Page 172 - 2023 SMOG Digital

PROCAINAMIDE Lactation?(Not Recommended) Trade Name: Procanbid
Class / Mechanism of Action
Antiarrhythmic Agent, Class Ia
Decreases myocardial excitability & conduction velocity, may depress myocardial contractility by
increasing the electrical stimulation threshold of ventricle, His-Purkinje system and through direct cardiac
effects
Onset of action: IV: 5min, IM: (Not for emergent situations) 10-30min, Duration 4-6hr
Indications
Labeled Indications: Treatment of supraventricular arrhythmias, life-threatening ventricular arrhythmias.
Unlabeled: Atrial fibrillation (preexcited); Junctional tachycardia; Stable monomorphic ventricular
tachycardia.
Contraindications
• Hypersensitivity to procainamide, procaine, other ester-type local anesthetics
• complete heart block; second-degree AV block or various types of hemiblock
• SLE (Systemic lupus erythematosus)
• Torsade de pointes
Adverse Reactions / Precautions
• Lupus-like syndrome
• Hypotension
• Skin rash
• Diarrhea, dysgeusia, nausea/vomiting
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Ventricular arrhythmias/ Atrial fibrillation Ventricular arrhythmias:
(preexcited): Infants, Children, and Adolescents IV:
Note: Dose must be individualized and titrated to • Loading dose: 10-15mg/kg over 30-60min
patient response Neonates: Administer over 60min
• IV Loading dose: 10-17mg/kg at a rate of o Infants and Children: Administer over
20-50mg/min or 100mg q5min; o 30-60min
• Must dilute prior to IV administration. Dilute Adolescents: Administer at usual
loading dose to a maximum concentration of o infusion rate: 20-50mg/min not to
20mg/mL; administer loading dose at a max rate exceed 50mg/min
of 50mg/min until:
o Arrhythmia suppression • Maintenance infusion: 20-80mcg/kg/min;
maximum daily dose: 2000mg/24hr
o Hypotension
o QRS widens by >50%
o total dose 17mg/kg reached Note: Infusion rate should be decreased if QT
interval becomes prolonged or patient develops
heart block; discontinue the infusion if patient
• Maintenance infusion: 2-6mg/min develops hypotension or QRS interval widens to
>50% of baseline; severe hypotension can occur
with rapid IV administration

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