General

Pronunciation
toe-KAY-nide

Trade Name(s)

• Tonocard

Pregnancy Category
Category C

Ther. class.
antiarrhythmics
(class IB)

Indications

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

Action

• Suppresses automaticity of conduction tissue and spontaneous depolarization of the ventricles during diastole

• Has little or no effect on heart rate

Therapeutic Effect(s):
Suppression of arrhythmias

Pharmacokinetics

Absorption: Well absorbed after oral administration

Distribution: Widely distributed; crosses the blood-brain barrier

Metabolism and Excretion: Partially metabolized by the liver. 30–50% excreted unchanged by the kidneys

Half-life: 11–23 hr

TIME/ACTION PROFILE (antiarrhythmic effects)

ROUTE	ONSET	PEAK	DURATION
PO	30–60 min	0.5–2 hr	8–12 hr

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity

• Advanced heart block

Use Cautiously in:

• CHF

• Geriatric patients or hepatic or renal impairment (dosage reduction recommended)

• Pregnancy, lactation, or children (safety not established)

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.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.
*CAPITALS/italic indicates life-threatening and most frequent.

Interactions

Drug-Drug

• Additive cardiac effects with other antiarrhythmics

• Concurrent use with metoprolol may result increase the risk of adverse cardiovascular reactions

• Cimetidine or rifampin may decrease blood levels of tocainide

Route/Dosage

• PO (Adults): 400 mg q 8 hr initially; usual maintenance dose 1.2–1.8 g/day in divided doses q 8–12 hr.

Availability

• Tablets: 400 mg, 600 mg, 400 mg $85.74/100, 600 mg $109.27/100

Assessment

• ECG, pulse, and blood pressure should be monitored before and periodically throughout therapy

• Assess lungs periodically throughout therapy. Notify physician or other health care professional if cough, wheezing, or shortness of breath occurs. Pulmonary side effects usually occur after 3–18 wk of therapy and may be fatal. Chest x-rays should also be evaluated if signs of pulmonary complications occur

Lab Test Considerations

• CBC and WBC with differential and platelet counts should be monitored weekly during the first 3 mo of therapy and frequently thereafter. Blood counts should be performed promptly if patient develops signs of infection (fever, chills, sore throat, stomatitis), bleeding, or bruising. Leukopenia, agranulocytosis, and thrombocytopenia usually occur after 2–12 wk of therapy and return to normal 1 mo after discontinuation

Potential Nursing Diagnoses

• Decreased cardiac output (Indications)

• Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

PO: Administer with food or milk to minimize GI irritation

Patient/Family Teaching

• Instruct patient to take medication around the clock, exactly as directed, even if feeling well. If a dose is missed, take as soon as remembered if within 4 hr; do not take if remembered later. Do not double doses. Consult health care professional before discontinuing medication; gradual reduction in dosage may be needed to prevent worsening of condition

• Instruct patient or family member on how to take pulse. Advise patient to report changes in pulse rate or rhythm

• May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known

• Advise patient to inform health care professional of medication regimen before treatment or surgery

• Advise patient to carry identification describing disease process and medication regimen at all times

• Instruct patient to notify health care professional if trembling, shaking, fever, chills, sore throat, ulcers in the mouth, unusual bleeding or bruising, dyspnea, cough, wheezing, or palpitations occur. The occurrence of tremor may be used as an indication that maximum dose has been reached. Health care professional should also be notified if nausea, vomiting, or diarrhea becomes severe. Tocainide may be discontinued if pulmonary fibrosis, bone marrow depression, or severe skin reaction occurs

• Emphasize the importance of routine follow-up exams to monitor progress

Evaluation/Desired Outcomes

Resolution of ventricular arrhythmias without detrimental side effects

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