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procainamide
generic
Black Box Warnings .
Positive ANA Titer
positive ANA test w/ or w/o sx of lupus erythematosus assoc. w/ prolonged use; weigh benefit vs. risks of continued tx if positive ANA titer develops
Proarrhythmic Effects
restrict use to life-threatening ventricular arrhythmias, no survival benefit in pts w/o life-threatening arrhythmias
Blood Dyscrasias
agranulocytosis, myelosuppression, neutropenia, hypoplastic anemia and thrombocytopenia (0.5% incidence); deaths reported, 20-25% mortality w/ agranulocytosis; caution if pre-existing marrow failure or cytopenia of any type; monitor CBC w/ differential and platelet count qwk x3mo and then periodically; D/C tx if hematologic disorder develops
Adult Dosing .
Dosage forms: INJ
ventricular arrhythmias
- [1-6 mg/min IV]
- Start: 15-17 mg/kg/dose IV x1 or 100 mg IV q5-10min; Alt: 50 mg/kg/day IM divided q3-6h; Max: 1.5 g start, 9 g/day maintenance; Info: load until QRS widens 50%, arrhythmia suppressed, hypotension or max dose; adjust dose based on levels
sustained monomorphic ventricular tachycardia, hemodynamically stable (off-label)
- [1-4 mg/min IV]
- Start: 10-17 mg/kg/dose IV x1 or 100 mg IV q5min; Max: 17 mg/kg/dose start, 9 g/day maintenance; Info: load until QRS widens 50%, arrhythmia suppressed, hypotension or max dose; adjust dose based on levels; see ACLS: Tachycardia table for load infusion rate
supraventricular arrhythmia (off-label)
- [1-6 mg/min IV]
- Start: 15-17 mg/kg/dose IV x1 or 100 mg IV q5-10min; Alt: 50 mg/kg/day IM divided q3-6h; Max: 1.5 g start, 9 g/day maintenance; Info: for atrial fib/flutter, reentrant tachycardias, PSVT, WPW; load until QRS widens 50%, arrhythmia suppressed, hypotension or max dose; adjust dose based on levels
atrial fibrillation cardioversion (off-label)
- [1 g IV over 30min, then 2 mg/min IV over 1h]
renal dosing
- [see below]
- renal impairment: consider decr. usual dose or frequency
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: consider decr. usual dose or frequency
Peds Dosing .
- Dosage forms: INJ
ventricular arrhythmias
- [20-80 mcg/kg/min IV]
- Start: 15 mg/kg/dose IV x1 or 3-6 mg/kg/dose up to 100 mg IV q5-10min; Alt: 20-30 mg/kg/day IM divided q4-6h; Max: 15 mg/kg/dose start; 2 g/day IV, 4 g/day IM maintenance; Info: load until QRS widens 50%, arrhythmia suppressed, hypotension or max dose; adjust dose based on levels
PALS, SVT
- [15 mg/kg/dose IV/IO x1]
- Info: see PALS: Tachycardia table
PALS, VT
- [15 mg/kg/dose IV/IO x1]
- Info: see PALS: Tachycardia table
supraventricular arrhythmia (off-label)
- [20-80 mcg/kg/min IV]
- Start: 15 mg/kg/dose IV x1 or 3-6 mg/kg/dose up to 100 mg IV q5-10min; Alt: 20-30 mg/kg/day IM divided q4-6h; Max: 15 mg/kg/dose start; 2 g/day IV, 4 g/day IM maintenance; Info: for atrial fib/flutter, reentrant tachycardias, PSVT, WPW; load until QRS widens 50%, arrhythmia suppressed, hypotension or max dose; adjust dose based on levels
renal dosing
- [see below]
- CrCl <10: start 12 mg/kg/dose x1, then decr. usual maintenance dose, amount not defined
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: consider decr. usual dose or frequency