Intrahepatic cholestasis due to hypersensitivity reaction to procainamide

Article Abstract:

Procainamide is a drug commonly used to treat arrhythmias (irregular heartbeats). Rarely, side effects of procainamide have included acute febrile (fever) reaction and hepatitis (inflammation of the liver). A case is described of a 71-year-old man who developed hypersensitivity to procainamide which resulted in impaired liver function within four days of starting the medication. The patient was admitted to the hospital after fainting. He had a past history of heart attack, chronic obstructive lung disease, deficiency of pancreatic enzymes; he also smoked and consumed alcohol daily. Tests ruled out a heart attack, but showed ventricular tachycardia, rapid beating of the main pumping chamber of the heart, for which procainamide was prescribed. Four days later, he developed a fever, which was thought to be caused by hypersensitivity. Procainamide was discontinued two days later, and the patient subsequently developed dark urine, jaundice, and alterations in bilirubin levels and liver enzyme tests. Liver swelling was found, and testing showed that normal liver excretion of bilirubin and its products had stopped. Tests for hepatitis were negative. Liver enzyme and bilirubin levels progressively worsened for 4 to 10 days and then began to normalize. The patient had no further evidence of fever or jaundice, and died 16 months later of heart failure. Only four cases of liver dysfunction or hepatitis have previously been reported in association with procainamide therapy, and this is the first known case of arrested bile excretion as the principal liver dysfunction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Cholestasis, Procainamide

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Is amiodarone good for heartburn?

Article Abstract:

Amiodarone is a drug used in the treatment of life-threatening cardiac arrhythmias, abnormalities of heart rhythm. The drug appears to affect the heart muscle by blocking slow sodium channels, blocking beta adrenoreceptors, and probably blocking calcium channels. Amiodarone has serious side effects, which limit its use to cases in which the need for the drug's benefits outweighs the potential complications. However, in an unusual reversal of the normal state of affairs, it seems that one of the side effects of amiodarone may, in fact, be beneficial. In three patients with severe heartburn (the digestive disorder in which the esophagus is irritated by stomach acid) in addition their actual heart problem, treatment with amiodarone resolved the heartburn. The mechanism for this is not known, but perhaps the calcium-channel-blocking effects of the drug also affected the smooth muscle of the esophagus. An alternative hypothesis for the action of amiodarone on heartburn involves the similarity of amiodarone to the histamine antagonist ranitidine (Zantac), used to treat heartburn and peptic ulcers. This similarity may result in a decrease of secretion of stomach acid in response to amiodarone, and thus fewer symptoms of esophageal irritation. This second possible explanation is somewhat more speculative, since histamine-receptor blocking activity has not yet been demonstrated for amiodarone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Amiodarone, Gastroesophageal reflux, Heartburn

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Trimethoprim inhibition of the renal clearance of procainamide and N-acetylprocainamide

Article Abstract:

To evaluate the effect of the antibiotic trimethoprim on how the body disposes of procainamide, a heart medication used to restore normal rhythmic heartbeat to a patient who has an arrhythmia (abnormal heart rhythm), 10 healthy men were tested. The men were given procainamide and trimethoprim or procainamide and a placebo. Forty-five percent less procainamide was cleared from the body by the kidney when trimethoprim was given. In addition the amount of procainamide in the blood increased by 40 percent up to twelve hours after both medications were taken. There was minimal change in the electrical activity of the heart as measured by electrocardiogram (ECG) when procainamide was given with trimethoprim or with the placebo. It was concluded that trimethoprim may increase the amount of procainamide in the blood due to decreased excretion by the kidney.

Health aspects, Research, Physiological aspects, Kidneys, Kidney, Drug interactions, Trimethoprim, Procainamide hydrochloride

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