Tocainide

What is Tocainide

NOTE: This drug is discontinued in the US.

Tocainide is an oral, local anesthetic-type antiarrhythmic agent similar to both lidocaine and mexiletine.

Tocainide is categorized as a class Ib antiarrhythmic according to the Vaughan-Williams classification of antiarrhythmic agents and is used in the treatment of ventricular arrhythmias including unifocal and multifocal ventricular premature contractions, coupled ventricular premature contractions, and paroxysmal ventricular tachycardia.

It also has been used in certain types of neurologic diseases such as seizure disorders and pain associated with diabetic neuropathy.

However, tocainide can cause serious and potentially fatal hematological adverse effects.

Tocainide (Tonocard®) was approved by the FDA in November 1984.

Tonocard® tablets were discontinued on December 31, 2003; AstraZeneca has no further plans to manufacture or distribute Tonocard®.

Generic tocainide is not available.

Brand Name

Tonocard

Indications

  • neuropathic pain
  • ventricular tachycardia

For the treatment of sustained ventricular tachycardia that is deemed to be life-threatening

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. anemia
  4. angina
  5. anorexia
  6. anxiety
  7. arrhythmia exacerbation
  8. arthralgia
  9. ataxia
  10. AV block
  11. bradycardia
  12. bundle-branch block
  13. confusion
  14. constipation
  15. diarrhea
  16. dizziness
  17. drowsiness
  18. dyspepsia
  19. dysphagia
  20. eosinophilia
  21. fatigue
  22. hallucinations
  23. hearing loss
  24. heart failure
  25. hemolysis
  26. hypertension
  27. hypotension
  28. lethargy
  29. leukopenia
  30. myalgia
  31. myocardial infarction
  32. nausea
  33. neutropenia
  34. night sweats
  35. nystagmus
  36. palpitations
  37. pancreatitis
  38. paresthesias
  39. pericarditis
  40. pneumonitis
  41. premature ventricular contractions (PVCs)
  42. pulmonary edema
  43. pulmonary embolism
  44. pulmonary fibrosis
  45. QT prolongation
  46. rash
  47. respiratory arrest
  48. restlessness
  49. sinus tachycardia
  50. stomatitis
  51. thrombocytopenia
  52. tinnitus
  53. tremor
  54. ventricular fibrillation
  55. vertigo
  56. vomiting

Monitoring Parameters

  • CBC
  • ECG

Contraindications

  • amide local anesthetic hypersensitivity
  • AV block
  • bone marrow suppression
  • breast-feeding
  • cardiac arrhythmias
  • children
  • dialysis
  • geriatric
  • heart failure
  • hematological disease
  • hepatic disease
  • pregnancy
  • pulmonary disease
  • pulmonary fibrosis
  • renal disease
  • renal failure
  • renal impairment

Interactions

  • Bupivacaine; Lidocaine
  • Cimetidine
  • Colesevelam
  • Dofetilide
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Lacosamide
  • Lidocaine
  • Lidocaine; Prilocaine
  • Moricizine
  • Propranolol
  • Rifampin
  • Rifapentine
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