Page 165 - 2026 SMOG

PROCAINAMIDE (PROCANBID)
Class/Mechanism of Action
• Antiarrhythmic Agent, Class 1a
Decreases myocardial excitability and conduction velocity; may depress myocardial
contractility by increasing the electrical stimulation threshold of the ventricle, the His-Purkinje
system, and through direct cardiac effects.
˚ Onset of action—IV: 5min, IM (Not for emergent situations): 10–30min; Duration: 46hr
Indications
• Labeled Indications
˚ Treatment of refractory tachyarrhythmia with a pulse/hemodynamic compromise
˚
Wide-complex tachyarrhythmia/no hemodynamic compromise
• Off-Label Indications
˚ Atrial fibrillation (pre-excited); Junctional tachycardia; Stable monomorphic ventricular
tachycardia
Contraindications
• Hypersensitivity to Procainamide, procaine, other ester-type local anesthetics, or any
component of the formulation
• Complete heart block; second-degree AV block or various types of hemiblock
• SLE (Systemic Lupus Erythematosus)
• Torsades de Pointes
Adverse Reactions/Precautions
• Lupus-like syndrome
• Hypotension
• Skin rash
• Diarrhea, dysgeusia, nausea/vomiting
• May induce Torsades de Pointes
• Potentially fatal blood dyscrasias (e.g., agranulocytosis) have occurred with therapeutic doses.
• Avoid in prolonged QT or congestive heart failure
• Avoid use in patients with myasthenia gravis; may worsen condition
• Pregnancy: Avoid long-term treatment
• Lactation: Use with caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Ventricular Arrhythmias/Atrial Fibrillation SVT/Ventricular Arrhythmias
(Pre-Excited) • IV/IO
• IV ˚ 15mg/kg over 30–60min
˚ 20–50mg/min until: Note: Do not routinely administer Amiodarone
■ Arrhythmia suppression and Procainamide together
■ Hypotension
■ QRS widens by >50%
■ Total dose 17mg/kg reached
Maintenance infusion: 1–4mg/min
■

2026 Standard Medical Operating Guidelines (SMOG) • 157