Novokainamid

Novokainamid – antiarrhytmic drug.

Form of release and structure

• Tablets (on 10 pieces in blister strip packagings, in a pack cardboard 2 packagings; on 20 pieces in banks from dark glass, in a pack of cardboard 1 bank);
• Solution for intravenous and intramuscular administration (on 5 ml in ampoules from neutral glass, in a pack of cardboard 10 ampoules in a set with the scarificator or an ampoule knife).

Active agent: procaineamide, in 1 tablet – 250 mg, in 1 ml of solution – 100 mg.

Auxiliary components of tablets: sugar milk (lactose), potato starch, calcium stearate.

Additional substances of solution: water for injections, sodium disulphite.

Indications to use

• Trembling and/or atrial fibrillation;
• Ventricular premature ventricular contraction;
• Ventricular tachycardia;
• Atrial tachycardia;
• Ventricular disturbances of a rhythm.

Contraindications

Absolute (Novokainamid's use is strictly contraindicated):

• Cardiogenic shock;
• The extended QT interval;
• Arterial hypotension;
• Trembling and/or ventricular fibrillation;
• Chronic dekompensirovanny heart failure;
• The ventricular arrhythmia caused by intoxication cardiac glycosides;
• Ventricular tachycardias on the pirouette type;
• Sinuatrial and AV blockade of II and III degrees (in case of lack of the implanted electrocardiostimulator);
• System lupus erythematosus (in the anamnesis including);
• Leukopenia;
• Age up to 18 years;
• Lactation;
• Hypersensitivity to drug.

Relative (it is necessary to observe extra care in connection with risk of development of complications):

• Myocardial infarction;
• AV blockade of the I degree;
• Blockade of legs of a ventriculonector;
• Ventricular tachycardia at occlusion of a coronary artery;
• Chronic heart failure;
• Bronchial asthma;
• The expressed atherosclerosis;
• Myasthenia;
• Liver and/or renal failure;
• Surgical interventions (including surgical stomatology);
• Advanced age;
• Pregnancy (drug can be appointed only if the expected advantage for the woman surpasses potential risks for a fruit).

Route of administration and dosage

Tablets

In the form of tablets Novokainamid accept inside, regardless of meals:

• Ventricular premature ventricular contraction: the first reception – 0,25-1 g, further on 0,25-0,5 g each 3-6 hours. If there is a need, the daily dose is increased to 3-4 g;
• Paroxysms of a ciliary arrhythmia: 1-1,5 g once. If 1 hour later the effect is absent, it is necessary to accept 0,5 more g and further on 0,5-1 g each 2 hours until it is possible to stop a paroxysm. The most admissible daily dose makes 3 g.

Solution for intramuscular (in oil) and intravenous (in/in) introductions

Intravenously adult Novokainamid appoint 0,1-0,5 g in a dose. Part 5% with solution of a dextrose or 0,9% chloride sodium solution to concentration of 0,002-0,005 g/ml. Enter slowly with a speed of 0,025-0,05 g/minute before stopping of a paroxysm. At the same time constantly watch pulse rate, arterial pressure and the electrocardiogram. In need of introduction repeat in the dose appointed by the doctor each 5 minutes before achievement of therapeutic effect or a total dose of 1 g.

For the prevention of repeated arrhythmia it is possible to perform infusion of drug with a speed of 0,002-0,006 g/minute.

After stopping of arrhythmia for maintenance of effect perhaps intramuscular administration of drug in a dose of 0,5-1 g (2-3 g a day), however is more preferable an intravenous way of introduction.

Also perhaps drop introduction in a dose of 0,5-0,6 g within 25-30 minutes, a maintenance dose – 0,002-0,006 g/minute, in need of continuation of therapy in 3-4 hours after the end of infusion of the patient transfer to a peroral form of drug. At heart failure of the II degree the dose is reduced (not less than on 1/3).

Intramusculary Novokainamid appoint 0,05 g/kg of body weight of the patient in a daily dose and divide into several introductions.

The maximum doses for adults at intramuscular and drop intravenous administration: one-time – 1 g, daily – 3 g.

Side effects

• Central nervous system: a myasthenia, a depression, dizziness, hallucinations, a headache, spasms, sleeplessness, an ataxy, the general weakness, psychotic reactions with productive symptomatology;
• Alimentary system: diarrhea, bitterness in a mouth, nausea and vomiting;
• Cardiovascular system: lowering of arterial pressure, ventricular Bouveret's disease; at bystry intravenous administration – a collapse, an asystolia, disturbance of atrial or intra ventricular conduction;
• Allergic reactions: skin rash.

Special instructions

In the form of solution for in/in and introductions in oil Novokainamid has to be applied only in the conditions of a hospital.

During treatment it is necessary to control constantly the arterial pressure and the electrocardiogram, at the end of therapy control of formulas of peripheral blood is necessary.

At elderly people the probability of development of arterial hypotension is high.

At use of drug during pregnancy at the woman arterial hypotension can develop that can result in uteroplacental insufficiency.

Medicinal interaction

• Muscle relaxants, cytostatic, hypotensive, antiarrhytmic and holinoblokiruyushchy medicines: their action amplifies;
• Bretylium tosylate: its side effects amplify;
• Ranitidine and Cimetidinum: the renal clearance of procaineamide decreases, the period of its semi-removal is extended;
• Anti-myasthenic drugs: their activity decreases;
• Antihistamines: atropinopodobny effects amplify;
• Pimozidum: lengthening of an interval of QT is noted;
• Antiarrhytmic drugs III of a class: the risk of development of aritmogenny effect increases;
• Drugs, the oppressing marrowy hemopoiesis: the risk of a miyelosupressiya increases.

Terms and storage conditions

To store in protected from light, the place, unavailable to children. To observe temperature condition from 0 to 25 °C.

Period of validity – 5 years.