Pharmacokinetic and electrophysiologic interactions of amiodarone and procainamide

John Windle, Eric N. Prystowsky, William M. Miles, James J. Heger

Research output: Contribution to journalArticle

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Abstract

The effects of amiodarone on the pharmacokinetic and electrophysiologic properites of procainamide were examined in eight patients treated for recurrent ventricular arrhythmias who received intravenous procainamide, 6 to 15 mg/kg, at control and after 1 to 2 weeks of oral amiodarone treatment. Compared with control, procainamide plasma clearance decreased from 0.43 ± 0.12 L/kg-hr to 0.33 ± 0.12 L/kg-hr (P < 0.01), plasma elimination half-life increased from 3.77 ± 0.64 hours to 5.21 ± 0.42 hours (P < 0.01), and volume of distribution was unchanged from 2.31 ± 0.74 L/kg to 2.47 ± 0.90 L/kg during amiodarone treatment. As single agents, intravenous procainamide and oral amiodarone produced equivalent increases in QRS duration, rate-corrected QT interval, right ventricular effective refractory period, and cycle length of induced ventricular tachycardia. After the addition of intravenous procainamide to amiodarone the QRS duration, rate-corrected QT interval, and, in six of eight patients, ventricular tachycardia cycle length were significantly increased compared with control or either drug alone, suggesting additive electrophysiologic effect. However, acceleration of induced ventricular tachycardia occurred in one patient with combined treatment, suggesting a potential for adverse electrophysiologic interactions. These findings indicate that amiodarone has pharmacokinetic and electrophysiologic interactions with procainamide and suggest that the intravenous dose of procainamide be reduced by 20% to 30% during concurrent drug administration.

Original languageEnglish (US)
Pages (from-to)603-610
Number of pages8
JournalClinical Pharmacology and Therapeutics
Volume41
Issue number6
DOIs
StatePublished - Jun 1987

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Procainamide
Amiodarone
Pharmacokinetics
Ventricular Tachycardia
Pharmaceutical Preparations
Half-Life
Cardiac Arrhythmias
Therapeutics

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Pharmacokinetic and electrophysiologic interactions of amiodarone and procainamide. / Windle, John; Prystowsky, Eric N.; Miles, William M.; Heger, James J.

In: Clinical Pharmacology and Therapeutics, Vol. 41, No. 6, 06.1987, p. 603-610.

Research output: Contribution to journalArticle

Windle, John ; Prystowsky, Eric N. ; Miles, William M. ; Heger, James J. / Pharmacokinetic and electrophysiologic interactions of amiodarone and procainamide. In: Clinical Pharmacology and Therapeutics. 1987 ; Vol. 41, No. 6. pp. 603-610.
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