Side Effects of procainamide: A Synthesis of Findings from 28 Studies

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Original Abstract of the Article

Major Research Findings

Procainamide is an antiarrhythmic drug used to treat irregular heartbeats. It has been shown to be effective in treating ventricular arrhythmias, especially in patients with ischemic heart disease. 18 However, it can also cause side effects. A common side effect is worsening of ventricular arrhythmias, which may go unrecognized by the patient. 20 Procainamide can also cause lupus syndrome, a type of autoimmune disease that can occur when the medication overactivates the body's immune system. 7 Other potential side effects include gastrointestinal disturbances, autoimmune blood dyscrasias, and taste changes. 8 21 Procainamide can also affect the lungs, causing fibrous thickening or effusion. 3 It is important to note that these side effects may vary from patient to patient, and long-term effects are still not fully understood. 8 5

Reason for Side Effects

Side effects of procainamide are caused by reactive metabolites that are produced when the medication is metabolized in the body. These reactive metabolites can bind to cellular proteins, potentially inhibiting cellular function or triggering an immune response. 5 In addition, some side effects, like the worsening of ventricular arrhythmias, may be related to the drug's direct effects on the heart's electrical activity. 20

Common Side Effects

Worsening of Ventricular Arrhythmias

Procainamide can worsen ventricular arrhythmias, which is a potentially serious side effect that can occur in 11 to 16% of patients. 20 This side effect may go unrecognized because it often lacks symptoms. It is important to monitor patients closely for any changes in their heart rhythm.

Lupus Syndrome

Procainamide can cause lupus syndrome, a type of autoimmune disease. 7 This side effect is characterized by symptoms such as joint pain, fever, and fatigue. It is thought to be caused by the drug's ability to activate the immune system. This side effect can occur after months or even years of taking the medication. 7

Gastrointestinal Disturbances

Procainamide can cause gastrointestinal disturbances, including nausea, vomiting, and abdominal pain. 8 These side effects are likely related to the drug's effects on the digestive system.

Autoimmune Blood Dyscrasias

Procainamide can cause autoimmune blood dyscrasias, which occur when the immune system attacks blood cells. 8 These conditions can lead to anemia, leukopenia, and thrombocytopenia.

Taste Changes

Procainamide can cause taste changes, often described as a bitter taste. 21 The mechanism for this side effect is not fully understood, but it may be related to the drug's direct effects on taste receptors.

Side Effect Countermeasures

Worsening of Ventricular Arrhythmias

Patients taking procainamide should be monitored closely for any changes in their heart rhythm. 20 Doctors may need to adjust the dosage of procainamide or switch to a different medication if the side effect persists.

Lupus Syndrome

If symptoms of lupus syndrome develop, procainamide should be discontinued and treatment with corticosteroids may be necessary. 7 Patients taking procainamide should be monitored for any signs or symptoms of lupus.

Gastrointestinal Disturbances

Doctors may adjust the dosage of procainamide to manage gastrointestinal disturbances. 8 In some cases, antiemetics may be prescribed.

Autoimmune Blood Dyscrasias

Patients taking procainamide should have regular blood tests to monitor their blood cell counts. 8 If any abnormalities are detected, the drug may need to be discontinued and treatment with corticosteroids or other medications may be necessary.

Comparison of Studies

Common Points of Studies

Many studies have confirmed the effectiveness of procainamide in treating ventricular arrhythmias. 18 23 The studies also consistently report a range of potential side effects, including lupus syndrome, gastrointestinal disturbances, and autoimmune blood dyscrasias. 8 7

Differences in Studies

The effectiveness and side effects of procainamide can vary depending on the individual patient. 18 23 For instance, procainamide has been shown to be more effective than sotalol in patients with ischemic heart disease. 18 However, in patients with sustained ventricular tachycardia, procainamide may be less effective than flecainide. 23 These variations highlight the need for personalized medicine approaches when using procainamide.

Precautions for Real-Life Applications

It is crucial to be aware of the potential side effects of procainamide and to discuss them with your doctor. 20 8 Monitor yourself for any signs or symptoms of side effects, and report them to your doctor immediately. 8 Also, inform your doctor about all other medications you are taking, as procainamide may interact with other drugs and increase the risk of side effects. 26

Limitations of Current Research

More research is needed to fully understand the side effects of procainamide, particularly in the context of long-term use. 5 The variability in response to procainamide among patients makes it challenging to accurately predict who will experience side effects. 8

Future Research Directions

Future research should focus on understanding the long-term effects of procainamide, developing strategies to predict which patients are at risk for specific side effects, and exploring potential new medications that can reduce or eliminate these side effects. 5 4 Such research is essential for ensuring the safe and effective use of procainamide in treating heart arrhythmias.

Conclusion

Procainamide is a valuable medication for treating heart arrhythmias, but it is important to be aware of the potential side effects. 20 Close monitoring, open communication with your doctor, and a proactive approach to managing any potential side effects are crucial for maximizing the benefits of procainamide while minimizing risks. 8 Further research is needed to address the limitations in our understanding of procainamide's effects and develop safer and more effective treatment options. 5

Keywords
Benefit Keywords
Detoxification
1
Treatment of autoimmune diseases
2
Effective strategy against cancer
4
Prevents tachycardia
Treats tachycardia
8
Controlled release
Drug toxicity reduction
Improved therapy
11
Lupus diagnosis
12
Reduced arrhythmias
13
Improved drug monitoring
14
More effective than quinidine
Suppresses atrial flutter
16
Ventricular tachycardia treatment
17
PVC Control
VT Control
18
Improved isoniazid therapy
Improved sulphasalazine therapy
Reduced hydralazine-induced SLE
19
Cardiovascular disease treatment
21
Antiarrhythmic efficacy
22
Lengthened QRS duration
Prolonged refractoriness
VT suppression
23
Restoration of gene expression
Reversal of hypermethylation
24
Cardiovascular disease treatment
25
Increased indomethacin efficacy
26
Effective fetal tachyarrhythmia treatment
27
Effective VPD suppression
28
Risk Keywords
SLE-like syndrome
Side effects
1
Drug-induced lupus
2
Drug-induced lupus
Pleural side effects
3
Hypomethylation resistance
Side effects
Toxicity
4
Drug toxicity
Drug-drug interactions
5
Drug side effects
6
Drug-induced lupus
7
Blood dyscrasias
Gastrointestinal problems
Lupus-like syndrome
QT prolongation
8
Drug-induced LQTS
9
Drug hypersensitivity syndrome
Drug-induced lupus
Idiosyncratic reactions
Serum sickness-like reaction
10
Side effects
13
False-negative errors
False-positive errors
14
Hemolytic anemia
15
Side effects possible
16
Side effects
17
Increased carbamazepine toxicity
Increased phenytoin toxicity
Increased serum fluoride
19
Aggravation of ventricular arrhythmia
20
Taste complaints
21
Heart failure
Hypotension
22
Congestive heart failure
Myocardial infarction
Pulmonary fibrosis
Sudden death
23
Myelosuppression
Side effects
24
Drug potentiation
26
Maternal rash
Neonatal hypothyroidism
27
Adverse effects
28
Literature analysis of 28 papers
Positive Content
19
Neutral Content
2
Negative Content
7
Article Type
3
0
0
15
28
1.

Influence of polymorphic N-acetyltransferases on non-malignant spontaneous disorders and on response to drugs.

Author: LaderoJ M

Detoxification
SLE-like syndrome
Side effects

This abstract discusses the role of polymorphic N-acetyl transferases (NAT) 1 and 2 in detoxification and their potential association with various spontaneous disorders, including malignancies, disimmune, and degenerative diseases.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

3.

[Drug-induced pleural pathology (excluding antineoplastic chemotherapy)].

Author: HaasC, HuguesF C, Le JeunneC

Drug-induced lupus
Pleural side effects

Drug-induced pleural side effects are rare but can include fibrous thickening or effusion, with most cases resolving upon withdrawal of the causative drug.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : French

4.

DNA methyltransferase-1 inhibitors as epigenetic therapy for cancer.

Author: SinghVarinder, SharmaPrince, CapalashNeena

Effective strategy against cancer
Hypomethylation resistance
Side effects
Toxicity

This review discusses nucleoside analogues (azacytidine, decitabine, zebularine, SGI-110, CP-4200), non-nucleoside ihibitors both synthetic (hydralazine, RG108, procaine, procainamide, IM25, disulfiram) and natural compounds (curcumin, genistein, EGCG, resveratrol, equol, parthenolide) which act through different mechanisms to inhibit DNMTs.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

7.

Drug-induced lupus.

Author: RubinRobert L

Drug-induced lupus

Drug-induced lupus is a side-effect of long-term therapy with over 40 medications. It is characterized by autoantibodies and systemic rheumatic symptoms. Patients fully recover after the offending medication is discontinued. The syndrome usually requires many months to years of drug exposure and is drug dose-dependent.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

8.

Procainamide: a perspective on its value and danger.

Author: EllenbogenK A, WoodM A, StamblerB S

Prevents tachycardia
Treats tachycardia
Blood dyscrasias
Gastrointestinal problems
Lupus-like syndrome
QT prolongation

Procainamide, a widely used antiarrhythmic agent, is effective in preventing ventricular tachycardia. Long-term therapy can be limited by side effects like lupus-like syndrome and blood dyscrasias. Monitoring QT interval is crucial to prevent drug toxicity.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

Drug-induced QT Interval Prolongation in the Intensive Care Unit.

Author: EtchegoyenCecilia Villa, KellerGuillermo Alberto, MradSebastian, ChengSixuan, Di GirolamoGuillermo

Drug-induced LQTS

This study addresses drug-induced QT interval prolongation, the most common acquired cause of Long QT syndrome (LQTS), which is characterized by an extended duration of the ventricular repolarization. This syndrome increases the risk for polymorphic ventricular tachycardia and sudden death.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

10.

Reactive metabolites and adverse drug reactions: clinical considerations.

Author: KnowlesSandra R, ShapiroLori E, ShearNeil H

Drug hypersensitivity syndrome
Drug-induced lupus
Idiosyncratic reactions
Serum sickness-like reaction

This study provides an overview of idiosyncratic drug reactions, including drug hypersensitivity syndrome, serum sickness-like reaction, and drug-induced lupus.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

12.

The clinical utility of antihistone antibodies. Autoantibodies reactive with chromatin in systemic lupus erythematosus and drug-induced lupus.

Author: BurlingameR W

Lupus diagnosis

This article discusses the diagnostic utility of autoantibodies reactive with histones and chromatin in systemic lupus erythematosus (SLE). The presence of antichromatin antibodies is helpful in diagnosing SLE and drug-induced lupus, while antibodies to denatured histones have limited diagnostic value.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

15.

[Drug-induced hemolytic anemia].

Author: WautierJ L, RougerP

Hemolytic anemia

This abstract discusses the potential of drug administration to cause hemolytic anemia, a condition involving the destruction of red blood cells. The authors list various drugs known to be associated with hemolysis.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : French

16.

Oral N-acetylprocainamide compared to quinidine plus digoxin in the chronic suppression of atrial flutter in humans.

Author: FeldG K, NademaneeK, NollE, SinghB N

More effective than quinidine
Suppresses atrial flutter
Side effects possible

N-acetylprocainamide was more effective and better tolerated than quinidine plus digoxin in suppressing atrial flutter in 18 patients.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

17.

Long-term efficacy of mexiletine alone and in combination with class Ia antiarrhythmic drugs for refractory ventricular arrhythmias.

Author: WhitfordE G, McGovernB, SchoenfeldM H, GaranH, NewellJ B, McElroyM, RuskinJ N

Ventricular tachycardia treatment
Side effects

The study assessed the efficacy of mexiletine alone and in combination with a class Ia antiarrhythmic drug for treating ventricular tachycardia (VT) in drug-refractory patients. Mexiletine was effective in 23% of patients, while the combination therapy was effective in 29%. Mexiletine was more effective in patients with nonsustained VT or ventricular fibrillation. While mexiletine therapy was associated with frequent, reversible side effects, combining mexiletine with a class Ia agent may lead to improved arrhythmia-free survival.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

18.

Comparative efficacy of oral sotalol and procainamide in patients with chronic ventricular arrhythmias: a multicenter study.

Author: LidellC, RehnqvistN, SjögrenA, Yli-UotilaR J, RønnevikP K

PVC Control
VT Control

Sotalol is a useful alternative to procainamide in controlling chronic premature ventricular contractions (PVCs), especially in patients with ischemic heart disease.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

20.

Aggravation of ventricular arrhythmia. A drug-induced complication.

Author: PodridP J

Aggravation of ventricular arrhythmia

Antiarrhythmic drugs can cause potentially serious side effects such as aggravation of ventricular arrhythmia, which occurs in 11-16% of drug tests. The side effect is often without symptoms and does not correlate with underlying heart disease.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

21.

Taste effects of lingual application of cardiovascular medications.

Author: ZervakisJ, GrahamB G, SchiffmanS S

Cardiovascular disease treatment
Taste complaints

Cardiovascular medications are often prescribed in Western countries. However, taste complaints are common side effects of these medications. This study tested 9 cardiovascular medications on human volunteers to determine their effects on taste receptors. All medications had a predominantly bitter taste and affected the taste of other stimuli.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

22.

Clinical pharmacology and pharmacokinetics of pirmenol.

Author: ReiterM J

Antiarrhythmic efficacy
Heart failure
Hypotension

Pirmenol hydrochloride is a promising antiarrhythmic agent with quinidine-like properties. It is well-tolerated and has a favorable pharmacokinetic profile, allowing less frequent dosing than other agents.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

23.

Chronic flecainide therapy selected by electrophysiology testing of intravenous flecainide.

Author: SombergJ C, TepperD, SacherH, SchwarzJ

Lengthened QRS duration
Prolonged refractoriness
VT suppression
Congestive heart failure
Myocardial infarction
Pulmonary fibrosis
Sudden death

Flecainide acetate was evaluated in 93 patients with ventricular tachycardia (VT). Flecainide was effective in 47% of patients, compared to 40% efficacy for procainamide. Both drugs prolonged refractoriness and lengthened QRS duration, but only procainamide increased the QT interval.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

24.

Reversal of GSTP1 CpG island hypermethylation and reactivation of pi-class glutathione S-transferase (GSTP1) expression in human prostate cancer cells by treatment with procainamide.

Author: LinX, AsgariK, PutziM J, GageW R, YuX, CornblattB S, KumarA, PiantadosiS, DeWeeseT L, De MarzoA M, NelsonW G

Restoration of gene expression
Reversal of hypermethylation
Myelosuppression
Side effects

This study investigated the effects of procainamide, a nonnucleoside inhibitor of DNA methyltransferases, on GSTP1 CpG island hypermethylation and expression in prostate cancer cells. Procainamide reversed hypermethylation and restored GSTP1 expression in vitro and in vivo, suggesting its potential as a therapeutic agent for prostate cancer.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

25.

Novel epigenetic-based therapies useful in cardiovascular medicine.

Author: NapoliClaudio, GrimaldiVincenzo, De PascaleMaria Rosaria, SommeseLinda, InfanteTeresa, SoricelliAndrea

Cardiovascular disease treatment

This review discusses the potential of epigenetic-based strategies for treating cardiovascular diseases. While promising, further research is needed to develop safe and effective therapies.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

27.

Role of amiodarone in the treatment of fetal supraventricular tachyarrhythmias and hydrops fetalis.

Author: KhositsethA, RaminK D, O'LearyP W, PorterC J

Effective fetal tachyarrhythmia treatment
Maternal rash
Neonatal hypothyroidism

The study reported the treatment of three consecutive hydropic fetuses with fetal tachyarrhythmias using amiodarone. Amiodarone, either in combination with digoxin or other medications, was found to be effective in achieving sinus rhythm or ventricular rate control. Although observed side effects included a maternal rash and transient neonatal hypothyroidism, amiodarone appears to be a promising and potentially safe treatment for fetal tachyarrhythmias and impending hydrops.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

28.

Activity of Procanbid, procainamide twice-daily formulation, to suppress ventricular premature depolarizations. The Study Group Investigators.

Author: KerinN Z, MeengsW L, TimmisG C, SalernoD, HaberH E, SingerR M

Effective VPD suppression
Adverse effects

A twice-daily formulation of procainamide was found to be as effective as the current four-times-daily formulation in suppressing ventricular premature depolarizations. The new formulation showed similar safety and tolerability, with only a low proarrhythmic rate.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

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