- What is procainamide, and how does it work (mechanism of action)?
- What brand names are available for procainamide?
- Is procainamide available as a generic drug?
- Do I need a prescription for procainamide?
- What are the side effects of procainamide?
- What is the dosage for procainamide?
- Which drugs or supplements interact with procainamide?
- Is procainamide safe to take if I'm pregnant or breastfeeding?
- What else should I know about procainamide?
What is procainamide, and how does it work (mechanism of action)?
Procainamide is an injectable antiarrhythmic drug that is used to correct disturbances in the heart's rhythm. Three actions are responsible for its ability to correct disturbances of rhythm and prevent their recurrence. Procainamide decreases the speed of electrical conduction through the heart muscle, prolongs the electrical phase during which the heart's muscle cells can be electrically stimulated, and prolongs the recovery period during which the heart muscle cells cannot be stimulated. Procainamide was approved for use by the FDA in 1950.
What brand names are available for procainamide?
Pronestyl, Procan-SR, Procanbid (These brands no longer are available in the U.S.)
What are the side effects of procainamide?
Common reactions include diarrhea, nausea, vomiting, rash, low blood pressure, itching, flushing, and slow heart beat. Severe reactions include abnormal heart beats, seizures, heart arrest, and blood disorders.
A severe reduction in white blood cell count occurs relatively rarely with procainamide therapy and is more common with the sustained-release preparations. This side effect has caused death. For this reason, patients on sustained-release procainamide get a complete blood count test (CBC) every 2 weeks for the first 3 months of treatment. A syndrome resembling lupus erythematosus, including fever, chills, joint pain, chest pain, and/or skin rash can occur with procainamide. The lupus-like syndrome is reversible after stopping the drug. Rarely, procainamide can cause confusion, hallucinations, and depression.
What is the dosage for procainamide?
An intravenous dose of 15 to 18 mg/kg may be administered over 25-30 minutes to adults. The initial dose is followed with a maintenance dose of 1-4 mg/min. Dose adjustments (reductions) are recommended in patients with liver and renal problems.
It can also be given by intramuscular (IM) injection. The IM dose is 0.5 to 1 g every 4 to 8 hours.
Dosing in children is based on both their age and weight. Infants usually need a loading dose. Depending on age and weight, a loading dose of the drug may be recommended; in addition, IV or IM dosing may be used. Pediatric specialists, or in an emergency, an Emergency Medicine physician should calculate the dose and route of administration.
Which drugs or supplements interact with procainamide?
: Amiodarone (Cordarone) increases the blood concentrations of procainamide by either decreasing the kidneys or the liver's abilities to remove procainamide. Combining procainamide with thioridazine (Mellaril), pimozide (Orap), quinolones for example, levofloxacin (Levaquin), tricyclic antidepressants for example, amitriptyline (Endep, Elavil), and ziprasidone (Geodon) may increase the risk of abnormal heart beats because these drugs may also prolong the recovery period of the heart. Concurrent administration of procainamide with other anti-arrhythmics can result in additive or antagonistic effects on the heart.
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Is procainamide safe to take if I'm pregnant or breastfeeding?
What else should I know about procainamide?
What preparations of procainamide are available?
Injection: 100 and 500 mg/ml.
How should I keep procainamide stored?
Procainamide may be kept at room temperature. If diluted, it is stable for 24 hours at room temperature or seven days if refrigerated at 2 C to 8 C (35 F to 46 F).
Procainamide (Pronestyl, Procan-SR, Procanbid) (These brands no longer are available in the U.S.) is an antiarrhythmic drug prescribed for the treatment of abnormal heart rhythms such as tachycardias, atrial fibrillation and flutter, ventricular tachycardia, and premature atrial and ventricle heart beats. Side effects, drug interactions, warnings and precautions, and patient information should be reviewed prior to taking any medication.
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Related Disease Conditions
Arrhythmias (Abnormal Heart Rhythms)
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus bradycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-Parkinson-White syndrome, brachycardia, or heart blocks. Treatment is dependent upon the type of heart rhythm disorder.
Atrial Fibrillation (AFib)
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm, which involves irregular and often rapid beating of the heart. Symptoms may include heart palpitations, dizziness, fainting, fatigue, shortness of breath, and chest pain. Atrial fibrillation treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate.
Premature Ventricular Contractions (PVCs)
Premature ventricular contractions (PVC) are premature heartbeats originating from the ventricles of the heart. PVCs are premature because they occur before the regular heartbeat. There are many causes of premature ventricular contractions to include: heart attack, high blood pressure, congestive heart failure, mitral valve prolapse, hypokalemia, hypoxia, medications, excess caffeine, drug abuse, and myocarditis.
Palpitations are uncomfortable sensations of the heart beating hard, rapidly, or irregularly. Some types of palpitations are benign, while others are more serious. Palpitations are diagnosed by taking the patient history and by performing an EKG or heart monitoring along with blood tests. An electrophysiology study may also be performed. Treatment of palpitations may include lifestyle changes, medication, ablation, or implantation of a pacemaker. The prognosis if palpitations depends on the underlying cause.
Atrial Fibrillation (AFib) Treatment Drugs
Atrial fibrillation (AFib) is a heart rhythm disorder that causes irregular and often rapid heartbeat. The medications to treat AFib include beta-blockers, blood thinners, and heart rhythm drugs. Atrial fibrillation drugs can cause serious side effects like seizures, vision changes, shortness of breath, fainting, other abnormal heart rhythms, excessive bleeding while coughing or vomiting, blood in the stool, and bleeding into the brain.
Neutropenia is a marked decrease in the number of neutrophils, neutrophils being a type of white blood cell (specifically a form of granulocyte) filled with neutrally-staining granules, tiny sacs of enzymes that help the cell to kill and digest microorganisms it has engulfed by phagocytosis. Signs and symptoms of neutropenia include gum pain and swelling, skin abscesses, recurrent ear and sinus infections, sore mouth, low-grad fever, pneumonia-like symptoms, and pain and irritation around the rectal area. Neutropenia has numerous causes, for example, infections (HIV, TB, mono); medications (chemotherapy); vitamin deficiencies (anemia); bone marrow diseases (leukemias), radiation therapy, autoimmune destruction of neutrophils, and hypersplenism. Treatment of neutropenia depends upon the cause and the health of the patient.
Paroxysmal Supraventricular Tachycardia (PSVT)
Paroxysmal supraventricular tachycardia (PSVT) is an abnormal conduction of electricity in particular areas of the heart. PSVT was referred to at one time as paroxysmal atrial tachycardia or PAT, however, the term PAT is reserved for as specific heart condition. Symptoms of PSVT include weakness, shortness of breath, chest pressure, lightheadedness, and palpitations. PSVT is treated with medications or procedures that return the heart to its normal electrical pattern.
Heart Disease in Women
Heart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women and health professionals are not aware of the risk factors for heart disease in women and may delay diagnosis and treatment. Lifestyle factors such as diet, exercise, tobacco use, overweight/obesity, stress, alcohol consumption, and depression influence heart disease risk in women. High blood pressure, high cholesterol, and diabetes also increase women's risk of heart disease. Electrocardiogram (EKG or ECG), stress-ECG, endothelial testing, ankle-brachial index (ABI), echocardiogram, nuclear imaging, electron beam CT, and lab tests to assess blood lipids and biomarkers of inflammation are used to diagnose heart disease. Early diagnosis and treatment of heart disease in women saves lives. Heart disease can be prevented and reversed with lifestyle changes.
Treatment & Diagnosis
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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Reference: FDA Prescribing Information