Procainamide (Pronestyl, Pronestyl-SR, Procan SR)

Category:

  • Cardiac

Description:

  • Antidysrhythmic (class IA)

Indications:

  • Life threatening ventricular dysrhythmias, less severe but symptomatic ventricular dysrhythmias in select patients

  • Maintenance of sinus rhythm following cardioversion in atrial fibrillation and/or flutter (non FDA approved)

  • Suppression of recurrent paroxysmal atrial fibrillation (non FDA approved)

Contraindications:

  • Complete heart block, lupus erythematosus

  • Torsade de pointes

 Precautions:

  • Pregnancy category C; compatible with breast feeding; long-term effect on nursing infant unknown

  • Post MI, 1st degree AV block (unless ventricular rate controlled by pacemaker)

  • Asymptomatic premature ventricular contractions, digitalis intoxication

  • CHF, myasthenia gravis, renal insufficiency, children

Adverse Reactions (Side Effects):

  • CNS: depression, dizziness, giddiness, hallucinations, headache, psychosis, weakness

  • CV: hypotension, 2nd degree heart block, ventricular arrhythmias

  • GI: abdominal pain, anorexia, bitter taste, diarrhea, hepatomegaly, nausea, vomiting

  • HEME: agranulocytosis, hemolytic anemia (rare), neutropenia, thrombocytopenia

  • SKIN: angioneurotic edema, flushing, pruritus, rash, urticaria

  • MISC: lupus erythematosus-like syndrome (arthralgia, plueral or abdominal pain, arthritis, pleural effusion, pericarditis, fever, chills, rash) in up to 30% on long-term therapy

Dosage:

Administered orally, intravenously, intramuscularly

  • Adult:   PO 250-500mg every 3-6 hours; PO SR 500-1000mg every 6 hours, usual dose 50 mg/kg/day, max 4g daily; IM 0.5-1g every 4-8 hours until PO therapy possible; IV 1g INF over 25-30 minutes or 100-200mg daily repeated every 5 minutes as needed to total dose of 1g as a loading dose, followed by continuous INF of 1-6 mg/min, titrate to patient response

  • Child:   PO 15-50 mg/kg/day divided every 3-6 hours, max 4g daily; IM 20-30 mg/kg/day divided every 4-6 hours, max 4g daily; IV 3-6 mg/kg INF over 5 minutes not to exceed 100mg daily as a loading dose, then 20-80 mcg/kg/minute as a continuous INF, max 4g daily

 

    

 
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