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Procainamide (Pronestyl, Pronestyl-SR, Procan SR)

Category:

  • Cardiac

Description:

  • Antidysrhythmic (class IA)

Indications:

  • Life threatening ventricular dysrhythmias, less severe but symptomatic ventricular dysrhythmias in select patients

  • Maintenance of sinus rhythm following cardioversion in atrial fibrillation and/or flutter (non FDA approved)

  • Suppression of recurrent paroxysmal atrial fibrillation (non FDA approved)

Contraindications:

  • Complete heart block, lupus erythematosus

  • Torsade de pointes

 Precautions:

  • Pregnancy category C; compatible with breast feeding; long-term effect on nursing infant unknown

  • Post MI, 1st degree AV block (unless ventricular rate controlled by pacemaker)

  • Asymptomatic premature ventricular contractions, digitalis intoxication

  • CHF, myasthenia gravis, renal insufficiency, children

Adverse Reactions (Side Effects):

  • CNS: depression, dizziness, giddiness, hallucinations, headache, psychosis, weakness

  • CV: hypotension, 2nd degree heart block, ventricular arrhythmias

  • GI: abdominal pain, anorexia, bitter taste, diarrhea, hepatomegaly, nausea, vomiting

  • HEME: agranulocytosis, hemolytic anemia (rare), neutropenia, thrombocytopenia

  • SKIN: angioneurotic edema, flushing, pruritus, rash, urticaria

  • MISC: lupus erythematosus-like syndrome (arthralgia, plueral or abdominal pain, arthritis, pleural effusion, pericarditis, fever, chills, rash) in up to 30% on long-term therapy

Dosage:

Administered orally, intravenously, intramuscularly

  • Adult:   PO 250-500mg every 3-6 hours; PO SR 500-1000mg every 6 hours, usual dose 50 mg/kg/day, max 4g daily; IM 0.5-1g every 4-8 hours until PO therapy possible; IV 1g INF over 25-30 minutes or 100-200mg daily repeated every 5 minutes as needed to total dose of 1g as a loading dose, followed by continuous INF of 1-6 mg/min, titrate to patient response

  • Child:   PO 15-50 mg/kg/day divided every 3-6 hours, max 4g daily; IM 20-30 mg/kg/day divided every 4-6 hours, max 4g daily; IV 3-6 mg/kg INF over 5 minutes not to exceed 100mg daily as a loading dose, then 20-80 mcg/kg/minute as a continuous INF, max 4g daily

 

 

 


The information contained here is an abbreviated summary. For more detailed and complete information, consult the manufacturer's product information sheets or standard textbooks

Source: Operational Medicine 2001,  Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This information is provided by The Brookside Associates.  The Brookside Associates, LLC. is a private organization, not affiliated with any governmental agency. The opinions presented here are those of the author and do not necessarily represent the opinions of the Brookside Associates or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. All material presented here is unclassified.

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