Procainamide
Mechanism :
It is an amide derivative of procaine used in the treatment of atrial and ventricular arrhythmias.
Indication :
- Ventricular arrhythmias
- Supraventricular arrhythmias
Contraindications :
Hypersensitivity to drug/class/component, SLE, 2nd or 3rd degree AV block, Torsades de pointes, Congenital long QT syndrome, uncorrected Electrolyte abnormalities.
Dosing :
Use in atrial fibrillation and flutter only after the ventricular rate is stabilized.
IV: Initial loading dose of 3-6 mg/kg over 5 mins; Maximum: 100 mg/dose. May be repeated to maximum of 15 mg/kg/dose every 5-10 mins as and when required; followed by maintenance dose of 0.02-0.08 mg/kg/min IV infusion. Maximum dose: 2 g/day.
Adverse Effect :
GI irritation, drug fever, tachycardia, SLE like syndrome, hepatomegaly, positive Coomb’s test, asystole, myocardial depression, hypotension and AV block.
Interaction :
Cimetidine, Ranitidine, Amiodarone, Beta- Blockers, Trimethoprim: Procainamide adjustments required.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Normal loading dose. Maintenance dose according to response, lower doses or longer dosage intervals may be required |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Dialysed. Dose as in GFR<10 mL/ min |
| HD | Dialysed. Dose as in GFR<10 mL/ min |
| HDF/High flux | Dialysed. Dose as in GFR<10 mL/ min |
| CAV/VVHD | Dialysed. Dose as in normal renal function |
Hepatic Dose :
Use with caution, monitor serum procainamide and NAPA concentrations closely and adjust dose accordingly.
Moderate hepatic impairment: daily dose reduction by 1/4th is recommended.
Severe hepatic impairment: daily dose reduction by 1/2 is recommended.