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Interaction of the antiarrhythmic drug procainamide with phospholipid bilayers.

Several hypotheses link the molecular mechanism of action of the antiarrhythmic drugs (AAD) that belong to class I to non-specific interactions with phospholipids sited in the neighborhood of sodium channels in the membrane of the myocardium. Procainamide (PROC), one of the least lipophilic drugs of this group, was induced to interact with bilayers of dimyristoylphosphatidylcholine (DMPC) and dimirystoylphosphatidylethanolamine (DMPE), liposomes of DMPC and human erythrocytes. The perturbing effects of PROC upon these systems were respectively determined by X-ray diffraction, fluorescence spectroscopy and scanning electron microscopy. It was found that PROC exerted very little effect upon DMPC and DMPE even at such a high concentration as 10 mM. However, at therapeutical plasma concentrations, PROC induced shape changes in vitro to red cells.

Dimyristoylphosphatidylcholine↗

Exacerbated muscle dysfunction by procainamide in rats with experimental myasthenia gravis.

The induction of experimental autoimmune myasthenia gravis (EAMG) has long been shown to result in inefficient function of the acetylcholine receptor (AChR) and concomitant impairment of AChR-dependent neuromuscular communication. As an animal model of human myasthenia gravis, AChR-immunized rats demonstrate symptoms of MG very similar to those observed in human patients resulting from the presence of circulating anti-AChR antibodies which interfere with the normal function of the receptor. In addition to antibody antagonists of neuromuscular function, a variety of drugs have been observed to be associated with possible exacerbations of impaired neuromuscular function leading to myasthenic crisis in some MG patients. One drug, the cardiac anti-arrhythmic agent, procainamide, has been reported to cause both pre-synaptic and post-synaptic electrophysiologic effects at the neuromuscular junction. The study described below extends these observations to include the demonstration of perturbed AChR-dependent contractile muscle function in a rat model of MG.

Animals↗

The assessment of an antiarrhythmic agent, sustained-release procainamide, with the aid of Holter monitoring.

A sustained-release preparation of procainamide (PAD) was evaluated in a double-blind cross-over study. The preparation was found to reduce ventricular ectopic activity in all seven patients who completed the investigation in five patients the effectiveness reached the defined level of significance. A larger clinical trial to assess the long-term use of this preparation in terms of efficacy, safety and convenience is recommended.

Adult↗

Inhibitory effects of procainamide on rabbit platelet aggregation and thromboxane B2 production in vitro.

AIM: To study the influences of procainamide (PA) on thrombin-induced rabbit platelet aggregation and thromboxane B2 (TXB2) production in vitro. METHODS: Turbidimetry and radioimmunoassay were used. RESULTS: PA 8.5, 34, 136, and 544 mumol.L-1 inhibited thrombin-induced platelet aggregation and TXB2 production, and the inhibitory rates were 45% +/- 37%, 48% +/- 32%, 88% +/- 23%, 92% +/- 15% and 53% +/- 24%, 65% +/- 26%, 90% +/- 6%, 95% +/- 6%, respectively. There was positive correlation between PA concentration and efficiency of inhibition of platelet aggregation and TXB2 production, and also between the inhibition % of platelet aggregation and that of production of TXB2. The three linear equations and main parameters were Y = 0.2075X-4.9157, r = 0.9985; Y = 0.9546X-34.6724, r = 0.9921; Y = 0.8202X + 19.7062, r = 0.9921. CONCLUSION: PA inhibited thrombin-induced platelet aggregation and TXB2 production in rabbits.

Animals↗

Effect of procainamide on ultrastructure of blood platelet in rabbits.

AIM: To study the effect of procainamide (PA) on the ultrastructure of blood platelets. METHODS: Arachidonic acid was added to PA-treated platelet-rich plasma to induce platelet aggregation. The 50-nm sections were examined with a transmission electron microscope. RESULTS: PA 8.5-136 mumol.L-1 markedly inhibited changes of pseudopods, alpha-granules, dense granules, glycogens, open canalicular system, and dense tubular system. CONCLUSION: PA markedly inhibited the changes of ultrastructure of blood platelet and releasing response.

Animals↗

Acetylation status is associated with serological changes but not clinically significant disease in patients receiving procainamide.

OBJECTIVE: Autoantibodies occur in the majority of patients receiving procainamide (PA) for more than one year. Slow acetylator status has been proposed to predispose to their development. We previously reported the results of serological evaluation of 52 asymptomatic patients receiving PA. The aims of this study were to follow these patients to determine the incidence of drug related lupus (DRL) and serologic changes in patients receiving longterm PA therapy; and to evaluate the possible effect of acetylator status on the development of PA autoimmunity. METHODS: Fifty-two patients receiving PA were reevaluated after a mean of 31.5 months. Antinuclear antibodies and antibodies to histones, dsDNA, and polyadenylic acid (PolyA) were assayed. Acetylator status was determined by phenotyping and genotyping methods. Five additional patients referred with a diagnosis of DRL were also evaluated. RESULTS: Autoantibodies were detected in the majority of patients still receiving PA and in some patients in whom PA had been discontinued. Slow acetylator status correlated with IgG antibodies to the H2A-2B dimer complex. Acetylator status did not correlate with PA dose. Seven of the 9 patients with PA related lupus were fast acetylators. CONCLUSION: Most patients receiving PA have autoantibodies that may persist after discontinuation of PA. Despite persistently high frequency of autoantibodies the majority of these patients did not develop DRL. Slow acetylator status correlated with IgG antibodies to H2A-2B but was not a risk factor for the development of PA related lupus.

Acetylation↗

Reversal of GSTP1 CpG island hypermethylation and reactivation of pi-class glutathione S-transferase (GSTP1) expression in human prostate cancer cells by treatment with procainamide.

Among the many somatic genome alterations present in cancer cells, changes in DNA methylation may represent reversible "epigenetic" lesions, rather than irreversible "genetic" alterations. Cancer cell DNA is typically characterized by increases in the methylation of CpG dinucleotides clustered into CpG islands, near the transcriptional regulatory regions of critical genes, and by an overall reduction in CpG dinucleotide methylation. The transcriptional "silencing" of gene expression associated with such CpG island DNA hypermethylation presents an attractive therapeutic target: restoration of "silenced" gene expression may be possible via therapeutic reversal of CpG island hypermethylation. 5-Aza-cytidine (5-aza-C) and 5-aza-deoxycytidine (5-aza-dC), nucleoside analogue inhibitors of DNA methyltransferases, have been widely used in attempts to reverse abnormal DNA hypermethylation in cancer cells and restore "silenced" gene expression. However, clinical utility of the nucleoside analogue DNA methyltransferase inhibitors has been limited somewhat by myelosuppression and other side effects. Many of these side effects are characteristic of nucleoside analogues that are not DNA methyltransferase inhibitors, offering the possibility that nonnucleoside analogue DNA methyltransferase inhibitors might not possess such side effects. Human prostate cancer (PCA) cells characteristically contain hypermethylated CpG island sequences encompassing the transcriptional regulatory region of GSTP1, the gene encoding the pi-class glutathione S-transferase (GSTP1), and fail to express GSTP1 as a consequence of transcriptional "silencing." Inactivation of GSTP1 by CpG island hypermethylation, the most common somatic genome alteration yet reported for human PCAs, occurs early during human prostatic carcinogenesis and results in a loss of GSTP1 "caretaker" function, leaving prostate cells with inadequate defenses against oxidant and electrophile carcinogens. We report here that the drug procainamide, a nonnucleoside inhibitor of DNA methyltransferases, reversed GSTP1 CpG island hypermethylation and restored GSTP1 expression in LNCaP human PCA cells propagated in vitro or in vivo as xenograft tumors in athymic nude mice.

Animals↗

Modified colorimetric method for procainamide in plasma.

We describe a modified colorimetric method for determining procainamide in plasma by use of a diazotization and coupling reaction with N-(1-naphthyl)-ethylenediamine dihydrochloride (Marshall's reagent). The sensitivity of the assay is increased twofold over the originally reported colorimetric method, and the lower limit of detection for the assay of a 1.0-ml plasma sample has been decreased to 0.5 mg/liter.

Colorimetry↗

Correlation of the electrophysiological and antiarrhythmic properties of the N-acetyl metabolite of procainamide with plasma and tissue drug concentrations in the dog.

N-acetylprocainamide (NAPA), a major metabolite of procainamide (PA) in man, has been reported recently to be biologically active. The present study compares the electrophysiological and antiarrhythmic effects of NAPA and PA and correlates their activity with plasma and tissue drug concentrations. In isolated canine Purkinje fibers, NAPA, in bath concentrations of 10 and 20 mg/l reduced automaticity and prolonged repolarization time. These effects were similar to those observed with similar concentrations of PA. Tissue concentrations of NAPA (77 +/- 2 mug/g) were significantly greater than those of PA (43+/-2 mug/g). Neither drug was metabolized by the fibers. In in vivo studies, NAPA (140-220 mg/kg) significantly suppressed the incidence of arrhythmias following coronary occlusion and digitalis intoxication. Similar protection was obtained with 40 to 60 mg/kg of PA. This difference in potency could not be attributed to differences in plasma and tissue concentrations of the drugs. These results show that NAPA is equally efficacious but less potent than PA as an antiarrhythmic drug in dogs.

Action Potentials↗

[Effects of amiodarone on kinetics of procainamide and its major metabolite disposition in rabbit].

The effects of steady state amiodarone on the kinetics of procainamide (PA) and its major metabolite, acetylprocainamide (NAPA), disposition in rabbits were examined. When PA was given alone, the pharmacokinetic parameters alpha, beta, Kmo, K1m.V1.V-1m, were 0.20 +/- 0.04, 0.016 +/- 0.003, 0.027 +/- 0.01, and 0.043 +/- 0.02 min-1, respectively. When PA was given in combination with amiodarone, the corresponding values were 0.37 +/- 0.08, 0.0059 +/- 0.002, 0.0096 +/- 0.004, and 0.016 +/- 0.003 min-1, respectively. The results indicated that the disposition kinetics of both PA and NAPA were significantly changed by steady state amiodarone.

Acecainide↗

Evaluation of very rapid emit Qst methods for measuring serum procainamide and N-acetylprocainamide concentrations.

This study assessed the Emit Qst procainamide (PA) and N-acetylprocainamide (NAPA) assays. Accuracy and intraday precision were evaluated by repeatedly measuring PA and NAPA concentrations in spiked serum samples using Qst and high-performance liquid chromatography methods. Interday precision was evaluated by measuring concentrations in spiked samples over 4 weeks. Correlation between methods was assessed in patient samples, and proportional, constant, and random errors were estimated. Intraday coefficients of variation (CVs) were below 6.4% for PA and NAPA for both methods; interday CVs were below 7.8%. The proportional, constant, and random errors of the PA Qst assay in patient samples were 5.7%, -0.224 mg/L, and +/- 0.574 mg/L, respectively. The same errors in the NAPA Qst assay were 17.2%, 0.229 mg/L, and +/- 1.79 mg/L, respectively. The Qst assays are rapid, accurate, and precise methods for routine clinical measurement of PA and NAPA, although the proportional error in the NAPA assay should be recognized.

Acecainide↗

[Combined pharmacokinetic and pharmacodynamic model analysis for procainamide and its metabolite].

The pharmacokinetic and pharmacodynamic profiles of procainamide (PA) and its major metabolite, acetylprocainamide (NAPA), were analyzed by extended combined pharmacokinetic and pharmacodynamic model in rabbits. The pharmacodynamic parameters Keo, S, Ce(50), Emax for PA were 0.023 +/- 0.005 min-1, 3.9 +/- 1.1, 3.6 +/- 0.9 micrograms.ml-1, 37 +/- 10 ms respectively and for NAPA were 0.061 +/- 0.017 min-1, 2.2 +/- 0.4, 6.2 +/- 1.7 micrograms.ml-1, 53.6 +/- 2.5 ms. Following PA iv to rabbit both PA and NAPA were involved in the QTc prolongation of the initial period, but the later action was mainly associated with NAPA. Differences of pharmacokinetic and pharmacodynamic parameters between PA and NAPA were found.

Acecainide↗

[Simultaneous predictions of disposition kinetics of procainamide and its metabolite N-acetylprocainamide in rat by a physiological pharmacokinetic model].

Disposition kinetics of procainamide (PA) and its metabolite N-acetylprocainamide (NAPA) in rats was simulataneously predicted by a physiological pharmacokinetic model. The parameters, such as clearances in kidney and liver and tissue/blood concentration ratios, which were needed for simulations, were determined. The estimated clearances of PA in rat blood, kidney and liver were 47. 28, 13. 56 and and 33. 71 ml.kg-1.min-1, respectively. Tissue/blood drug concentration ratios were obtained after iv administration according to Gallo's method and demonstrated that heart, liver, kidney, muscle and small intestine have greater affinity for PA than do blood components. The concentrations of PA and NAPA in rat tissues following iv administration of PA.HCl 75 mg/kg were predicted and compared with observed values. The results showed that a good agreement between predictions and observed data was found in most of rat tissues. Concentrations of PA and NAPA in plasma of man, based on scaling-up of kinetics of PA and NAPA from rat to man, was also simulated.

Acecainide↗

Procainamide pharmacokinetics in beagles: urinary pH dependency and comparison with n-acetylprocainamide.

Male and female beagles received intravenous (i.v.) bolus injections of procainamide (PA) to study its pharmacokinetic behavior and to determine the effect of urinary pH upon renal excretion. Urinary alkalinization caused an increase in plasma disappearance half-life (t1/2) and decreases in renal clearance (ClR) and total body clearance (ClB), while the apparent volume of distribution remained unchanged. Acid hydrolysis of the urine collected caused a 17% increase in the amount of PA measured. This hydrolyzable substance was found not to be the N-acetylated metabolite of PA. When i.v. N-acetylprocainamide (NAPA) was administered in crossover fashion to some of the above animals, it exhibited a longer t1/2 than PA. Mean ClR and mean ClB values were smaller with NAPA while both compounds showed similar dependence upon renal and non-renal clearance mechanisms.

Animals↗

A high performance liquid chromatographic assay for tocainide with alternate application for the determination of lidocaine, procainamide, and N-acetylprocainamide.

We describe a simple, isocratic high-performance liquid chromatographic method for measuring the oral antiarrhythmic agent tocainide in serum. The extraction requires 200 microliters of serum, is performed on a reverse-phase column, and utilizes the drug mepivacaine as the internal standard. This analytical method can also be used to assay procainamide, n-acetylprocainamide, or lidocaine with minor modifications to either the extraction protocol or the wavelength used to monitor column eluant.

Acecainide↗

Arrhythmia control by selective lengthening of cardiac repolarization: role of N-acetylprocainamide, active metabolite of procainamide.

In recent years, data has become available to support the concept that a selective lengthening of the cardiac action potential (a Class III antiarrhythmic action) by whatever mechanism with an attendant increase in the effective refractory period constitutes a distinct antiarrhythmic mechanism. Such an action is exemplified clinically by hypocalemia and hypothyroidism and pharmacologically by amiodarone, sotalol and bretylium, all of which have other associated features. The N-acetylation of procainamide leads to the pharmacologically active compound, N-acetylprocainamide (NAPA). The loss of propensity to block depolarization with the preservation of the effect on repolarization in the case of NAPA makes the compound a class III antiarrhythmic agent. The process of N-acetylation has also led to longer elimination half-life and predominantly renal excretion with linear kinetics but with the preservation of the antiarrhythmic properties of the parent compound. The electrophysiologic data are consistent with the results of studies which have demonstrated that NAPA has the potential to suppress premature ventricular contractions and prevent spontaneously occurring as well inducible ventricular tachycardia in patients with heart disease. The effects on atria indicate that the drug has the potential to electively reverse atrial flutter and fibrillation to normal rhythm and maintain stability of sinus rhythm. The overall experimental and clinical data warrant further evaluation of NAPA as an antiarrhythmic agent.

Acecainide↗

More-sensitive enzyme-multiplied immunoassay technique for procainamide and N-acetylprocainamide in plasma, serum, and urine.

A commercially available (Syva Co.) enzyme-multiplied immunoassay technique (EMIT) for the quantitative determination of procainamide (PA) and N-acetylprocainamide (NAPA) was modified to allow automated quantitative analysis of approximately 100 samples per day, in a working range of 0.1 to 2.0 micrograms/mL. Such a test was needed to evaluate the pharmacokinetic characteristics of controlled-release dosage forms characterized by long half-lives at low plasma concentration. Analytical recovery of PA and NAPA from serum, plasma, and urine was satisfactory, but at extreme ratios for PA:NAPA the accuracy of determining the lower-concentration component became unsatisfactory. In fact, however, we found no such ratios in 5400 clinical samples assayed by this procedure.

Acecainide↗

Comparison of the pharmacokinetic and pharmacodynamic properties of procainamide and N-acetylprocainamide.

Although procainamide (PA) has been widely used to treat patients with both ventricular and supraventricular arrhythmias since 1951, more than twenty years elapsed before N-acetylprocainamide (NAPA) was identified as a major PA metabolite and shown in PA-treated patients to have plasma concentrations generally equaling or being 2 to 3 times greater than those of the parent drug. Numerous investigations have been conducted since then to characterize the pharmacokinetics and pharmacodynamics of NAPA and to compare these properties with those of PA. Salient differences have been that the elimination half-life of NAPA is 2.5 times that of PA, even when renal function is normal; that NAPA has a spectrum of electrophysiologic action that differs from PA in that NAPA only prolongs action potential duration; and that NAPA is less likely than PA to cause a syndrome resembling systemic lupus erythematosus. Although these properties have provided an impetus for the development of NAPA as an antiarrhythmic drug in its own right, emphasis is placed in this review on the implications of these findings for individualizing PA therapy.

Acecainide↗