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Pronounced: TAH-nuh-card
Generic name: Tocainide hydrochloride

Why is this drug prescribed: Tonocard is used to treat severe irregular heartbeat (arrhythmias). Arrhythmias are generally divided into two main types: heartbeats that are faster than normal (tachycardia), or heartbeats that are slower than normal (bradycardia). Irregular heartbeats are often caused by drugs or disease but can occur in otherwise healthy people with no history of heart disease or other illness. Tonocard works differently from other antiarrhythmic drugs, such as quinidine (Quinidex), procainamide (Procan SR), and disopyramide (Norpace). It is similar to lidocaine (Xylocaine) and is effective in treating severe ventricular arrhythmias (irregular heartbeats that occur in the main chambers of the heart).

Most important fact about this drug: Tonocard can cause serious blood and lung disorders in some patients, especially in the first 3 months of treatment. Be sure to notify your doctor if any of the following occurs: painful or difficult breathing, wheezing, cough, easy bruising or bleeding, tremors, palpitations, rash, soreness or ulcers in the mouth, sore throat, fever, and chills.

How should you take this medication: It is important to take Tonocard on a regular schedule, exactly as prescribed by your doctor. Try not to miss any doses. If this medication is not taken regularly, your condition can worsen. --If you miss a dose... If less than 2 hours have passed, take the forgotten dose as soon as you remember. If you are more than 2 hours late, skip the dose. Never try to "catch up" by taking a double dose. --Storage instructions... Keep the container tightly closed, and store it at room temperature. Protect from extreme heat.

What side effects may occur: Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Tonocard. More common side effects may include: Confusion/disorientation, dizziness/vertigo, diarrhea/loose stools, excessive sweating, hallucinations, increased irregular heartbeat, lack of coordination, loss of appetite, nausea, nervousness, rash/skin eruptions, tingling or pins and needles, tremor, vision disturbances, vomiting Less common side effects may include: Arthritis, anxiety, chest pain, congestive heart failure, drowsiness, exhaustion, fatigue, headache, hearing loss, hot/cold feelings, involuntary eyeball movement, joint pain, low blood pressure, muscle pain, pounding heartbeat, rapid heartbeat, ringing in ears, sleepiness, slow heartbeat, sluggishness, unsteadiness, walking disturbances Rare side effects may include: Abdominal pain/discomfort, agitation, allergic reactions, anemia, angina, blood clots in lungs, blood disorders, changes in blood counts, changes in heart function, chills, cinchonism (a sensitivity reaction with symptoms including ringing in the ears, loss of hearing, dizziness, light-headedness, headache, nausea, and/or disturbed vision), cold hands and feet, coma, constipation, decreased mental ability, decreased urination, depression, difficulty breathing, difficulty speaking, difficulty sleeping, difficulty swallowing, disturbed behavior, disturbed dreams, dizziness on standing, double vision, dry mouth, earache, enlarged heart, fainting, fever, fluid in lungs, fluid retention, flushing, general bodily discomfort, hair loss, heart attack, hepatitis, hiccups, high blood pressure, hives, increased stuttering, increased urination, lung disorders, memory loss, muscle cramps, muscle twitching/spasm, myasthenia gravis, neck pain or pain extending from the neck, pallor, pneumonia, seizures, skin peeling, slurred speech, smell disturbance, stomach upset, taste disturbance, thirst, weakness, yawning, yellow eyes and skin

Why should this drug not be prescribed: If you have heart block (conduction disorder) and do not have a pacemaker, or if you are sensitive to or have ever had an allergic reaction to Tonocard or certain local anesthetics such as Xylocaine, do not take this medication.

Special warnings about this medication: Be alert for signs of the blood and lung disorders that can occur early in your treatment. (See "Most important fact about this drug.") If you have congestive heart failure, make sure the doctor is aware of it. Tonocard could worsen this condition. Also make certain that the doctor is aware of any kidney or liver problems that you have. You will need to be monitored more carefully. Before any kind of surgery, including dental surgery and emergency treatment, make sure the surgeon knows that you are taking Tonocard.

Possible food and drug interactions when taking this medication: If Tonocard is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Tonocard with any of the following: The anesthetic Lidocaine (Xylocaine) The blood pressure medicine Metoprolol (Lopressor) Other antiarrhythmics such as Quinidex, Procan, Mexitil

Special information if you are pregnant or breastfeeding: The effects of Tonocard during pregnancy have not been adequately studied. However, animal studies have shown an increase in stillbirths and spontaneous abortions. If you are pregnant or plan to become pregnant, inform your doctor immediately. Tonocard may appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

Recommended dosage: ADULTS: Dosages of Tonocard must be adjusted according to its effects on each individual. Your doctor should monitor you carefully to determine if the dosage you are taking is working properly. He may divide your doses further or make other changes, such as shortening the time between doses, if side effects occur. The usual starting dose is 400 milligrams every 8 hours. The usual dose range is between 1,200 and 1,800 milligrams total per day divided into 3 doses. This medication can be taken in 2 doses a day with careful monitoring by your doctor. Doses beyond 2,400 milligrams per day are rarely used. Some people, particularly those with reduced kidney or liver function, may be treated successfully with less than 1,200 milligrams per day. CHILDREN: The safety and effectiveness of this drug in children have not been established.

Overdosage: Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately. There are no specific reports of Tonocard overdose. However, the first and most important signs of overdose would be expected to appear in the central nervous system. Disorders of the stomach and intestines might follow. Convulsions and heart and lung slowing or stopping might occur.

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