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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
PubMed
Summary
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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.

Related Experiment Videos

  • 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.