Procainamide

Procainamide Brand Names

Procanbid | Pronestyl | Pronestyl-SR

What is Procainamide

Procainamide is a potent class Ia antiarrhythmic agent used in the treatment of several cardiac arrhythmias including atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia, and ventricular tachycardia.

A derivative of the local anesthetic procaine, procainamide is similar in action to quinidine and disopyramide. Emergency use of procainamide is limited by the need for a prolonged drug infusion time to avoid hypotension.

Although amiodarone is recommended first-line, procainamide is a potential treatment alternative for perfusing ventricular tachycardia during cardiopulmonary resuscitation (CPR) in patients with preserved left ventricular function.

Procainamide was given FDA approval in 1950 and has been used in clinical medicine since 1951.

Indications

1. atrial fibrillation
2. atrial flutter
3. cardiopulmonary resuscitation
4. junctional ectopic tachycardia
5. paroxysmal atrial tachycardia
6. paroxysmal supraventricular tachycardia (PSVT)
7. paroxysmal supraventricular tachycardia (PSVT) prophylaxis
8. supraventricular arrhythmias
9. ventricular tachycardia
10. Wolff-Parkinson-White (WPW) syndrome

• When using procainamide for non-emergent indications, adjust the dose according to patient response, renal function, serum procainamide concentrations, and, when indicated, serum NAPA concentrations.

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

NOTE: ACLS guidelines recommend the use of procainamide for patients with hemodynamically stable monomorphic ventricular tachycardia who do not have severe congestive heart failure, acute myocardial infarction, or prolonged QT

Side Effects

1. abdominal pain
2. agranulocytosis
3. angioedema
4. anorexia
5. aplastic anemia
6. arrhythmia exacerbation
7. arthralgia
8. asthenia
9. asystole
10. bone marrow suppression
11. chills
12. depression
13. diarrhea
14. dizziness
15. dyspepsia
16. elevated hepatic enzymes
17. fever
18. flushing
19. hallucinations
20. heart failure
21. hemolytic anemia
22. hepatic failure
23. hyperbilirubinemia
24. hypotension
25. leukopenia
26. lupus-like symptoms
27. maculopapular rash
28. myalgia
29. nausea
30. neutropenia
31. pancytopenia
32. pericarditis
33. positive antinuclear antibodies
34. PR prolongation
35. pruritus
36. psychosis
37. QT prolongation
38. rash
39. thrombocytopenia
40. torsade de pointes
41. urticaria
42. ventricular fibrillation
43. ventricular tachycardia
44. vomiting
45. weakness

Monitoring Parameters

• CBC
• serum creatinine/BUN
• serum procainamide concentrations

Contraindications

• agranulocytosis
• apheresis
• arrhythmia exacerbation
• asthma
• atrial fibrillation
• atrial flutter
• AV block
• bone marrow suppression
• bradycardia
• breast-feeding
• bundle-branch block
• cardiogenic shock
• cardiomyopathy
• celiac disease
• digitalis toxicity
• ester local anesthetic hypersensitivity
• females
• fever
• geriatric
• heart failure
• hemolytic anemia
• hemorrhagic shock
• hepatic disease
• human immunodeficiency virus (HIV) infection
• hyperparathyroidism
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypotension
• hypothermia
• hypothyroidism
• leukopenia
• long QT syndrome
• mortality
• myasthenia gravis
• myocardial infarction
• neutropenia
• pheochromocytoma
• positive antinuclear antibodies
• pregnancy
• QT prolongation
• renal disease
• renal failure
• renal impairment
• rheumatoid arthritis
• shock
• sickle cell disease
• sleep deprivation
• slow acetylation
• stroke
• sulfite hypersensitivity
• systemic lupus erythematosus (SLE)
• thrombocytopenia
• torsade de pointes
• ventricular dysfunction

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