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Procainamide

Classification

Class 1A antiarrhythmic

Indications

CCP: Ventricular or supraventricular arrhythmias

Contraindications

Hypersensitivity
SLE
2^nd or 3^rd degree block
Torsades de pointes
Congenital prolonged QT syndrome
Uncorrected electrolyte abnormalities

Caution

QT prolongation
Familial history of prolonged QT syndrome
Bradycardia
Recent MI
CHF
Renal impairment
Bone marrow depression
Myasthenia gravis

Adult dosages

CCP: Ventricular arrhythmias

10-17 mg/kg at a rate of 20-50 mg/minute to a max of 17 mg/kg. IV
or 100 mg q 5 minutes to a max of 17 mg/kg IV
administered until arrhythmia is controlled, hypotension occurs, or QRS wideness by 50%
Maintenance 1-4 mg/min IV infusion

Supraventricular arrhythmias

10-17 mg/kg/dose IV x1 to a max of 17 mg/kg Infused over 25-30 minutes. (not to exceed 50 mg/min)
Maintenance 1-4 mg/min IV infusion

Pediatric Considerations And Dosing

CCP: Ventricular arrhythmias

Loading dose 3-6 mg/kg IV over 5 minutes not to exceed 100 mg/dose may repeat q 5-10 minutes PRN (not to exceed 15 mg/kg)
Maintenance 20-80 mcg/kg/min IV infusion

CCP: Supraventricular arrhythmias

Loading dose 3-6 mg/kg IV over 5 minutes not to exceed 100 mg/dose may repeat q 5-10 minutes PRN (not to exceed 15 mg/kg)
Maintenance 20-80 mcg/kg/min IV infusion

Mechanism Of Action

Class 1A antiarrhythmic that inhibits recovery after repolarization resulting in a decreased myocardial excitation and conduction velocity. Sodium channel blockade results in direct membrane stabilization that decreases conduction velocity and prolongs refractoriness.

Pharmacokinetics

Onset: 10-30 minutes

Peak plasma time: 15-60 minutes

Half-life: 2.5-4.7 hours

Adverse Effects

V-fib
Asystole
QT prolongation
Torsades de pointes
Seizures
Thrombocytopenia
Neutropenia
Hemolytic anemia
SLE
Agranulocytosis
Hypotension
Bradycardia
Flushing
Urticaria
Angioedema
Pruritus
Rash
Fever
Nausea/vomiting
Hallucinations
Elevated LFT’s
Diarrhea
Dipzziness

Warning And Precautions

Long-term administration often leads to positive antinuclear antibody test results (ANA).
Proarrhythmic effects.
Multiple blood dyscrasias have been reported. These include, agranulocytosis, myelosuppression, neutropenia, hypoplastic anemia, and thrombocytopenia.

Drug Interactions

Cisapride
Desipramine
Dronedarone
Fingolimod
Pimozide
Quinidine
Thioridazine
Ziprasidone
Amiodarone
Amitriptyline
Amoxapine
Chlorpromazine
Clomipramine
Disopyramide
Dofetilide
Doxepin
Droperidol
Epinephrine
Erythromycin
Fluconazole
Fluphenazine
Goserelin
Haloperidol
Ibutilide
Imipramine
Indapamide
Ketoconazole
Leuprolide
Lofepramine
Lumefantrine
Maprotiline
Moxifloxacin
Nilotinib
Nortriptyline
Octreotide
Pentamidine
Merphenazine
Prochlorperazine
Promazine
Promethazine
Protriptyline
Sotalol
Trazadone
Trifluoperazine
Trimipramine