Procainamide Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Arrhythmias

IV:
Loading dose: 15 to 18 mg/kg administered as slow infusion over 25 to 30 minutes or 100 mg/dose at a rate not to exceed 50 mg/minute repeated every 5 minutes as needed to a total dose of 1 gram.
Maintenance dose: 1 to 4 mg/minute by continuous infusion. Maintenance infusions should be reduced by one-third in patients with moderate renal or cardiac impairment and by two-thirds in patients with severe renal or cardiac impairment.

ACLS guidelines: Loading dose: Infuse 20 mg/minute (up to 50 mg/minute for more urgent situations) until arrhythmia is controlled, hypotension occurs, QRS complex widens by 50% of its original width, or total of 17 mg/kg is given. Note: Not recommended for use in ongoing ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) due to prolonged administration time and uncertain efficacy. Follow with maintenance dose as continuous infusion.

IM:
50 mg/kg divided into fractional amounts of 1/8 to 1/4 and injected every 3 to 6 hours or 0.5 to 1 gram every 4 to 8 hours.

Oral: ORAL procainamide is not available in the US but is available in Canada.
40 to 50 kg:
Immediate-release: 250 mg orally every 3 hours.
Sustained-release: 500 mg every 6 hours.
Twice daily formulation: 1000 mg every 12 hours.

60 to 70 kg:
Immediate-release: 375 mg every 3 hours.
Sustained-release: 750 mg every 6 hours.
Twice daily formulation: 1500 mg every 12 hours.

80 to 90 kg:
Immediate-release: 500 mg every 3 hours.
Sustained-release: 1000 mg every 6 hours.
Twice daily formulation: 2000 mg every 12 hours.

100 kg or more (Immediate-release) 625 mg every 3 hours.
Sustained-release: 1250 mg every 6 hours.
Twice daily formulation: 2500 mg every 12 hours.

Usual Pediatric Dose for Arrhythmias

less than 1 month:
Loading dose: 7 to 10 mg/kg IV infused over 60 minutes followed by a continuous IV infusion of 20 to 80 mcg/kg/minute; a retrospective study of 20 neonates (GA: 25 weeks or older) reported a mean loading dose of 9.6 ± 1.5 mg/kg and a mean continuous infusion rate of 37.56 ± 13.52 mcg/kg/minute. Note: Procainamide serum concentrations were supratherapeutic in five neonates studied; four of the five were less than 36 weeks GA and all five had Clcr less than 30 mL/minute/1.73 m2; these results indicate that doses may need to be decreased in preterm neonates and in those with renal impairment.

1 year or older:
Oral: (ORAL procainamide is not available in the US but is available in Canada.)
15 to 50 mg/kg/day divided every 3 to 6 hours. Maximum 4 g/day.

IV:
loading dose: 3 to 6 mg/kg over 5 minutes (not to exceed 100 mg per dose), may repeat every 5 to 10 minutes to maximum total loading dose of 15 mg/kg; do not exceed 500 mg in 30 minutes.
maintenance dose: continuous IV infusion: 20 to 80 mcg/kg/minute; maximum dose: 2 g/day.

IM:
20 to 30 mg/kg/day divided every 4 to 6 hours. Maximum 4 g/day.

Stable wide complex tachycardia of unknown origin (atrial or ventricular) or SVT (PALS, 2010): Note: Avoid or use extreme caution when administering procainamide with other drugs that prolong QT interval (e.g., amiodarone); consider consulting with expert.
Loading dose: 15 mg/kg infused intravenously over 30 to 60 minutes; monitor ECG and blood pressure; stop the infusion if hypotension occurs or QRS complex widens by more than 50% of baseline

Renal Dose Adjustments

Oral:
CrCl less than 10 mL/min: A dosing interval of every 8 to 24 hours is recommended.
CrCl 10 to 50 mL/min: A dosing interval of every 6 to 12 hours is recommended.

IV:
Reduce loading dose to 12 mg/kg in severe renal impairment.
Maintenance infusions should be reduced by one-third in patients with moderate renal impairment and by two-thirds in patients with severe renal impairment.

Liver Dose Adjustments

A 50% reduction in the dose is recommended.

Dose Adjustments

Patients with congestive heart failure should receive 2/3 of the loading dose.
Patients that have a slow acetylator phenotype should receive 2/3 of the maintenance dose.
Patients that have a fast acetylator phenotype should receive 1/3 higher maintenance dose.

Dialysis

Moderately hemodialyzable (20% to 50%):
Monitor procainamide/N-acetylprocainamide (NAPA) levels; a 200 mg supplemental dose post-hemodialysis may be necessary.
NAPA: Not dialyzable (0% to 5%)
Procainamide/NAPA: Not peritoneal dialyzable (0% to 5%)
Procainamide/NAPA: Replace by blood level during continuous arteriovenous or venovenous hemofiltration.

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