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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Procainamide is an amide compound similar to lidocaine used to treat ventricular tachycardia. This drug’s pharmacokinetics during pregnancy were reported in a case report; fetal levels were approximately one-fourth maternal levels (Garite and Briggs, 1987). No reports are published of procainamide use during the first trimester of pregnancy and congenital anomalies. The safety profile of a closely related drug, lidocaine, suggests procainamide probably does not pose a great risk when used during pregnancy (Little and Gilstrap, 1989). However, as always, the absence of evidence is not evidence of absence. Breastfeeding is not contraindicated in mothers on procainamide (American Academy of Pediatrics, 2001). A rare complication of chronic use of procainamide is a lupus-like syndrome (serious rash) may occur. Prolonged use should be avoided, unless necessary for life threatening conditions (Rotmensch et al., 1987). It is an old FDA category C drug under the old system. No infants in the Swedish Birth Defects Registry were exposed to procainamide (Kallen, 2019).
Cardiovascular drugs
Published in Bev-Lorraine True, Robert H. Dreisbach, Dreisbach’s HANDBOOK of POISONING, 2001
Bev-Lorraine True, Robert H. Dreisbach
Procainamide is used for the treatment of cardiac irregularities. As little as 200 mg (2 ml of 10% solution) intravenously has caused death as a result of either hypersensitivity or rapid injection. At least four fatalities have been reported from procainamide poisoning. The rapid administration of procainamide causes irregularities of ventricular contraction, including tachycardia or fibrillation. Agranulocytosis from procainamide is apparently a hypersensitivity reaction.
Antidysrhythmic Drugs in Pediatrics
Published in Sam Kacew, Drug Toxicity and Metabolism in Pediatrics, 1990
Howard C. Mofenson, Thomas R. Caraccio, Kathleen Mimnagh, Peter Bruzzo
Procainamide has been effective in (1) the treatment of atrial extrasystoles, paroxysmal supraventricular tachycardias, atrial fibrillation, ventricular extrasystoles, and tachycardias and (2) in preventing recurrence of atrial flutter and fibrillation following cardioversion. Procainamide is also effective in controlling the ventricular response in patients with the Wolff-Parkinson-White (WPW) syndrome complicated by atrial flutter or atrial fibrillation.49
Management of Wolff-Parkinson-White syndrome in a patient with peripartum cardiomyopathy
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Snigdha Bendaram, Sherif Elkattawy, Muhammad Atif Masood Noori, Hardik Fichadiya, Sarah Ayad, Parminder Kaur, Raja Pullatt, Fayez Shamoon
Amiodarone is effective but has significant side effects; thus, it can be employed in patients where other therapies failed or are not feasible. As per 2014 AHA guidelines, for patients with pre-excitation and rapid ventricular rate, management involves intravenous procainamide in hemodynamically stable patients and synchronized cardioversion in unstable ones. In a small, non-randomized trial containing a subset of patients with AVRT, ten patients treated with a combination of propafenone and beta-blocker therapy had no recurrence at >9 months after discharge [9]. Cardioversion can be performed during any week of pregnancy; although there is a theoretical risk of triggering an arrhythmia in the fetus, the risk is supposed to be small due to the small amount of energy directly reaching the fetus itself [10,11]. However, there have been cases reported of fetal arrhythmias requiring emergent C-section after cardioversion, and hence monitoring fetal heart rhythm is recommended [12].
Brugada syndrome clinical update
Published in Hospital Practice, 2021
Rhadames Rojas, Risheek Kaul, Daniel Frenkel, Ethan G Hoch, Sei Iwai, Jason T Jacobson, Wilbert S. Aronow
Frequently, variations in the EKG pattern can occur in a patient including complete absence of the BrS pattern. Repositioning the right precordial leads from the traditional location in the 4th intercostal space to more a cranial position in the 2nd or 3rd intercostal space may increase the ability to detect Brugada pattern EKG given its proximity to the right ventricular outflow tract (RVOT) [14]. Sodium channel blocking drugs (such as those listed in Table 1) can also be used to unmask the Type 1 EKG pattern and establish the diagnosis [15,16]. During a drug challenge, continuous EKG monitoring along with full resuscitative equipment is necessary for every test. The drug challenge must be stopped when the diagnosis has been established, or alternatively if there is prolongation of the QRS width to 130% of baseline, or presence of frequent premature ventricular stimuli. The drug challenge is typically performed when there is a clinical suspicion for the disease based on the patient’s history and presentation. Drug-induced tests can have false negatives 14–32% of the time especially when using procainamide and flecainide [1,17,18]. If the history is highly suggestive, a repeat test using intravenous ajmaline should be considered if available. In the United States, only intravenous procainamide is routinely available. In countries where intravenous sodium channel blockers are not available, there are limited data to support the use of oral flecainide [19].
Cardiac arrhythmias in pregnant women: need for mother and offspring protection
Published in Current Medical Research and Opinion, 2020
Theodora A. Manolis, Antonis A. Manolis, Evdoxia J. Apostolopoulos, Despoina Papatheou, Helen Melita, Antonis S. Manolis
Quinidine (former FDA category C) has the longest record of use in pregnancy. There are reports of preterm labor, thrombocytopenia, and fetal acoustic nerve injury and ototoxicity noted at high doses61,120. Teratogenicity has not been reported for quinidine. Quinidine has been used successfully for both maternal and, due to the ease of placental transfer, fetal ventricular and supraventricular arrhythmias118,121. Serum-level monitoring is required to avoid proarrhythmia. Procainamide is also considered safe to use during pregnancy and has been used frequently, however its use has been limited to acute therapy, due to the high likelihood of drug-induced lupus reported with chronic use. Particular attention should be paid to monitor for hypotension during its IV administration; slow infusion rate at ≤20–50 mg/min is recommended. Experience with disopyramide in pregnancy is limited.