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Drug Interactions between cimetidine and Pronestyl

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

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Interactions between your drugs

Moderate

procainamide cimetidine

Applies to: Pronestyl (procainamide) and cimetidine

MONITOR: Cimetidine may increase plasma concentrations of procainamide and its active metabolite, NAPA. The mechanism is related to decreased renal tubular secretion of procainamide and NAPA. 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: If these two drugs are given together, serum procainamide and NAPA levels, 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. Famotidine and nizatidine do not appear to interact in this manner and may be considered as alternatives.

References (6)
  1. Lai MY, Jiang FM, Chung CH, et al. (1988) "Dose dependent effect of cimetidine on procainamide disposition in man." Int J Clin Pharmacol Ther Toxicol, 26, p. 118-21
  2. Rodvold KA, Paloucek FP, Jung D, Gallastegui J (1987) "Interaction of steady-state procainamide with H2-receptor antagonists cimetidine and ranitidine." Ther Drug Monit, 9, p. 378-83
  3. Bauer LA, Black D, Gensler A (1990) "Procainamide-cimetidine drug interaction in elderly male patients." J Am Geriatr Soc, 38, p. 467-9
  4. Higbee MD, Wood JS, Mead RA (1984) "Procainamide-cimetidine interaction: a potential toxic interaction in the elderly." J Am Geriatr Soc, 32, p. 162-4
  5. Somogyi A, McLean A, Heinzow B (1983) "Cimetidine-procainamide pharmacokinetic interaction in man: evidence of competition for tubular secretion of basic drugs." Eur J Clin Pharmacol, 25, p. 339-45
  6. Christian CD, Meredith CG, Speeg KV (1984) "Cimetidine inhibits renal procainamide clearance." Clin Pharmacol Ther, 36, p. 221-7

Drug and food interactions

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

cimetidine food

Applies to: cimetidine

Concurrent use of cimetidine and ethanol may result in increased ethanol concentrations. The mechanism appears to be due to inhibition of gastric alcohol dehydrogenase by cimetidine, leading to increased bioavailability of the alcohol and inhibition of hepatic metabolism of alcohol. The clinical significance of this interaction is limited. More importantly, patients requiring cimetidine for gastrointestinal disease should be counseled to avoid alcohol to prevent worsening of their disease. The other H-2 receptor antagonists appear to have minimal effects on the concentrations of alcohol.

References (2)
  1. Feely J, Wood AJ (1982) "Effects of cimetidine on the elimination and actions of ethanol." JAMA, 247, p. 2819-21
  2. Hansten PD (1992) "Effects of H2-receptor antagonists on blood alcohol levels." JAMA, 267, p. 2469
Minor

cimetidine food

Applies to: cimetidine

Caffeine effects may be increased in patients also taking cimetidine. The mechanism may be due to decreased caffeine metabolism induced by cimetidine. Although adequate clinical data are lacking, a reduction in dose or elimination of caffeine may be needed if excess CNS stimulation is observed.

References (2)
  1. (2001) "Product Information. Tagamet (cimetidine)." SmithKline Beecham
  2. Broughton LJ, Rodgers HJ (1981) "Decreased systenuc clearance of caffeine due to cimetidine." Br J Clin Pharmacol, 12, p. 155-9
Minor

cimetidine food

Applies to: cimetidine

H2 antagonists may reduce the clearance of nicotine. Cimetidine, 600 mg given twice a day for two days, reduced clearance of an intravenous nicotine dose by 30%. Ranitidine, 300 mg given twice a day for two days, reduced clearance by 10%. The clinical significance of this interaction is not known. Patients should be monitored for increased nicotine effects when using the patches or gum for smoking cessation and dosage adjustments should be made as appropriate.

References (1)
  1. Bendayan R, Sullivan JT, Shaw C, Frecker RC, Sellers EM (1990) "Effect of cimetidine and ranitidine on the hepatic and renal elimination of nicotine in humans." Eur J Clin Pharmacol, 38, p. 165-9

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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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

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