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Procainamide

    Brands

    DEA Class; Rx

    Common Brand Names; Pronestyl (SR)

    • Antidysrhythmics, Ia

    IV class IA antiarrhythmic agent
    Used for atrial fibrillation/flutter, paroxysmal atrial tachycardia, and ventricular tachycardia
    Derivative of the local anesthetic procaine

    Indicated for the treatment of ventricular tachycardia with pulses (stable monomorphic or wide-complex regular ventricular tachycardia) during cardiopulmonary resuscitation (CPR) in patients with preserved left ventricular function.

    For the treatment of ventricular arrhythmias such as sustained ventricular tachycardia or junctional ectopic tachycardia in situations other than cardiac arrest; or for the conversion to and/or maintenance of sinus rhythm in patients with supraventricular arrhythmias including paroxysmal atrial tachycardia, atrial fibrillation, atrial flutter, or paroxysmal supraventricular tachycardia (PSVT)†; or for paroxysmal supraventricular tachycardia (PSVT) prophylaxis in patients with reentrant tachycardia, including patients with Wolff-Parkinson-White (WPW) syndrome.

    Hypersensitivity to procainamide or other ingredients

    Complete heart block, 2°/3° AV block, SLE, torsade de pointes

    • Increased antinuclear antibodies (50%)
    • SLE-like syndrome (30%)
    • Hypotension (5%)
    • Arrhythmias
    • Asystole
    • Heart block
    • Wide PR or QRS
    • Asthenia
    • Ataxia
    • Depression
    • Chills
    • Psychosis
    • Abdominal pain
    • Bitter taste
    • N/V
    • Myopathy
    • Rash
    • Leukopenia

    May produce life-threatening hematologic disorders (leukopenia, agranulocytosis)

    Consider toxicity if serum level >12 mg/L [51 umol/L]

    May exacerbate arrhythmias or produce paradoxical ventricular tachycardia in AFib/AFlutter patients

    Exercise caution in arrhythmias associated with digitalis intoxication; drug can suppress digitalis-induced arrhythmias; however, concomitant marked disturbance of atrioventricular conduction may result in additional depression of conduction and ventricular asystole or fibrillation; consider use only if discontinuation of digitalis and therapy with potassium, lidocaine, or phenytoin are ineffective

    Exercise caution if patient exhibits or develops first-degree heart block while receiving therapy; reduce dose if it occurs; if block persists despite dose reduction, evaluate whether to continue therapy by weighing benefit versus risk of increased heart block

    Prior to therapy, cardiovert or digitalize patients with atrial flutter or fibrillation to avoid enhancement of A-V conduction which may result in ventricular rate acceleration beyond tolerable limits; adequate digitalization reduces but does not eliminate possibility of sudden increase in ventricular rate as atrial rate is slowed by drug in these arrhythmias

    Use caution in patients with congestive heart failure, and those with acute ischemic heart disease or cardiomyopathy, when administering therapy; even slight depression of myocardial contractility may further reduce cardiac output of damaged heart

    May produce enhanced prolongation of conduction or depression of contractility and hypotension when used concurrently with other Group 1A antiarrhythmic agents such as quinidine or disopyramide, especially in patients with cardiac decompensation; reserve such use for patients with serious arrhythmias unresponsive to single drug and administer only if close observation is possible

    Renal insufficiency may lead to accumulation of high plasma levels from conventional doses of drug, with effects similar to those of overdosage, unless dosage is adjusted for individual patient

    Pregnancy Category: C

    Lactation: crosses into breast milk, discontinue drug or do not nurse

    Procainamide has a narrow therapeutic index. In all populations, dosage is individualized based on patient weight, renal function, clinical goals, patient response, serum procainamide concentrations and, when needed, serum N-acetylprocainamide (NAPA) levels.

    Procainamide hydrochloride

    injection solution

    • 100 mg/mL
    • 500mg/mL