Disopyramide should not be administered in cardio-genic shock, preexisting second- or third-degree A-V block, or known hypersensitivity to the drug. Neither should it be given to patients who are poorly compensated or those with uncompensated heart failure or severe hypotension. Because of its ability to slow cardiac conduction, disopyramide is not indicated for the treatment of digitalis-induced ventricular arrhythmias. Patients with congenital prolongation of the QT interval should not receive quinidine, procainamide, or disopyra-mide because further prolongation of the QT interval may increase the incidence of ventricular fibrillation.
Because of its anticholinergic properties, disopyra-mide should not be used in patients with glaucoma. Urinary retention and benign prostatic hypertrophy are also relative contraindications to disopyramide therapy. Patients with myasthenia gravis may have a myasthenic crisis after disopyramide administration as a result of the drug's local anesthetic action at the neuromuscular junction. The elderly patient may exhibit increased sensitivity to the anticholinergic actions of disopyramide.
Caution is advised when disopyramide is used in conjunction with other cardiac depressant drugs, such as verapamil, which may adversely affect atrioventricular conduction.
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