• Treatment of a wide variety of ventricular and atrial arrhythmias, including:
  • Atrial premature contractions,
  • Premature ventricular contractions,
  • Ventricular tachycardia,
  • Paroxysmal atrial tachycardia.
• Maintenance of normal sinus rhythm after conversion from atrial fibrillation or flutter.

Contraindicated in:

• Hypersensitivity
• AV block
• Myasthenia gravis.

Use Cautiously in:

• MI or digoxin toxicity
• HF, renal dysfunction, or hepatic dysfunction (dose ↓ recommended)
• Geri: Dose ↓ recommended)
• OB: Lactation: Pedi: Safety not established.

CNS: SEIZURES, confusion, dizziness.

CV: ASYSTOLE, HEART BLOCK, VENTRICULAR ARRHYTHMIAS, hypotension.

GI: diarrhea, anorexia, bitter taste, nausea, vomiting.

Derm: rash.

Hemat: AGRANULOCYTOSIS, eosinophilia, leukopenia, thrombocytopenia.
Misc: chills, drug-induced systemic lupus syndrome, fever.

Drug-Drug:

• May have additive or antagonistic effects with other antiarrhythmics.
• Additive neurologic toxicity (confusion, seizures) with lidocaine.
• Antihypertensives and nitrates may potentiate hypotensive effect.
• Potentiates neuromuscular blocking agents.
• May partially antagonize the therapeutic effects of anticholinesterase agents in myasthenia gravis.
• ↑risk of arrhythmias with pimozide.
• Additive anticholinergic effects with other drugs possessing anticholinergic properties, including antihistamines, antidepressants, atropine, haloperidol, and phenothiazines.
• Effects of procainamide may be ↑ by cimetidine, quinidine, or trimethoprim.

(Generic available)

• Injection: 100 mg/mL; 500 mg/mL;

• IM (Adults): 50 mg/kg/day in divided doses q 3–6 hr.
• IV (Adults): 100 mg q 5 min until arrhythmia is abolished or 1000 mg have been given; wait at least 10 min until further dosing or loading infusion of 500–600 mg over 30–60 min followed by maintenance infusion of 1–4 mg/min.

Pronestyl

• Decreases myocardial excitability.
• Slows conduction velocity.
• May depress myocardial contractility.

• Suppression of arrhythmias.

Therapeutic Classification: antiarrhythmics (class IA)

Absorption: Well absorbed (75–90%) following IM administration.

Distribution: Rapidly and widely distributed.

Metabolism/Excretion: Converted by the liver to N-acetylprocainamide (NAPA), an active antiarrhythmic compound. Remainder (40–70%) excreted unchanged by the kidneys.

Half-life: 2.5–4.7 hr (NAPA — 7 hr); ↑ in renal impairment.

(antiarrhythmic effects)

• May cause dizziness. Caution patient to request assistance with ambulation until response to medication is known.
• Advise patient to notify health care professional immediately if signs of drug-induced lupus syndrome (fever, chills, joint pain or swelling, pain with breathing, skin rash), leukopenia (sore throat, mouth, or gums), or thrombocytopenia (unusual bleeding or bruising) occur. Medication may be discontinued if these occur.
• Advise patient to carry identification at all times describing disease process and medication regimen.
• Emphasize the importance of routine follow-up exams to monitor progress.

proe-KANE-ah-mide