procainamide

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.

Adv. Reactions/Side Effects ⬆ ⬇

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

Interactions ⬆ ⬇

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.

Availability ⬆ ⬇

(Generic available)

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

Route/Dosage ⬆ ⬇

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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

Therapeutic effects:

Suppression of arrhythmias.

Classifications ⬆ ⬇

Therapeutic Classification: antiarrhythmics (class IA)

Pharmacokinetics ⬆ ⬇

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.

Time/Action Profile ⬆ ⬇

(antiarrhythmic effects)

ROUTE	ONSET	PEAK	DURATION
IV	immediate	25–60 min	3–4 hr

Patient/Family Teaching ⬆ ⬇

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.
Rep: 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.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

0409- Hospira, Inc.
- 0409-1902- Procainamide Hydrochloride
  - 0409-1902-01- 25 CARTON in 1 CASE (0409-1902-01) > 1 VIAL, MULTI-DOSE in 1 CARTON > 10 mL in 1 VIAL, MULTI-DOSE

0409- Hospira, Inc.
- 0409-1903- Procainamide Hydrochloride
  - 0409-1903-01- 25 CARTON in 1 PACKAGE (0409-1903-01) > 1 VIAL, MULTI-DOSE in 1 CARTON > 2 mL in 1 VIAL, MULTI-DOSE

14789- Nexus Pharmaceuticals Inc
- 14789-900- Procainamide Hydrochloride
  - 14789-900-02- 1 VIAL, MULTI-DOSE in 1 CARTON (14789-900-02) > 2 mL in 1 VIAL, MULTI-DOSE

14789- Nexus Pharmaceuticals Inc
- 14789-901- Procainamide Hydrochloride
  - 14789-901-10- 10 VIAL, MULTI-DOSE in 1 CARTON (14789-901-10) > 10 mL in 1 VIAL, MULTI-DOSE

63739- McKesson Corporation
- 63739-459- Procainamide Hydrochloride
  - 63739-459-05- 5 BAG in 1 BOX (63739-459-05) > 1 VIAL, MULTI-DOSE in 1 BAG > 10 mL in 1 VIAL, MULTI-DOSE

71872- Medical Purchasing Solutions, LLC
- 71872-7115- Procainamide Hydrochloride
  - 71872-7115-1- 1 VIAL, MULTI-DOSE in 1 BAG (71872-7115-1) > 1 INJECTION in 1 VIAL, MULTI-DOSE

71872- Medical Purchasing Solutions, LLC
- 71872-7170- Procainamide Hydrochloride
  - 71872-7170-1- 1 VIAL, MULTI-DOSE in 1 BAG (71872-7170-1) > 1 INJECTION in 1 VIAL, MULTI-DOSE

76329- International Medication Systems, Limited
- 76329-3399- Procainamide Hydrochloride
  - 76329-3399-5- 5 SYRINGE in 1 PACKAGE (76329-3399-5) > 10 mL in 1 SYRINGE

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Indications ⬇

Contraind./Precautions ⬆ ⬇