Procainamide Hydrochloride and Sitavig

• 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.

Ventricular Arrhythmias

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.

Supraventricular Tachyarrhythmias

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.

Arrhythmias during Surgery and Anesthesia

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

Malignant Hyperthermia

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

• Generic Name: acyclovir
• Dosage Forms: tablet, orally disintegrating, delayed release
• Other Brand Names: Sitavig, Zovirax

Sitavig is a prescription medicine used to treat cold sores (herpes labialis) in adults with normal immune systems. It is not known if it is safe and effective in children.

Do not use this medicine if you are allergic to:

acyclovir or any of the ingredients in Sitavig. See the end of this leaflet for a complete list of ingredients. milk protein concentrate

Before using Sitavig, tell your healthcare provider about all of your medical conditions, including if you:

are pregnant or plan to become pregnant. It is not known if this medicine will harm your unborn baby. are breastfeeding or plan to breastfeed. It is not known if this medicine passes into your breast milk. Tell your healthcare provider about all the medicines you take, including prescription or over-the-counter medicines, vitamins, or herbal supplements.

See the detailed Instructions for Use for information about how to use this medicine.

Use exactly as your healthcare provider tells you to use it. Use within one hour after you have the first symptom of a cold sore, such as itching, redness, burning, or tingling, and before a cold sore appears. You may eat and drink while using Sitavig. Do not crush, chew, suck, or swallow the tablets. Sitavig will slowly dissolve over time while in your mouth and should be left in place. Gently rinse your mouth with water to clean your teeth while Sitavig is in place. Drink more liquids if your mouth becomes dry while using Sitavig.

You should avoid activities that may prevent Sitavig from sticking to your gum, including: touching or pressing Sitavig after you apply it, wearing upper dentures, chewing gum, and brushing your teeth during the treatment day.

The most common side effects include:

headache and pain where Sitavig is applied.

These are not all the possible side effects of Sitavig. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also:

Sitavig side effects (in more detail)