Procainamide Hydrochloride and Simvastatin and niacin

• Generic Name: procainamide
• Dosage Forms: n.a.
• Other Brand Names: Pronestyl, Procan SR, Pronestyl-SR, Procanbid

Comparably effective to quinidine for atrial or ventricular arrhythmias; choice based on pharmacokinetics and adverse effect profile.

Treatment of ventricular arrhythmias (e.g., sustained VT) that in the judgment of the clinician are life-threatening, but usually not the antiarrhythmic of first choice.

Not a first-line drug of choice during cardiac arrest, but may be used for treatment of wide-complex tachycardias in the periarrest period; included in current ACLS treatment guidelines for adult and pediatric tachycardia.

May be used in the treatment of sustained, stable monomorphic VT not associated with angina, pulmonary edema, or hypotension (BP <90 mm Hg) in patients with preserved ventricular function.

Some experts recommend revascularization and β-blockade followed by IV antiarrhythmic drugs, such as procainamide or amiodarone, for patients with recurrent or incessant polymorphic VT due to acute myocardial ischemia.

Because of procainamide's arrhythmogenic potential, lack of evidence for improved survival for class I antiarrhythmic agents, and risk of serious, potentially fatal adverse hematologic effects (see Boxed Warning), particularly leukopenia or agranulocytosis, use for less severe arrhythmias not recommended.

Reserve for suppression and prevention of documented life-threatening ventricular arrhythmias in carefully selected patients in whom the benefits of procainamide therapy outweigh the possible risks.

Avoid treatment of asymptomatic VPCs.

Initiate procainamide therapy only in a hospital setting.

Has been used for treatment of various supraventricular tachycardias (SVTs); because of higher risk of toxicity and proarrhythmic effects, antiarrhythmic agents generally reserved for patients who do not respond to or cannot be treated with AV nodal blocking agents (β-adrenergic blocking agents, verapamil, diltiazem).

May be useful in patients with preexcited atrial fibrillation and rapid ventricular response associated with Wolff-Parkinson-White syndrome; however, direct-current cardioversion is treatment of choice when patient is hemodynamically compromised.

Also has been used for treatment of junctional tachycardia; however, more limited role and generally considered only when IV β-adrenergic blocking agents are ineffective.

Used parenterally (preferably IM) in the treatment of arrhythmias that occur during surgery and anesthesia.

IV procainamide has been used effectively in the treatment of malignant hyperthermia.

• Generic Name: niacin / simvastatin
• Dosage Forms: n.a.
• Other Brand Names: Simcor

Simvastatin and niacin combination is used together with a proper diet to lower cholesterol and triglyceride (fat) levels in the blood. Simvastatin and niacin may help prevent medical problems caused by clogged blood vessels, such as heart attacks and strokes.

Simvastatin and niacin work together to treat cholesterol and lipid (fat) disorders. Niacin is vitamin B3, which reduces the amount of cholesterol in the blood. Simvastatin belongs to the group of medicines called HMG-CoA inhibitors or statins. It works to reduce the amount of cholesterol in the blood by blocking an enzyme that is needed to make cholesterol.

Simvastatin and niacin was available only with your doctor's prescription. The Simcor(R) product will no longer be marketed in the United States as of April 18, 2016.