Procainamide

Co-administration may lead to torsade de pointes-type ventricular tachycardia due to QT prolongation. Avoid concomitant use.

Class Ia antiarrhythmic; potential to prolong refractoriness. Discontinue for at least three half-lives prior to sotalol dosing.

Class I antiarrhythmic. Amiodarone inhibits procainamide metabolism. Reserve concomitant use; initiate at lower dose and reduce previous dose by 30-50%.

( 7.3 ) 7.1 Drugs that Prolong QT Avoid use of anagrelide in patients taking medications that may prolong QT interval (including, but not limited to, chloroquine, clarithromycin, haloperidol, methadone, moxifloxacin, amiodarone, disopyramide, procainamide, and pimozide) [see Warnings and Precautions (5.1) and Clinical Pharmacology (12.2) ] .

( 7.3 ) 7.1 Drugs that Prolong QT Avoid use of AGRYLIN in patients taking medications that may prolong QT interval (including, but not limited to, chloroquine, clarithromycin, haloperidol, methadone, moxifloxacin, amiodarone, disopyramide, procainamide, and pimozide) [see Warnings and Precautions (5.1) and Clinical Pharmacology (12.2) ] .

May prolong neuromuscular blockade action of cisatracurium besylate. Use peripheral nerve stimulator and monitor clinical signs.

Antiarrhythmic affected by clarithromycin CYP3A inhibition. Increased concentrations may elevate risk of adverse effects.

Concurrent antiarrhythmic use may cause excessive QRS widening and/or Q-T prolongation.

Class Ia anti-arrhythmic drug that may increase risk of QT prolongation and Torsades de Pointes due to additive effects on heart rate and QT interval.

Should be avoided due to risk of QT prolongation and torsades de pointes.

Cardiac effects may be additive or antagonistic and toxic effects may be additive when administered with lidocaine.

Class Ia anti-arrhythmic; associated with Torsades de Pointes in bradycardia patients. Cardiologist advice recommended if ZEPOSIA treatment considered.

Class Ia anti-arrhythmic drug associated with Torsades de Pointes in bradycardic patients; cardiologist consultation advised.

May enhance rocuronium bromide activity and neuromuscular blockade.

Class Ia antiarrhythmic associated with Torsades de Pointes in bradycardia patients; seek cardiologist advice before using with siponimod.

May enhance the neuromuscular blocking action of succinylcholine.

Class IA antiarrhythmic that prolongs QTc interval. Concomitant use should be avoided due to additive QTc prolongation risk.

Class IA antiarrhythmic that prolongs QT interval; should be avoided with toremifene citrate or requires close monitoring.

May enhance the neuromuscular blocking action of atracurium.

Class 1A antiarrhythmic known to prolong QTc interval; caution advised when used with haloperidol decanoate due to risk of QT prolongation.

Class 1A antiarrhythmic that prolongs QTc interval; caution advised when used with haloperidol due to risk of QT prolongation.

When administered with lidocaine, cardiac effects may be additive or antagonistic and toxic effects may be additive.

Cationic drug eliminated by renal tubular secretion with potential for interaction with metformin by competing for common renal tubular transport systems.

Amiodarone inhibits metabolism of procainamide; reduce dose and monitor carefully.

Procainamide Ranitidine, a substrate of the renal organic cation transport system, may affect the clearance of other drugs eliminated by this route. High doses of ranitidine (e.g., such as those used in the treatment of Zollinger-Ellison syndrome) have been shown to reduce the renal excretion of procainamide and N-acetylprocainamide resulting in increased plasma levels of these drugs. Although this interaction is unlikely to be clinically relevant at usual ranitidine doses, it may be prudent to monitor for procainamide toxicity when administered with oral ranitidine at a dose exceeding 300 mg per day.

Procainamide: Ranitidine, a substrate of the renal organic cation transport system, may affect the clearance of other drugs eliminated by this route. High doses of ranitidine (e.g., such as those used in the treatment of Zollinger-Ellison syndrome) have been shown to reduce the renal excretion of procainamide and N-acetylprocainamide resulting in increased plasma levels of these drugs. Although this interaction is unlikely to be clinically relevant at usual ranitidine doses, it may be prudent to monitor for procainamide toxicity when administered with oral ranitidine at a dose exceeding 300 mg per day.

May enhance the neuromuscular blocking action of succinylcholine.

8,9 Procainamide Closely monitor for clinical and ECG signs of procainamide toxicity and/or procainamide plasma concentration if available Trimethoprim increases the plasma concentrations of procainamide and its active N-acetyl metabolite (NAPA) when trimethoprim and procainamide are coadministered. The increased procainamide and NAPA plasma concentrations that resulted from the pharmacokinetic interaction with trimethoprim are associated with further prolongation of the QTc interval.

May increase serum concentration of trospium and/or procainamide due to competition for renal tubular secretion. Careful patient monitoring is recommended.

Prazosin has been administered without adverse drug interaction with procainamide in limited clinical experience.

Administered without adverse drug interaction in limited clinical experience.

Although not studied with alosetron, inhibition of N-acetyltransferase may have clinically relevant consequences for drugs such as isoniazid, procainamide, and hydralazine.

Although not studied with alosetron, inhibition of N-acetyltransferase may have clinically relevant consequences for drugs such as isoniazid, procainamide and hydralazine.

Drugs that cause QT prolongation include: specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, thioridazine, mesoridazine, droperidol, and pimozide), specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin), Class 1A antiarrhythmics (e.g., quinidine, procainamide) or Class III antiarrhythmics (e.g., amiodarone, sotalol), and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus) [see Warnings and Precautions (5.9) ] .

These include: specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

These include: specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

Cationic drugs Cationic drugs (eg, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, or vancomycin) that are eliminated by renal tubular secretion theoretically have the potential for interaction with metformin by competing for common renal tubular transport systems.

Clinically Significant Drug Interactions with Clarithromycin Tablets Drugs That Are Affected By Clarithromycin tablets Drug(s) with Pharmacokinetics Affected by Clarithromycin tablets Recommendation Comments Antiarrhythmics: Disopyramide Quinidine Dofetilide Amiodarone Sotalol Procainamide Not Recommended Disopyramide, Quinidine : There have been postmarketing reports of torsades de pointes occurring with concurrent use of clarithromycin and quinidine or disopyramide.

Potential for Drug Interaction It appears possible, although there is no supporting experimental evidence, that the high renal clearance of desyglymidodrine (a base) is due to active tubular secretion by the base-secreting system also responsible for the secretionof such drugs as metformin, cimetidine, ranitidine, procainamide, triamterene, flecainide, and quinidine.

These include: specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

Perhaps by competing for pathways of renal clearance, coadministration of quinidine causes an increase in serum levels of procainamide .

Perhaps by competing for pathways of renal clearance, coadministration of quinidine causes an increase in serum levels of procainamide .

7.8 Procainamide Procainamide has been shown to increase the duration of neuromuscular block and decrease infusion requirements of neuromuscular blocking agents [see Warnings and Precautions ( 5.10 )]. ( 7.7 ) Enhanced rocuronium bromide activity possible : Inhalation anesthetics ( 7.3 ), certain antibiotics ( 7.1 ), quinidine ( 7.10 ), magnesium ( 7.6 ), lithium ( 7.4 ), local anesthetics ( 7.5 ), procainamide ( 7.8 ) Reduced rocuronium bromide activity possible : Anticonvulsants.

E xamples: Specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

Examples: Specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

Examples: Class 1A antiarrhythmics: quinidine, procainamide, disopyramide; Class 3 antiarrhythmics: amiodarone, sotalol; Antipsychotics: ziprasidone, chlorpromazine, thioridazine; Antibiotics: gatifloxacin

Dofetilide Procainamide Sotalol Quinidine Colchicine Clinical Effect Clarithromycin is an inhibitor of CYP3A and the efflux transporter, P-glycoprotein (P-gp).