhythm such as ventricular
asystole or fibrillation are more common with intravenous administration
of procainamide than with intramuscular administration. Because procainamide
is a peripheral vasodilator in concentrations higher than the usual therapeutic
range, transient high plasma levels which may occur especially during
intravenous administration may produce temporary but at times severe lowering
of blood pressure (see OVERDOSAGE
and PRECAUTIONS).
Multisystem
A lupus erythematosus-like syndrome of arthralgia, pleural or abdominal
pain, and sometimes arthritis, pleural effusion, pericarditis, fever,
chills, myalgia, and possibly related hematologic or skin lesions (see
below) is fairly common after prolonged procainamide administration, perhaps
more often in patients who are slow acetylators (see boxed WARNINGS
and PRECAUTIONS). While some series
have reported less than 1 in 500, others have reported the syndrome in
up to 30 percent of patients on long-term oral procainamide therapy. If
discontinuation of procainamide does not reverse the lupoid symptoms,
corticosteroid treatment may be effective.
Hematologic
Neutropenia, thrombocytopenia or hemolytic anemia may rarely be encountered.
Agranulocytosis has occurred after repeated use of procainamide, and deaths
have been reported. (See WARNINGS:
BOXED WARNING.)
Skin
Angioneurotic edema, urticaria, pruritus, flushing and maculopapular
rash have also occurred.
Gastrointestinal
Anorexia, nausea, vomiting, abdominal pain, bitter taste or diarrhea
may occur in 3 to 4 percent of patients taking oral procainamide.
Elevated Liver Enzymes
Elevations of transaminase with and without elevations of alkaline phosphatase
and bilirubin have been reported. Some patients have had clinical symptoms
(e.g., malaise, right upper quadrant pain). Deaths from liver failure
have been reported.
Nervous System
Dizziness or giddiness, weakness, mental depression and psychosis with
hallucinations have been reported.
DRUG INTERACTIONS
If other antiarrhythmic drugs are being used additive effects on the
heart may occur with procainamide administration, and dosage reduction
may be necessary (see WARNINGS).
Anticholinergic drugs administered concurrently with procainamide may
produce additive antivagal effects on A-V nodal conduction, although this
is not as well documented for procainamide as for quinidine.
Patients taking procainamide who require neuromuscular blocking agents
such as succinylcholine may require less than usual doses of the latter,
due to procainamide effects on reducing acetylcholine release.
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