PROCAINAMIDE

Antiarrhythmic medicine

Dosage Forms

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Tablet

250 mg

Uses

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  • Severe ventricular arrhythmias resistant to lidocaine or after a myocardial infarction
  • Atrial tachycardia
  • Atrial fibrillation
  • Maintenance of sinus rhythm after cardioversion of atrial fibrillation

Dose and Duration

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Ventricular arrhythmias

Adult: by mouth, up to 50 mg/kg daily in divided doses every 3–6 hours, preferably controlled by monitoring plasma procainamide concentration (therapeutic concentration usually within the range of 3–10 micrograms/ml)

Atrial arrhythmias

Adult: higher doses may be required

Contraindications

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  • Torsades de pointes
  • Systemic lupus erythematosus
  • Heart block
  • Heart failure
  • Hypotension

Side Effects

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  • Nausea, vomiting, diarrhoea
  • Anorexia
  • Rash, pruritus, urticaria
  • Flushing, fever
  • Myocardial depression, heart failure
  • Angioedema
  • Depression, dizziness
  • Psychosis

Interactions

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  • Alcuronium, suxamethonium, vecuronium (enhanced muscle relaxant effect)
  • Amitriptyline, chlorpromazine, clomipramine, fluphenazine, haloperidol (increased risk of ventricular arrhythmias)
  • Artemether + lumefantrine (risk of arrhythmias)
  • Atenolol, lidocaine, timolol, propranolol (increased myocardial depression)

Pregnancy

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  • Do not use

Breast-feeding

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  • Can be used

⚠️ Caution

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  • Use with caution in the elderly, renal impairment, hepatic impairment, asthma and myasthenia gravis
  • Avoid use or reduce dose in renal or hepatic impairment