EMERGENCY EDUCATION CENTER
UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS
Course: Pharmacology
Content: PROCAINAMIDE (PRONESTYL)
A.
Actions
1.
2.
3.
4.
Decreases myocardial excitability and automaticity in the atria, Purkinje fibers and
ventricles (Inhibits ectopic pacemaker)
Prolongs repolarization of myocardial cells which may terminate reentry
dysrythmias
Peripheral vasodilator
Negative inotrope
B.
Indications
From the AHA
1.
Wide variety of arrhythmias, including stable monomorphic VT with normal QT
interval and preserved LV function
2.
IF BP stable-Reentry SVT uncontrolled by adenosine and vagal maneuvers
3.
Stable wide complex tachycardia of unknown origin
4.
Atrial fibrillation with rapid rate in WPW
C.
Side Effects
1.
2.
3.
4.
D.
Precautions
1.
2.
E.
Hypotension
Change in mental status
AV conduction defects
Torsades de Pointes
CHF or renal dysfunction
May produce dysrythmias in the setting of an AMI, low potassium or low
magnesium
Contraindications
1.
2.
3.
4.
Use with other drugs that prolong QT (ex Amiodarone) or patients known to have
prolonged QT
Ventricular pacemaker with heart rate less than 100
Asystole/PEA
Torsades de Pointes or patients with prolonged QT intervals
F.
Dosage
1.
Recurrent pulseless V Fib/V Tach
a. 20 mg/min IV infusion
b. 50 mg/min IV infusion in urgent situations
c. administered to a total of 17 mg/kg
d. use in cardiac arrest limited by need for slow infusion and uncertain efficacy
G.
H.
2.
Pulses present
a. 20 mg/min IV infusion
b. administered to a total of 17 mg/kg
3.
Maintenance infusion
a.1-4 mg/min (in D5W or NS)
Administration
1.
Procainamide may be given until:
dysrythmia is suppressed
QRS duration increases by >50%
hypotension occurs
total dose of 17 mg/kg is administered
2.
If cardiac or renal dysfunction is present reduce maximum total dose to 12mg/kg
and maintenance infusion to 1-2 mg/min
4.
BP and ECG must be monitored continuously
Miscellaneous
1.
Procainamide
Oral procainamide is an outpatient cardiac medication