Procainamide
Procainamide is a Class Ia antiarrhythmic agent. It works by blocking sodium channels, thereby slowing conduction, prolonging the action potential duration, and increasing the refractory period in myocardial cells. It is metabolized in the liver to its active metabolite, N-acetylprocainamide (NAPA). Due to its potential for proarrhythmia, severe hypotension, and drug-induced lupus erythematosus-like syndrome, its use is typically reserved for life-threatening arrhythmias and requires close monitoring.
Dosage by Body Weight
Dosage must be highly individualized based on patient response, age, renal function, and cardiac status. Intravenous administration requires continuous ECG and blood pressure monitoring. Therapeutic drug monitoring (measuring plasma levels of procainamide and NAPA) is strongly recommended.
- Body Weight
- Below 5 kg
- Dose
- Not routine
- Frequency
- Use only if prescribed
- Tracking Notes
- Requires strict neonatal intensive care monitoring. Pediatric dosing is typically calculated strictly by body weight (e.g., 2 to 6 mg/kg IV loading dose).
- Body Weight
- 5-7 kg
- Dose
- Individualized weight-based calculation (typically 10 to 42 mg)
- Frequency
- Administered slowly over 5 minutes or as a continuous infusion
- Tracking Notes
- Must be administered in an intensive care setting with continuous ECG and blood pressure monitoring.
- Body Weight
- 8-10 kg
- Dose
- Individualized weight-based calculation (typically 16 to 60 mg)
- Frequency
- Administered slowly over 5 minutes or as a continuous infusion
- Tracking Notes
- Monitor QRS duration and blood pressure closely; reduce dose in patients with renal impairment.
- Body Weight
- 11-15 kg
- Dose
- Individualized weight-based calculation (typically 22 to 90 mg)
- Frequency
- Administered slowly over 5 minutes or as a continuous infusion
- Tracking Notes
- Monitor plasma concentrations of procainamide and N-acetylprocainamide (NAPA).
- Body Weight
- 16-20 kg
- Dose
- Individualized weight-based calculation (typically 32 to 120 mg)
- Frequency
- Administered slowly over 5 minutes or as a continuous infusion
- Tracking Notes
- Discontinue infusion immediately if severe hypotension or excessive QRS widening occurs.
| Body Weight | Dose | Frequency | Tracking Notes |
|---|---|---|---|
| Below 5 kg | Not routine | Use only if prescribed | Requires strict neonatal intensive care monitoring. Pediatric dosing is typically calculated strictly by body weight (e.g., 2 to 6 mg/kg IV loading dose). |
| 5-7 kg | Individualized weight-based calculation (typically 10 to 42 mg) | Administered slowly over 5 minutes or as a continuous infusion | Must be administered in an intensive care setting with continuous ECG and blood pressure monitoring. |
| 8-10 kg | Individualized weight-based calculation (typically 16 to 60 mg) | Administered slowly over 5 minutes or as a continuous infusion | Monitor QRS duration and blood pressure closely; reduce dose in patients with renal impairment. |
| 11-15 kg | Individualized weight-based calculation (typically 22 to 90 mg) | Administered slowly over 5 minutes or as a continuous infusion | Monitor plasma concentrations of procainamide and N-acetylprocainamide (NAPA). |
| 16-20 kg | Individualized weight-based calculation (typically 32 to 120 mg) | Administered slowly over 5 minutes or as a continuous infusion | Discontinue infusion immediately if severe hypotension or excessive QRS widening occurs. |
Formulation
Purpose
Treatment of documented life-threatening ventricular arrhythmias, such as sustained ventricular tachycardia. Also used for supraventricular arrhythmias under specific specialist guidance.
Generic Name
Procainamide hydrochlorideBranded Drug Names
Procainamide is listed as a generic drug name. Common branded medicines that may contain the same active ingredient include:
Scheduled Drug
No. This medicine is generally not treated as a scheduled/prescription-only drug in common consumer references, but local rules may vary.