Procainamide

 Procainamide:

(Lexicomp, 21^st ed. 2014-2015)

 

SVT:

(May use for stable, monomorphic VT and pre-excited A fib).

Newborn:

IV-Loading dose 5-10 mg over 60 min.

Infusion: 20 – 80 mcg/kg/min.

(Lower dose for preterm and renal impairment).

Infants/Children/Adults:

Loading dose 10-2 mg/kg over 30-60 min.

Infusion: 20-80 mcg/kg/min.

 

Monitoring:

EKG (PR interval, QTc prolongations), BP, CBC/diff.

Drug level: 6-12 hrs. after starting infusion.

Therapeutic range:

Procainamide level 4-10 mcg/ml. (> 10-12 mcg/ml is toxic)

Proc + NAPA level = 10-30 mcg/ml.

Side effects:

- PR, QTc prolongation, Paradoxical increase in ventricular rate in Afib.

- Agranulocytosis

- ANA positive

- Others.