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Drug Interactions between Pronestyl and Quin-G

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

quiNIDine procainamide

Applies to: Quin-G (quinidine) and Pronestyl (procainamide)

GENERALLY AVOID: Limited clinical data suggest that quinidine may significantly increase serum levels and half-life of procainamide. The mechanism may be related quinidine-induced reduction in the renal clearance of procainamide. Increased procainamide serum concentrations may result in ECG changes such as QRS widening or prolonged QT interval and increased risk of arrhythmias such as torsades de pointes.

MANAGEMENT: Until more data are available, quinidine and procainamide should generally not be administered concurrently unless benefit to the patient outweighs risk. If these two drugs are given together, serum procainamide and NAPA levels, and ECG changes and hemodynamic status should be closely monitored. Patients should be advised to promptly notify their physician if they experience drowsiness, dizziness, syncope, confusion, tremor, or palpitations.

References

  1. Saal K, Werner J, Greene L, et al. "Effect of amiodarone on serum quinidine and procainamide levels." Am J Cardiol 53 (1984): 1264-7
  2. Highes B, Dyer J, Schwartz A "Increased procainamide plasma concentration caused by quinidine: a new drug interaction." Am Heart J 114 (1987): 908-9

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Drug and food interactions

Moderate

quiNIDine food

Applies to: Quin-G (quinidine)

GENERALLY AVOID: In a small, randomized, crossover study, the administration of quinidine with grapefruit juice (compared to water) to healthy volunteers significantly prolonged the time to reach peak plasma quinidine concentrations and decreased the plasma concentrations of its major metabolite, 3-hydroxyquinidine. These changes were associated pharmacodynamically with both a delay and a reduction in the maximal effect on QTc interval. The proposed mechanism is delay of gastric emptying as well as inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits.

MANAGEMENT: Given the drug's narrow therapeutic index, patients receiving quinidine therapy should avoid the consumption of grapefruits and grapefruit juice to prevent any undue fluctuations in plasma drug levels.

References

  1. Ace LN, Jaffe JM, Kunka RL "Effect of food and an antacid on quinidine bioavailability." Biopharm Drug Dispos 4 (1983): 183-90
  2. Min DI, Ku YM, Geraets DR, Lee HC "Effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of quinidine in healthy volunteers." J Clin Pharmacol 36 (1996): 469-76
  3. Ha HR, Chen J, Leuenberger PM, Freiburghaus AU, Follah F "In vitro inhibition of midazolam and quinidine metabolism by flavonoids." Eur J Clin Pharmacol 48 (1995): 367-71
  4. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther 68 (2000): 468-77
View all 4 references

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Minor

procainamide food

Applies to: Pronestyl (procainamide)

Ethanol may increase the acetylation of procainamide. Subtherapeutic plasma levels of procainamide may result in some patients. Because the acetylated metabolite of procainamide also possesses antiarrhythmic properties, the clinical effects are unclear.

References

  1. Olsen H, Morland J "Ethanol-induced increase in procainamide acetylation in man." Br J Clin Pharmacol 13 (1982): 203-8

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Antiarrhythmics

Therapeutic duplication

The recommended maximum number of medicines in the 'antiarrhythmics' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antiarrhythmics' category:

  • Pronestyl (procainamide)
  • Quin-G (quinidine)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

Duplication

Group i antiarrhythmics

Therapeutic duplication

The recommended maximum number of medicines in the 'group I antiarrhythmics' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'group I antiarrhythmics' category:

  • Pronestyl (procainamide)
  • Quin-G (quinidine)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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