Procainamide: Difference between revisions
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== | ==General== | ||
*Class Ia | *Type: Class Ia [[Antiarrhythmic]] | ||
* | *Dosage Forms: 100mg/mL (10 mL); 500mg/mL (2 mL) | ||
* | *Common Trade Names: Apo-Procainamide; Procainamide Hydrochloride Injection | ||
== Adult Dosing == | ==Adult Dosing== | ||
* | ===[[Arrythmia]]=== | ||
''Drug of Choice for stable [[wide complex tachycardia]] (Class IIa recommendation) | |||
*100 mg IV x 2 min q5min as needed to max dose 17 mg/kg | |||
*Give until: | *Give until: | ||
** | **Arrhythmia is suppressed | ||
** | **Patient develops hypotension | ||
**QRS segment prolongs by >50% of baseline | **QRS segment prolongs by >50% of baseline | ||
** | **Total of 17 mg/kg given | ||
*If effective, start continuous infusion at 1-4 mg/min | *If effective, start continuous infusion at 1-4 mg/min | ||
**Continuous infusion has fewer adverse effects than bolus | **Continuous infusion has fewer adverse effects than bolus | ||
== Indications == | ==Pediatric Dosing== | ||
===[[Arrythmia]]=== | |||
*Stable wide-complex [[tachycardia]] or [[SVT]] | |||
*15mg/kg infused over 30-60 minutes | |||
**Stop infusion if hypotension occurs or QRS complex widens by >50% of baseline | |||
==Special Populations== | |||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Class C | |||
*[[Lactation risk categories|Lactation risk]]: Procainamide and its metabolite are found in breast milk. Due to the potential for adverse events in the nursing infant, breast-feeding is not recommended by the manufacturer. | |||
*Renal Dosing | |||
**Adult: Drip rate is 1-2 mg/min for renal/cardiac failure | |||
**Pediatric | |||
*Hepatic Dosing | |||
**Adult | |||
**Pediatric | |||
==Indications== | |||
*Wide-complex tachycardia of unknown type (in patient with preserved left ventricular function) | *Wide-complex tachycardia of unknown type (in patient with preserved left ventricular function) | ||
*Stable ventricular tachycardia | *Stable ventricular tachycardia | ||
== Contraindications == | ==Contraindications== | ||
*Allergy to class/drug | |||
*Not recommended for ventricular fibrillation or pulseless ventricular tachycardia, as it takes too long to dose | *Not recommended for ventricular fibrillation or pulseless ventricular tachycardia, as it takes too long to dose | ||
*2nd or 3rd atrioventricular block | *2nd or 3rd atrioventricular block | ||
| Line 27: | Line 44: | ||
*Myasthenia gravis | *Myasthenia gravis | ||
== Adverse | ==Adverse Reactions== | ||
*Myocardial depression | *Myocardial depression | ||
*Watch for QRS/QT segment prolongation, ventricular tachycardia, ventricular fibrillation, complete atrioventricular block, torsades de pointes | *Watch for QRS/QT segment prolongation, ventricular tachycardia, ventricular fibrillation, complete atrioventricular block, torsades de pointes | ||
== | ==Pharmacology== | ||
*Onset of action | *Half-life: | ||
**Children: 1.7 hours | |||
**Adults with normal renal function: 2.5-4.7 hours | |||
*Metabolism: By acetylation in the liver to produce N-acetyl procainamide (NAPA) | |||
*Excretion: Urinary excretion (25% as NAPA) | |||
*Kinetics: Onset of action 5 - 10 minutes | |||
===Mechanism of Action=== | |||
[[File:iPad_image_2015-5-25-1435238186649_0.jpg|thumbnail]] | |||
*Class Ia | |||
**Binds to fast sodium channels in inactive state inhibiting recovery after repolarization | |||
**Prolongs action potential and reduces speed of impulse conduction | |||
***Depresses myocardial conduction | |||
**May act as negative inotrope, causing hypotension through peripheral vasodilation | |||
==Comments== | |||
==See Also== | ==See Also== | ||
*[[Antiarrhythmics]] | *[[Antiarrhythmics]] | ||
[[Category: | ==References== | ||
<references/> | |||
[[Category:Pharmacology]] | |||
[[Category:Cardiology]] | |||
Latest revision as of 03:40, 28 November 2019
General
- Type: Class Ia Antiarrhythmic
- Dosage Forms: 100mg/mL (10 mL); 500mg/mL (2 mL)
- Common Trade Names: Apo-Procainamide; Procainamide Hydrochloride Injection
Adult Dosing
Arrythmia
Drug of Choice for stable wide complex tachycardia (Class IIa recommendation)
- 100 mg IV x 2 min q5min as needed to max dose 17 mg/kg
- Give until:
- Arrhythmia is suppressed
- Patient develops hypotension
- QRS segment prolongs by >50% of baseline
- Total of 17 mg/kg given
- If effective, start continuous infusion at 1-4 mg/min
- Continuous infusion has fewer adverse effects than bolus
Pediatric Dosing
Arrythmia
- Stable wide-complex tachycardia or SVT
- 15mg/kg infused over 30-60 minutes
- Stop infusion if hypotension occurs or QRS complex widens by >50% of baseline
Special Populations
- Pregnancy Rating: Class C
- Lactation risk: Procainamide and its metabolite are found in breast milk. Due to the potential for adverse events in the nursing infant, breast-feeding is not recommended by the manufacturer.
- Renal Dosing
- Adult: Drip rate is 1-2 mg/min for renal/cardiac failure
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Indications
- Wide-complex tachycardia of unknown type (in patient with preserved left ventricular function)
- Stable ventricular tachycardia
Contraindications
- Allergy to class/drug
- Not recommended for ventricular fibrillation or pulseless ventricular tachycardia, as it takes too long to dose
- 2nd or 3rd atrioventricular block
- Severe glycoside intoxication
- Prolonged QT segment
- Myasthenia gravis
Adverse Reactions
- Myocardial depression
- Watch for QRS/QT segment prolongation, ventricular tachycardia, ventricular fibrillation, complete atrioventricular block, torsades de pointes
Pharmacology
- Half-life:
- Children: 1.7 hours
- Adults with normal renal function: 2.5-4.7 hours
- Metabolism: By acetylation in the liver to produce N-acetyl procainamide (NAPA)
- Excretion: Urinary excretion (25% as NAPA)
- Kinetics: Onset of action 5 - 10 minutes
Mechanism of Action
- Class Ia
- Binds to fast sodium channels in inactive state inhibiting recovery after repolarization
- Prolongs action potential and reduces speed of impulse conduction
- Depresses myocardial conduction
- May act as negative inotrope, causing hypotension through peripheral vasodilation