II. Mechanism
- See Class Ia Antiarrhythmic
- Suppresses ventricular ectopy
- Suppresses Phase 4 diastolic depolarization
- Reduces automaticity of all Pacemakers
- Slows intraventricular conduction
- May terminate reentrant Arrhythmias
III. Indications
- Ventricular Tachycardia (refractory to Lidocaine)
- Ventricular Fibrillation
-
Atrial Fibrillation with accessory pathway (preexcitation, WPW) rate control and cardioversion
- Time to Cardioversion: 1 hour
- Conversion Rate: 20%
- Chronic Efficacy: 50%
IV. Contraindications
- Structural Heart Disease (e.g. Acute Myocardial Infarction, LV Dysfunction)
- Risk for lethal ventricular Arrhythmias and increased mortality
- Hypokalemia
- Hypomagnesemia
-
Systemic Lupus Erythematosus
- Risk of blood dyscrasias
V. Precautions
- Proarrhythmic
- Risk for ventricular Arrhythmias and mortality in structural heart disease (Acute Myocardial Infarction, LV Dysfunction)
- Monitoring
- Blood Pressure Monitoring
- Electrocardiogram Monitoring
- Complete Blood Count (esp. White Blood Cells and Platelet Count)
- Toxic metabolite N-acetylprocainamide (NAPA)
VI. Dosing
- Preparation of Procainamide Infusion
- Dilute 2 g in 250 ml D5W (8 mg/ml)
- Endpoints to Dosing
- Arrhythmia is suppressed
- Hypotension
- QRS Complex widening over 50% of original width
- PR Interval or QT Interval lengthening over 50%
- Maximum total dose reached: 17 mg/kg or 1000 mg administered
- Child
- Load
- Start 2 to 6 mg/kg (up to 100 mg) IV infused over 5 minutes
- Repeat dose every 5 to 10 min as needed up to cummulative maximum of 15 mg/kg
- Maintenance
- Infuse 20 to 80 mcg/kg/minute
- Maximum 2 grams/day
- Load
- Adult
- Load
- Infuse 20 mg/min (or 100 mg IV every 10 minutes) until any above endpoint reached
- Max Total Dose: 17 mg/kg or 1000 mg administered
- Maintenance: 1-4 mg/min (up to 6 mg/min)
- Start after effect is achieved with loading dose
- Load
-
Liver Disease
- Decrease dose or decrease dosing frequency
-
Renal Insufficiency
- GFR 35 to 59 ml/min
- Decrease initial maintenance dose by 30%
- GFR 15 to 34 ml/min
- Decrease initial maintenance dose by 40 to 60%
- GFR <15 ml/min
- Reduce dose, Exercise caution and monitor closely
- GFR 35 to 59 ml/min
VII. Adverse Effects
- Common
- Electrocardiogram changes
- QRS Complex widening
- PR Interval lengthening
- QTc Prolongation
- Electrocardiogram changes
- Serious
- Hypotension
- Atrioventricular conduction disturbance
- Malignant Ventricular Arrhythmia
- Torsades de Pointes
- May parodoxically increase the ventricular response to atrial tachyarrhythmia
- Blood Dyscrasias (esp. in Systemic Lupus Erythematosus)
VIII. Pharmacokinetics
- Low Protein Binding
- Hepatic metabolism with renal excretion
- Metabolized to the active, and toxic metabolite N-acetylprocainamide (NAPA)
IX. Safety
- Pregnancy Category C
- Unknown safety in Lactation
X. References
- Procainamide Injection Solution (DailyMed)
XI. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 78-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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Definition (MSH) | A class Ia antiarrhythmic drug that is structurally-related to PROCAINE. |
Definition (CSP) | derivative of procaine, cardiac depressant used in treatment of cardiac arrhythmias. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D011342 |
SnomedCT | 11959009, 372589008 |
LNC | LP32138-7, LP16261-7, MTHU005035 |
English | Procainamide, Amide, Procaine, Procaine Amide, procainamide, Benzamide, 4-amino-N-(2-(diethylamino)ethyl)-, Procainamide [Chemical/Ingredient], procaine amide, Benzamide, p-amino-N-(2-(diethylamino)ethyl)-, p-Aminobenzoic Diethylaminoethylamide, PROCAINAMIDE, Procainamide (product), Procainamide (substance) |
Swedish | Prokainamid |
Czech | prokainamid |
Finnish | Prokaiiniamidi |
Russian | NOVOKAINAMID, PROKAINAMID, НОВОКАИНАМИД, ПРОКАИНАМИД |
Japanese | プロカインアミド, プロカインアミド塩酸塩 |
Italian | Procainammide, Procanaimide |
Polish | Prokainamid |
Spanish | procainamida (producto), procainamida (sustancia), procainamida, Procainamida, Procaína Amida |
French | Procaïnamide |
German | Procain-Amid, Procainamid |
Portuguese | Amida Procaínica, Procainamida |
Ontology: Pronestyl (C0392424)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D011342 |
English | pronestyl, Pronestyl, Apothecon Brand of Procainamide Hydrochloride, Bristol-Myers Squibb Brand of Procainamide Hydrochloride |