Remission of Procainamide-Induced Lupus Erythematosus with N-Acetylprocainamide Therapy
Authors: G. PAUL STEC
Journal: Annals of Internal Medicine (1979)

Brief Reports1 May 1979Remission of Procainamide-Induced Lupus Erythematosus with N-Acetylprocainamide TherapyG. PAUL STEC, M.D., JUAN J. L. LERTORA, M.D., Ph.D., ARTHUR J. ATKINSON Jr., M.D., MARY JANE NEVIN, R.N., WILLIAM KUSHNER, M.S.E.E., CHARLES JONES, FRANK R. SCHMID, M.D., JOSEPH ASKENAZI, M.D.G. PAUL STEC, M.D., JUAN J. L. LERTORA, M.D., Ph.D., ARTHUR J. ATKINSON Jr., M.D., MARY JANE NEVIN, R.N., WILLIAM KUSHNER, M.S.E.E., CHARLES JONES, FRANK R. SCHMID, M.D., JOSEPH ASKENAZI, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-5-799 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptWe describe here the case of a patient with a procainamide-induced systemic lupus erythematosus-like reaction whose arthralgias improved during antiarrhythmic therapy with the major metabolite of procainamide, N-acetylprocainamide (NAPA). His elevated antinuclear antibody (ANA) titers also returned to normal, but at a somewhat slower rate.A 63-year-old man with right calf claudication and three myocardial infarctions within the past 6 years was hospitalized for treatment of frequent premature ventricular contractions with the investigational drug NAPA (Arnar-Stone Laboratories, MoGaw Park, Illinois). Procainamide, 500 mg every 6 h, had been the antiarrhythmic therapy for the previous 2 years. The patient had generalized...References1. ROTHFIELD N: Detection of antibodies to nuclear antigens by immunofluorescence, in Manual of Clinical Immunology, edited by ROSE NR, FRIEDMAN H. Washington, D.C., American Society for Microbiology, 1976, pp. 647-651 Google Scholar2. LERTORAATKINSONKUSHNERNEVINLEEJONESSCHMID JAWMWCF: Long-term antiarrhythmic therapy with N-acetylprocainamide. Clin Pharmacol Ther, in press Google Scholar3. DRAYERREIDENBERGSEVY DMR: N-acetylprocainamide: an active metabolite of procainamide. Proc Soc Exp Biol Med 146:358-363, 1974 CrossrefMedlineGoogle Scholar4. ELSONSTRONGLEEATKINSON JJWA: Antiarrhythmic potency of N-acetylprocainamide. Clin Pharmacol Ther 17:134-140, 1975 CrossrefMedlineGoogle Scholar5. ATKINSONLEEQUINNKUSHNERNEVINSTRONG AWMWMJ: Dose-ranging trial of N-acetylprocainamide in patients with premature ventricular contractions. Clin Pharmacol Ther 21:575-587, 1977 CrossrefMedlineGoogle Scholar6. DUTCHERSTRONGLUCASLEEATKINSON JJSWA: Procainamide and N-acetylprocainamide kinetics investigated simultaneously with stable isotope methodology. Clin Pharmacol Ther 22:447-457, 1977 CrossrefMedlineGoogle Scholar7. REFSUMFRISLIDLUNDELANDMARK HKPK: Effects of N-acetylprocainamide as compared with procainamide in isolated rat atria. Eur J Pharmacol 33:47-52, 1975 CrossrefMedlineGoogle Scholar8. FREEMANHARBISONWOOSLEYOATES RRRJ: A proposed reactive metabolite of procainamide in procainamide-induced systemic lupus erythematosus (abstract). Fed Proc 36:971, 1977 Google Scholar9. WOOSLEYDRAYERREIDENBERGNIESCARROATES RDMAKJ: Effect of acetylator phenotype on the rate at which procainamide induces antinuclear antibodies and the lupus syndrome. N Engl J Med 298:1157-1159, 1978 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Northwestern University Medical School and Veterans Administration Lakeside Hospital Chicago, Illinois PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByDrug-induced lupusAcecainideDrug-induced lupusBiochemical Mechanisms of Drug ToxicityAdverse immunological effects of drugs other than anticance drugs and drugs used in immunologyANTIDYSRHYTHMIC DRUGSBiochemical Mechanisms of Drug ToxicityAcecainideDRUG-INDUCED AUTOIMMUNE DISORDERSDRUG-INDUCED LUPUSPharmacology of the class 111 antiarrhythmic agent sematilide in patients with arrhythmiasThe Role of Leukocyte-Generated Reactive Metabolites in the Pathogenesis of Ideosyncratic Drug ReactionsDrug Metabolism by Leukocytes and Its Role in Drug-Induced Lupus and Other Idiosyncratic Drug ReactionsN-acetylprocainamide is a less potent inducer of t cell autoreactivity than procainamideCardiovascular Drugs in PregnancyThe Pharmacology of Antiarrhythmic DrugsDrug-induced lupus.Electrophysiologic evaluation of the antiarrhythmic effects of N-acetylprocainamide for ventricular tachycardia secondary to coronary artery diseaseN -Acetylprocainamide Kinetics During Intravenous Infusions and Subsequent Oral Doses in Patients with Coronary Artery Disease and Ventricular ArrhythmiasDrug-Related Rheumatic DiseasesCardiac glycosides and drugs used in dysrhythmiasTherapy with Conventional Antiarrhythmic Drugs for Ventricular ArrhythmiasTorsade de pointes induced by N-AcetylprocainamideAntiarrhythmic Therapy: Clinical Pharmacology UpdateAromatic amines and the pathogenesis of lupus erythematosusImportance of metabolites in antiarrhythmic therapyLupus erythematosus-like disease due to hydrazineAntipolynucleotide antibodies: The rheumatic connectionOrthopedic surgeryClinical use of antiarrhythmic drugsClass I antiarrhythmic agents: Quinidine, procainamide and N-acetylprocainamide, disopyramideUpdate on Quinidine and ProcainamideDrug-induced Lupus: Clinical and Serological StudiesAutoantibodies to Nuclear Antigens (ANA): Their Immunobiology and MedicineLong-term antiarrhythmic therapy with acetylprocainamideThe chemical induction of systemic lupus erythematosus and lupus-like illnessesAcetylprocainamide Therapy in Patients with Previous Procainamide-Induced Lupus SyndromeJEFFREY KLUGER, M. D., DENNIS E. DRAYER, Ph.D., MARCUS M. REIDENBERG, M.D., ROBERT LAHITA, Ph.D.; M.DDrug-induced lupus: An adjuvant disease?Pharmacokinetics of Procainamide and N-Acetylprocainamide in RatsDrugs and the KidneyClinical pharmacology and antiarrhythmic efficacy of N-acetylprocainamideCardiac glycosides and drugs used in dysrhythmiasChronic ventricular arrhythmias: Comparative drug effectiveness and toxicityThe clinical pharmacology and antiarrhythmic efficacy of acetylprocainamide in patients with arrhythmiasAcetylator phenotype in idiopathic systemic lupus erythematosusProcainamide, NAPA and systemic lupus.PDA by Doppler echo.Systemic lupus erythematosusAntibodies to Nuclear Antigens in Patients Treated with Procainamide or AcetylprocainamideRENAL EFFECTS OF TOLAZOLINE IN RABBITSPROCAINAMIDE, ACETYLPROCAINAMIDE, AND DRUG-INDUCED LUPUS ERYTHEMATOSUSTheoretical Basis for Interest in Acetylprocainamide and Clinical Experiences with This New Antiarrhythmic AgentDrug-Induced Lupus Erythematosus 1 May 1979Volume 90, Issue 5Page: 799-801KeywordsAntinuclear antibodiesArthralgiaDrugsLupus erythematosusMetabolitesMyocardial infarctionPremature ventricular contraction Issue Published: 1 May 1979 PDF DownloadLoading ...