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Procainamide-induced myasthenic crisis
P J Godley1, T A Morton, J A Karboski
1College of Pharmacy, University of Texas, Austin 78712.
Therapeutic Drug Monitoring
|July 1, 1990
Summary
Procainamide caused respiratory failure in a myasthenia gravis patient. This drug-induced respiratory event resolved quickly after discontinuing procainamide, with no need for other interventions.
Area of Science:
- Clinical Medicine
- Pharmacology
- Neurology
Background:
- Myasthenia gravis is an autoimmune disorder affecting neuromuscular junctions.
- Respiratory complications are a known risk in myasthenia gravis patients.
- Procainamide is an antiarrhythmic drug with potential side effects.
Observation:
- A patient with myasthenia gravis developed acute respiratory failure.
- The respiratory failure was temporally associated with procainamide administration.
- No significant levels of N-acetyl-procainamide, a metabolite, were detected.
Findings:
- Procainamide, independent of its metabolite, can precipitate respiratory failure in myasthenic patients.
- The adverse event was reversible upon cessation of the drug.
- Successful extubation occurred within 12 hours of the last procainamide dose.
Implications:
- Clinicians should exercise caution when prescribing procainamide to patients with myasthenia gravis.
- Monitoring for respiratory compromise is crucial in myasthenic patients receiving procainamide.
- This case underscores the importance of considering drug-induced toxicity in unexplained respiratory failure.