Acetylprocainamide Therapy in Patients with Previous Procainamide-Induced Lupus Syndrome

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Abstract
Acetylprocainamide was used to treat 11 patients with previous procainamide-induced lupus syndrome for cardiac arrhythmias. Three patients from whom procainamide had been withdrawn and whose lupus was in remission did not have a recurrence during a course of acetylprocainamide therapy of a longer average duration than their prior procainamide therapy. Lupus symptoms subsided during treatment in 2 patients who had symptoms when acetylprocainamide was started. Drug fever developed in 1 patient and another had a mild recurrence of lupus symptoms during high-dose acetylprocainamide therapy that regressed with dosage reduction. All patients had small amounts of circulating procainamide from in vivo deacetylation of acetylprocainamide. These observations supported the hypothesis that the aromatic amino group on procainamide was important for induction of lupus syndrome and that acetylating this amino group blocked the lupus-inducing effect.