Pronunciation: pro-CANE-uh-mide HIGH-droe-KLOR-ide
Class: Antiarrhythmic agent
- Injection 100 mg/mL
- Injection 500 mg/mL
Procan SR (Canada)
Increases effective refractory period of atria and bundle of His-Purkinje system; reduces impulse conduction velocity and myocardial excitability in atria, Purkinje fibers, and ventricles.
Rapid absorption (IM), immediate absorption (IV).
Protein binding is 15% to 20%, also bound to tissues of the heart, liver, lung, and kidney. Vd is 2 L/kg. The drug distributes into breast milk (procainamide and N-acetylprocainamide [NAPA]).
Metabolized in liver to NAPA, an active metabolite exerting significant antiarrhythmic activity. Approximately 25% of dose converted to NAPA, up to 40% conversion occurs in patients who are rapid acetylators.
The half-life is 3 to 4 h (healthy renal function, procainamide) and approximately 6 h (NAPA). Urinary excretion (6% to 52% NAPA, 30% to 60% as unchanged procainamide); a trace amount is excreted in urine as free and conjugated p-aminobenzoic acid.
15 to 60 min (IM), and immediate (IV).
Special PopulationsRenal Function Impairment
Elimination half-life is prolonged.Elderly
Elimination half-life is prolonged.Children
In infants, half-life and renal Cl are reduced.
Indications and Usage
Treatment of documented ventricular arrhythmias that are life threatening.
Complete heart block; idiosyncratic hypersensitivity; lupus erythematosus; torsades de pointes.
Dosage and AdministrationAdults
IV 20 mg/min for 25 to 30 min as loading dose, then 2 to 6 mg/min for maintenance.
IM 50 mg/kg/day in divided doses every 3 to 6 h until oral therapy is possible.
- Prepare IV infusion solution using D5W. Use controlled infusion device.
- IV solutions may turn slightly yellow or light amber on standing, but potency is not affected.
- For direct IV injection, do not exceed max IV rate of 50 mg/min and do not give more than 100 mg in any 5-min period.
- Wait 3 to 4 h after last IV dose before first oral dose.
Store between 59° and 86°F for 24 h or for 7 days if refrigerated. Discard IV infusion solutions that are darker than light amber.
Drug InteractionsAmiodarone, cimetidine, trimethoprim
May increase procainamide and NAPA concentrations.Cisapride, quinolone antibiotics (eg, gatifloxacin), thioridazine, ziprasidone
May increase the risk of life-threatening cardiac arrhythmias, including torsades de pointes.Group 1a antiarrhythmic agents (eg, quinidine)
Coadministration with procainamide is contraindicated.
Proarrhythmic effects; hypotension.
Dizziness; weakness; depression; psychosis with hallucinations.
Angioneurotic edema; urticaria; pruritus; flushing; rash.
Nausea; vomiting; anorexia; abdominal pain.
Neutropenia; thrombocytopenia; hemolytic anemia; agranulocytosis.
Lupus erythematosus-like syndrome.
Procainamide has proarrhythmic effects. May cause or aggravate CHF or produce severe hypotension, especially in patients with CHF, acute ischemic heart disease, or cardiomyopathy.Hematological
Agranulocytosis, bone marrow depression, neutropenia, hypoplastic anemia, and thrombocytopenia have been reported and may occur, usually within first 12 wk of therapy at recommended doses. Use caution in patients with preexisting marrow failure or cytopenia.Positive ANA titer
Chronic administration may result in positive titers with or without symptoms of lupus erythematosus–like syndrome. Approximately 50% of patients will develop ANA within 2 to 18 mo of starting therapy.
Category C .
Excreted in breast milk.
Safety and efficacy not established.
Consider the possibility of cross-sensitivity to procainamide in patients sensitive to procaine or other ester-type local anesthetics.
Individual dose adjustment may be necessary.
Special Risk Patients
Elderly patients and patients with renal, hepatic, or cardiac function impairment will require smaller or less frequent doses. Individual dosage adjustment will be necessary.
Parenteral forms contain sulfites.
Avoid use of product in treatment of patients with this condition.
Agranulocytosis, bone marrow depression, neutropenia, hypoplastic anemia, and thrombocytopenia have been reported; monitor carefully.
Complete heart block
Do not administer to patients with complete heart block because of effects in suppressing nodal or ventricular pacemakers and hazard of asystole.
Concurrent antiarrhythmic agents
May see enhanced prolongation of conduction or depression of contractility and hypotension.
Use with caution treating arrhythmias associated with digitalis intoxication.
First-degree heart block
Use with caution if first-degree heart block develops during procainamide therapy.
Patients may experience increase of muscle weakness. Observe closely.
Predigitalization for atrial flutter or fibrillation
Cardiovert or digitalize patient prior to procainamide therapy to avoid enhancement of AV conduction.
Hypotension, widening of QRS complex, prolonged QT and PR intervals, ventricular tachyarrhythmias.
- Explain importance of informing other health care providers or dentists about therapy before surgical or dental procedures.
- Emphasize importance of drug compliance. Caution patient not to make up for missed doses.
- Instruct patient to report the following symptoms to health care provider immediately: difficulty breathing, pounding or irregular heartbeat, joint pain, fever, chills, skin rash, continued dizziness.
- Explain that diarrhea, nausea, dizziness, or loss of appetite may occur and to contact health care provider if symptoms are bothersome.
- Advise patient that drug may cause dizziness and to use caution when driving or performing other tasks requiring mental alertness.
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