Generic Name: procainamide (injection) (proe KANE a mide)
Brand Name: Pronestyl, Procan SR, Pronestyl-SR, Procanbid
What is procainamide injection?
Procainamide affects the way your heart beats.
Procainamide is used to help keep the heart beating normally in people with certain heart rhythm disorders of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart).
Procainamide may also be used for purposes not listed in this medication guide.
What is the most important information I should know about procainamide injection?
Procainamide is given in a hospital setting. Your heart rate, breathing, blood pressure and other vital signs will be watched closely while you are receiving procainamide.
You should not use this medication if you are allergic to procainamide, or if you have a serious heart condition such as "AV block" (unless you have a pacemaker), lupus, or a history of "Long QT syndrome."
If possible, before you receive procainamide, tell your doctor if you have congestive heart failure, circulation problems, a history of heart attack or stroke (including "mini-stroke"), a weak immune system, kidney or liver disease, myasthenia gravis, asthma, or if you are allergic to aspirin, sulfites, or any type of numbing medicine.
In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast feeding. Make sure any doctor caring for you afterward knows that you have received this medication.
Procainamide can lower blood cells that help your body fight infections. Tell your doctor if you develop signs of infection such as fever, chills, sore throat, flu symptoms, easy bruising or bleeding (nosebleeds, bleeding gums), loss of appetite, nausea and vomiting, sores in your mouth and throat, or unusual weakness.
What should I discuss with my healthcare provider before receiving procainamide injection?
You should not receive this medication if you are allergic to procainamide, or if you have:
a serious heart condition such as "AV block" (unless you have a pacemaker);
a history of "Long QT syndrome."
If possible before you receive procainamide, tell your doctor if you have:
congestive heart failure;
a history of heart attack or stroke (including "mini-stroke");
a weak immune system;
asthma or sulfite allergy;
if you are allergic to aspirin; or
if you have ever had an allergic reaction to a numbing medicine.
FDA pregnancy category C. It is not known whether procainamide will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
Procainamide can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using procainamide.
In an emergency situation, it may not be possible before you are treated with procainamide to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.
How is procainamide injection given?
Procainamide is injected into a muscle or into a vein through an IV. You will receive procainamide injection in a hospital setting where your heart can be monitored in case the medication causes serious side effects.
Your heart rate will be constantly monitored using an electrocardiograph or ECG (sometimes called an EKG). This machine measures electrical activity of the heart. Your breathing, blood pressure and other vital signs will be watched closely while you are receiving procainamide.
Procainamide can lower blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Contact your doctor at once if you develop signs of infection such as fever, chills, sore throat, flu symptoms, easy bruising or bleeding (nosebleeds, bleeding gums), loss of appetite, nausea and vomiting, mouth sores, or unusual weakness.
Your doctor will need to check your progress on a regular basis. Do not miss any scheduled appointments.
What happens if I miss a dose?
Since procainamide is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.
What happens if I overdose?
Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.
Overdose symptoms may include drowsiness, tremors, weak or shallow breathing, and fainting.
What should I avoid while receiving procainamide injection?
Avoid being near people who have colds, the flu, or other contagious illnesses. Contact your doctor at once if you develop signs of infection.
This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Procainamide injection side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Tell your caregivers at once if you have a serious side effect such as:
a new or a worsening irregular heartbeat pattern;
chest pain, wheezing, trouble breathing;
feeling like you might pass out;
signs of infection such as fever, chills, sore throat, flu symptoms, pale skin, easy bruising or bleeding (nosebleeds, bleeding gums), loss of appetite, nausea and vomiting, sores in your mouth and throat, unusual weakness;
depressed mood, hallucinations, severe dizziness;
upper stomach pain, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
joint pain or swelling with fever, swollen glands, muscle pain or weakness, unusual thoughts or behavior, patchy skin color, red spots.
Less serious side effects may include:
mild dizziness or tired feeling;
flushing (warmth, redness, or tingly feeling); or
mild itching or rash.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
Procainamide dosing information
Usual Adult Dose for Arrhythmias:
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.
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.
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.
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
What other drugs will affect procainamide injection?
Tell your doctor about all other medicines you use, especially:
cimetidine (Tagamet, Tagamet HB);
digoxin (digitalis, Lanoxin);
atropine (Atreza, Sal-Tropine), belladonna (Donnatal, and others), benztropine (Cogentin);
dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm Scop);
bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);
irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Hyomax), or propantheline (Pro Banthine).
bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare); or
heart rhythm medications such as amiodarone (Cordarone, Pacerone), quinidine (Quin-G), disopyramide (Norpace), flecaininde (Tambocor), mexiletine (Mexitil), propafenone, (Rythmol), and others.
This list is not complete and other drugs may interact with procainamide. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Where can I find more information?
- Your doctor or pharmacist can provide more information about procainamide injection.
- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
- Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2012 Cerner Multum, Inc. Version: 5.01.
Date modified: March 15, 2017
Last reviewed: September 20, 2011
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