Abstract
Procainamide is a class IA antiarrhythmic drug indicated for the treatment of life-threatening or symptomatic ventricular arrhythmias. The current sustained-release formulation requires 6-hour dosing (qid). To improve patient compliance, a new sustained-release formulation for twice-daily (bid) administration has been developed (Procanbid, Parke-Davis). This study assesses the pharmacologic equivalence of the bid and qid formulations in the suppression of symptomatic ventricular premature depolarizations (VPDs). Fourteen centers enrolled a total of 99 patients with frequent symptomatic VPDs (average ≥20 VPDs/hr) who previously responded to and tolerated the procainamide qid formulation. During the first week of the double-blind phase, patients were randomized to either placebo or procainamide dosages of 1000, 2000, or 4000 mg/d (bid or qid formulations). In the second week, the patients were crossed over to the alternate formulation. Seventy-seven patients qualified for the primary activity analysis. The bid and qid formulations showed comparable effectiveness in the suppression of mean VPDs with a linear dose-response relationship. The VPD suppression was not attenuated towards the end of the dosing interval for either formulation. Sixty-eight of these patients entered an optional 1-year extension to receive the bid formulation. Thirty-seven (54%) patients had adverse effects. Of those, 15 (22%) had side effects considered treatment related. Most of the adverse events occurred during the first 6 weeks of treatment. Only a few patients (8%) withdrew as a consequence of treatment with the bid formulation. The overall safety profile of the bid formulation was similar to other formulations, and the procainamide bid formulation has a low proarrhythmic rate (`3%). In conclusion, the effectiveness of the twice-daily formulation of procainamide in the suppression of VPDs is comparable to the currently available qid formulation.
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References
Hoffman BF, Rosen MR, Wit AL. Electrophysiology and pharmacology of cardiac arrhythmias. Cardiac effects of quinidine and procainamide. Am Heart J 1975;90:117–122.
Woske H, Belford J, Fastier FN, Brooks McC. The effect of procainamide on excitability, refractoriness and conduction in the mammalian heart. J Pharmacol Exp Ther 1953;107:134–140.
Hilleman DE. Bioavailability issues with procainamide. Arrhythmia Clinic 1992;5:3–8.
Lima JJ. Principles of therapeutic drug monitoring. In: Evans WE, Sclentag JJ, Jusko WJ, eds. Applied Pharmacokinetics. Vancouver, WA: 1992:22-1;22–33. Applied Therapeutics.
Smith TL, Kinkel A. Plasma levels of procainamide after administration of conventional and sustained-release preparations. Curr Therap Res 1980;27:217–228.
Baker BA, Reynolds JR, Gelckel L, A'Zary E, Bodenheimer MM. Comparative bioavailability of two oral sustained-release procainamide products. Clin Pharm 1988;7:135–138.
Yang BB, Abel RB, Uprichard ACG, Smithers JA, Forgue ST. Pharmacokinetic and pharmacodynamic comparisons of BID and QID formulations of procainamide in patients with frequent ventricular premature depolarizations. J Clin Pharmacol 1996;36:623–633.
Members of the Cardiac Arrhythmia Pilot Study (CAPS). Effects of encainide, flecainide, imipramine and moricizine on ventricular arrhythmias during the year after acute myocardial infarction: THE CAPS. Am J Cardiol 1988;61:501–509.
Caine ME, Josephson ME. Procainamide. In: Gould LA, ed. Drug Treatment of Cardiac Arrhythmias. New York: Futura, P 1983:73–108.
Michelson EL, Dreifus LS. Sustained-release and immediate-release procainamide: Comparative efficacy and equivalence in ambulatory patients with frequent premature ventricular contractions. Vasc Med 1984;12:155.
Anderson JL. Conventional and sustained release procainamide. Update on pharmacology and clinical use. Clin Ther 1985;7:618–640.
Giardina EGV, Fenster PE, Bigger JT Jr, Mayersohn M, Perrier D, Marcus FI. Efficacy, plasma concentrations and adverse effects of a new sustained release procainamide preparation. Am J Cardiol 1980;46:855–861.
Kerin NZ, Somberg J. Proarrhythmia: Definition, risk factors, causes, treatment and controversies. Am Heart J 1994;128:576–585.
Torres V, Flowers D, Somberg JC. The arrhythmogenicity of antiarrhythmic agents. Am Heart J 1985;109:1090–1097.
Velebit V, Podrid P, Lown B, Cohen BH, Graboys TB. Aggravation and provocation of ventricular arrhythmias by antiarrhytimic drugs. Circulation 1982;65:886–894.
Koch-Wesser J, Klein SM. Procainamide dosage schedules, plasma concentrations and clinical effects. JAMA 1971;215:1454–1460.
Kosowsky BD, Taylor J, Lown B, Ritchie RF. Long-term use of procainamide following acute myocardial infarction. Circulation 1973;42:1204–1210.
Karlsson E. Plasma levels of procainamide after administration of conventional and sustained-release tablets. Eur J Clin Pharmacol 1973;6:245–250.
Physicians Desk Reference. Procan SR prescribing information 1992;1760–1751.
Giardina EGV. Procainamide: Clinical pharmacology and efficacy against ventricular arrhythmias. In: Garfein OB, ed. Clinical Pharmacology of Cardiac Antiarrhythmic Agents: Classical and Current Concepts Reevaluated. New York: New York Academy of Sciences 1984:177–188.
Danielly J, DeJong R, Radke-Mitchell LC, Uprichard ACG. Procainamide-associated blood dyscrasias. Am J Cardiol 1994;74:1179–1180.
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Kerin, N.Z., Meengs, W.L., Timmis, G.C. et al. Activity of Procanbid Procainamide Twice-Daily Formulation, to Suppress Ventricular Premature Depolarizations. Cardiovasc Drugs Ther 11, 169–175 (1997). https://doi.org/10.1023/A:1007736931662
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DOI: https://doi.org/10.1023/A:1007736931662