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Drug Interactions between Pronestyl and Quineprox

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

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Interactions between your drugs

Major

procainamide hydroxychloroquine

Applies to: Pronestyl (procainamide) and Quineprox (hydroxychloroquine)

GENERALLY AVOID: Class IA (e.g., disopyramide, quinidine, procainamide) and class III (e.g., amiodarone, dofetilide, sotalol) antiarrhythmic agents can cause dose-related prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: Coadministration of class IA or class III antiarrhythmic agents with other drugs that can prolong the QT interval should preferably be avoided unless benefits are anticipated to outweigh the risks. Caution and clinical monitoring are recommended if concomitant use is required. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

References

  1. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories PROD (2002):
  2. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical PROD (2002):
  3. "Product Information. Procan SR (procainamide)." Parke-Davis PROD (2001):
  4. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
  5. "Product Information. Betapace (sotalol)." Berlex Laboratories PROD (2001):
  6. "Product Information. Norpace (disopyramide)." Searle PROD (2001):
  7. Trujillo TC, Nolan PE "Antiarrhythmic agents - Drug interactions of clinical significance." Drug Safety 23 (2000): 509-32
  8. Yamreudeewong W, DeBisschop M, Martin L, Lower D "Potentially Significant Drug Interactions of Class III Antiarrhythmic Drugs." Drug Saf 26 (2003): 421-38
  9. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  10. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  11. Cerner Multum, Inc. "Australian Product Information." O 0
  12. EMA. European Medicines Agency. European Union "EMA - List of medicines under additional monitoring. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000366.jsp&mid=WC0b01ac058067c852" (2013):
  13. Maxa JL, Hebeler RF, Adeeko MA "Torsades de pointes following concurrent amiodarone and levofloxacin therapy." Proc (Bayl Univ Med Cent) 19 (2006): 345-6
View all 13 references

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Drug and food interactions

Moderate

hydroxychloroquine food

Applies to: Quineprox (hydroxychloroquine)

GENERALLY AVOID: Theoretically, grapefruit and grapefruit juice may increase the plasma concentrations of hydroxychloroquine or chloroquine and the risk of toxicities such as QT interval prolongation and ventricular arrhythmias. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruit. Following coadministration with cimetidine, a weak to moderate CYP450 3A4 inhibitor, a 2-fold increase in chloroquine exposure occurred. Since chloroquine and hydroxychloroquine have similar structures and metabolic elimination pathways, a similar interaction may be observed with hydroxychloroquine. In general, the effect of grapefruit juice is concentration-, dose- and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit juice (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. Pharmacokinetic interactions involving grapefruit juice are also subject to a high degree of interpatient variability, thus the extent to which a given patient may be affected is difficult to predict.

MANAGEMENT: Although clinical data are lacking, it may be advisable to avoid the consumption of grapefruit, grapefruit juice, and any supplement containing grapefruit extract during hydroxychloroquine or chloroquine therapy.

References

  1. Cerner Multum, Inc. "Australian Product Information." O 0

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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

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.

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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