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tocainide (toe-kay-nide)



Therapeutic: antiarrhythmics (class IB)


Life-threatening ventricular arrhythmias, including multifocal and unifocal premature ventricular contractions and ventricular tachycardia.


Suppresses automaticity of conduction tissue and spontaneous depolarization of the ventricles during diastole. Has little or no effect on heart rate. Therapeutic Effects: Suppression of arrhythmias.

Adverse Reactions/Side Effects

CNS: SEIZURES, changes in mood, drowsiness, hallucinations, headache, restlessness, tremor, coma, dizziness, mental depression, paranoia. EENT: blurred vision, thirst, tinnitus. Resp: PULMONARY FIBROSIS, pneumonia. CV: SINUS ARREST, CHF, arrhythmias, bradycardia, hypotension, palpitations, tachycardia, angina, conduction disturbances, hypertension. GI: anorexia, diarrhea, nausea, vomiting, abdominal discomfort, constipation, drug-induced hepatitis, dyspepsia, dysphagia. GU: urinary retention. Derm: alopecia, flushing, rashes, sweating. Hemat: AGRANULOCYTOSIS, leukopenia, neutropenia, thrombocytopenia. MS: arthralgia, myalgia. Neuro: myasthenia gravis, numbness.


Examination and Evaluation

  • Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

  • Monitor cardiac symptoms at rest and during exercise. Seek immediate medical assistance if symptoms of sinus arrest develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea, and loss of consciousness.

  • Assess signs of congestive heart failure including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

  • Assess any breathing problems or signs of pulmonary fibrosis or pneumonia such as dry cough, wheezing, chest pain, shortness of breath, fever, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function. Report any pulmonary dysfunction to the physician.

  • Monitor signs of blood dyscrasias including agranulocytosis, neutropenia, and leukopenia (fever, sore throat, mucosal lesions, signs of infection) or thrombocytopenia (bruising, nose bleeds, bleeding gums). Report these signs to the physician immediately.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

  • Be alert for early signs of myasthenia gravis syndrome, such as drooping eyelids, facial muscle weakness, and difficulty swallowing and speaking. Report these signs to the physician immediately, and monitor other muscle groups for signs of unusual weakness and fatigue, especially after repeated contraction.

  • Assess any joint or muscle pain to rule out musculoskeletal ...

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