• Ventricular and atrial arrhythmias, including:
  • Ventricular tachycardia,
  • Atrioventricular reentrant tachycardia,
  • Atrial fibrillation

Contraindicated in:

• Hypersensitivity
• AV block
• Myasthenia gravis
• Lactation: Lactation.

Use Cautiously in:

• MI or digoxin toxicity
• HF, renal impairment, or hepatic impairment (dose ↓ recommended)
• OB: Safety not established in pregnancy
• Pedi: Safety and effectiveness not established in children
• Geri: Dose ↓ recommended.

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

Derm: rash.

GI: diarrhea, anorexia, nausea, vomiting.

Hemat: AGRANULOCYTOSIS, eosinophilia, leukopenia, thrombocytopenia.

Neuro: confusion, dizziness, SEIZURES.
Misc: chills, drug-induced lupus, 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)

• Solution for injection: 100 mg/mL; 500 mg/mL;

• IV (Adults): 100 mg every 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: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Converted by the liver by N-acetyltransferase to N-acetylprocainamide (NAPA), an active antiarrhythmic compound; rate of acetylation is genetically determined (slow acetylators have ↑ procainamide levels and ↑ risk of toxicity; fast acetylators have ↓ procainamide levels and ↑ risk for treatment failure). 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 females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding.
• 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