Dosing & Uses
Dosage Forms & Strengths
injection solution
- 100 mg/mL
- 500mg/mL
Arrhythmia
50 mg/kg/day (15-18 mg/kg/dose) IV initially
For direct IV injection into a vein or established infusion line: Not to exceed 50 mg/min
May administer doses of 100 mg q5min at this rate until arrhythmia is suppressed or until 500 mg has been administered, after which it is advisable to wait ≥10 min to allow for more distribution into tissues before resuming
Alternatively
- Loading dose (20 mg/mL concentration): Infuse IV at 1 mL (20 mg)/min for 25-30 minutes to deliver 500-600 mg
- Maintenance dose (2 mg/mL concentration): Infuse IV at 1-3 mL (2-6 mg)/min
- If patient is fluid restricted, use 4 mg/mL concentration and infuse at 0.5-1.5 mL/min
Dosage Modifications
Renal impairment
- Reduce loading dose to 12 mg/kg in severe renal impairment
- Maintenance infusions should be reduced by one-third in patients with moderate renal impairment and by two-thirds in patients with severe renal impairment.
Hepatic Impairment
- Reduce dose by 50%
Dosage Forms & Strengths
injection solution
- 100 mg/mL
- 500mg/mL
Arrhythmia
Adjust dose to patient's response
IM Administration
- 20-30 mg/kg/day IM divided q4-6hr; not to exceed 4 g/day
IV Administration
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (51)
- amiodarone
amiodarone and procainamide both increase QTc interval. Contraindicated.
- amitriptyline
amitriptyline and procainamide both increase QTc interval. Contraindicated.
- amoxapine
amoxapine and procainamide both increase QTc interval. Contraindicated.
- artemether/lumefantrine
artemether/lumefantrine and procainamide both increase QTc interval. Contraindicated.
- chlorpromazine
chlorpromazine and procainamide both increase QTc interval. Contraindicated.
- clomipramine
clomipramine and procainamide both increase QTc interval. Contraindicated.
- desipramine
desipramine and procainamide both increase QTc interval. Contraindicated.
- disopyramide
disopyramide and procainamide both increase QTc interval. Contraindicated.
- dofetilide
dofetilide and procainamide both increase QTc interval. Contraindicated.
procainamide, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects. - doxepin
doxepin and procainamide both increase QTc interval. Contraindicated.
- dronedarone
dronedarone and procainamide both increase QTc interval. Contraindicated.
- droperidol
droperidol and procainamide both increase QTc interval. Contraindicated.
- epinephrine
epinephrine and procainamide both increase QTc interval. Contraindicated.
- epinephrine racemic
epinephrine racemic and procainamide both increase QTc interval. Contraindicated.
- erythromycin base
erythromycin base and procainamide both increase QTc interval. Contraindicated.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate and procainamide both increase QTc interval. Contraindicated.
- erythromycin lactobionate
erythromycin lactobionate and procainamide both increase QTc interval. Contraindicated.
- erythromycin stearate
erythromycin stearate and procainamide both increase QTc interval. Contraindicated.
- fingolimod
fingolimod increases effects of procainamide by pharmacodynamic synergism. Contraindicated. Due to increased risk of bradycardia, AV block, and torsade de pointes, concomitant use is contraindicated.
- fluconazole
fluconazole and procainamide both increase QTc interval. Contraindicated.
- fluphenazine
fluphenazine and procainamide both increase QTc interval. Contraindicated.
- goserelin
goserelin increases toxicity of procainamide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- haloperidol
haloperidol and procainamide both increase QTc interval. Contraindicated.
- ibutilide
ibutilide and procainamide both increase QTc interval. Contraindicated.
- imipramine
imipramine and procainamide both increase QTc interval. Contraindicated.
- indapamide
indapamide and procainamide both increase QTc interval. Contraindicated.
- ketoconazole
ketoconazole and procainamide both increase QTc interval. Contraindicated.
- leuprolide
leuprolide increases toxicity of procainamide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- levoketoconazole
levoketoconazole and procainamide both increase QTc interval. Contraindicated.
- lofepramine
lofepramine and procainamide both increase QTc interval. Contraindicated.
- lumefantrine
lumefantrine and procainamide both increase QTc interval. Contraindicated.
- maprotiline
maprotiline and procainamide both increase QTc interval. Contraindicated.
- moxifloxacin
moxifloxacin and procainamide both increase QTc interval. Contraindicated.
- nilotinib
nilotinib and procainamide both increase QTc interval. Contraindicated.
- nortriptyline
nortriptyline and procainamide both increase QTc interval. Contraindicated.
- octreotide
octreotide and procainamide both increase QTc interval. Contraindicated.
- octreotide (Antidote)
octreotide (Antidote) and procainamide both increase QTc interval. Contraindicated.
- pentamidine
pentamidine and procainamide both increase QTc interval. Contraindicated.
- perphenazine
perphenazine and procainamide both increase QTc interval. Contraindicated.
- pimozide
pimozide and procainamide both increase QTc interval. Contraindicated.
- prochlorperazine
prochlorperazine and procainamide both increase QTc interval. Contraindicated.
- promazine
promazine and procainamide both increase QTc interval. Contraindicated.
- promethazine
promethazine and procainamide both increase QTc interval. Contraindicated.
- protriptyline
protriptyline and procainamide both increase QTc interval. Contraindicated.
- quinidine
quinidine and procainamide both increase QTc interval. Contraindicated.
- sotalol
procainamide and sotalol both increase QTc interval. Contraindicated.
- thioridazine
thioridazine and procainamide both increase QTc interval. Contraindicated.
- trazodone
trazodone and procainamide both increase QTc interval. Contraindicated.
- trifluoperazine
trifluoperazine and procainamide both increase QTc interval. Contraindicated.
- trimipramine
trimipramine and procainamide both increase QTc interval. Contraindicated.
- ziprasidone
procainamide and ziprasidone both increase QTc interval. Contraindicated.
Serious - Use Alternative (101)
- adagrasib
adagrasib, procainamide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.
- alfuzosin
alfuzosin and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- amiodarone
amiodarone will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and procainamide both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- anagrelide
anagrelide and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- apomorphine
apomorphine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- aripiprazole
aripiprazole and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- arsenic trioxide
arsenic trioxide and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
asenapine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- atomoxetine
atomoxetine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- bremelanotide
bremelanotide will decrease the level or effect of procainamide by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.
- buprenorphine
buprenorphine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- chloroquine
chloroquine increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug.
- cimetidine
cimetidine will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
clozapine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- dacomitinib
dacomitinib will increase the level or effect of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
- dasatinib
dasatinib and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
degarelix and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- digoxin
digoxin will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
- dofetilide
dofetilide will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
- dolasetron
dolasetron and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- donepezil
donepezil and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- efavirenz
efavirenz and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- eliglustat
eliglustat and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and procainamide both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.
- entrectinib
procainamide and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
eribulin and procainamide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.
- escitalopram
escitalopram increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and procainamide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
- fingolimod
fingolimod and procainamide both increase QTc interval. Contraindicated.
- flecainide
flecainide and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
fluoxetine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- formoterol
formoterol and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- foscarnet
foscarnet and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- gadobenate
gadobenate and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- gemifloxacin
gemifloxacin and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- gilteritinib
gilteritinib and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- givosiran
givosiran will increase the level or effect of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.
- glasdegib
procainamide and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- granisetron
granisetron and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- histrelin
histrelin increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug.
- hydroxyzine
hydroxyzine increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- iloperidone
iloperidone and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and procainamide both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.
- isoflurane
isoflurane and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib and procainamide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
- lapatinib
lapatinib and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- levofloxacin
levofloxacin and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- lithium
lithium and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
macimorelin and procainamide both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
- mefloquine
mefloquine increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- methadone
methadone and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- mirtazapine
mirtazapine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib and procainamide both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.
- ofloxacin
ofloxacin and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- olanzapine
olanzapine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- ondansetron
procainamide and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
- oxaliplatin
oxaliplatin and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- paliperidone
paliperidone and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
procainamide and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.
- paroxetine
paroxetine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- pimavanserin
pimavanserin and procainamide both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.
- posaconazole
posaconazole and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- primaquine
primaquine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
quinidine will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
- ranolazine
procainamide and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
ribociclib and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- risperidone
procainamide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.
- romidepsin
procainamide and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- saquinavir
saquinavir, procainamide. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Increased risk of PR or QT prolongation and cardiac arrhythmias.
- sertraline
sertraline and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
sevoflurane and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
siponimod, procainamide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Because of the potential additive effects on heart rate, siponimod should generally not be initiated in patients taking QT prolonging drugs with known arrhythmogenic properties, heart rate lowering calcium channel blockers, or other drugs that may decrease heart rate. If treatment considered, obtain cardiology consult regarding switching to non-heart-rate lowering drugs or appropriate monitoring for treatment initiation.
- sulfamethoxazole
sulfamethoxazole and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- sunitinib
sunitinib and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- tacrolimus
tacrolimus and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- tafenoquine
tafenoquine will increase the level or effect of procainamide by Other (see comment). Avoid or Use Alternate Drug. Tafenoquine inhibits organic cation transporter-2 (OCT2) and multidrug and toxin extrusion (MATE) transporters in vitro. Avoid coadministration with OCT2 or MATE substrates. If coadministration cannot be avoided, monitor for substrate-related toxicities and consider dosage reduction if needed based on product labeling of the coadministered drug.
- telavancin
procainamide and telavancin both increase QTc interval. Avoid or Use Alternate Drug.
- tetrabenazine
tetrabenazine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
procainamide and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.
- trilaciclib
trilaciclib will decrease the level or effect of procainamide by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of trilaciclib (OCT2, MATE1, and MATE-2K inhibitor) with substrates where minimal increased concentration in kidney or blood may lead to serious or life-threatening toxicities.
- trimethoprim
procainamide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- triptorelin
triptorelin increases toxicity of procainamide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- tropisetron
procainamide and tropisetron both increase QTc interval. Avoid or Use Alternate Drug.
- umeclidinium bromide/vilanterol inhaled
procainamide increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- vemurafenib
vemurafenib increases levels of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with agents with narrow therapeutic windows is not recommended as vemurafenib may alter their concentrations. If coadministration cannot be avoided, use caution and consider dose reduction of concomitant CYP2D6 substrate drug. Combination may increase risk QT prolongation.
- venlafaxine
procainamide and venlafaxine both increase QTc interval. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
procainamide increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- voriconazole
procainamide and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (73)
- abiraterone
abiraterone increases levels of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
- albuterol
albuterol and procainamide both increase QTc interval. Use Caution/Monitor.
- alfuzosin
procainamide and alfuzosin both increase QTc interval. Use Caution/Monitor.
- arformoterol
arformoterol and procainamide both increase QTc interval. Use Caution/Monitor.
- azithromycin
azithromycin and procainamide both increase QTc interval. Modify Therapy/Monitor Closely.
- bedaquiline
procainamide and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- bosutinib
bosutinib and procainamide both increase QTc interval. Use Caution/Monitor.
- capecitabine
capecitabine and procainamide both increase QTc interval. Use Caution/Monitor.
- ciprofloxacin
ciprofloxacin and procainamide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.
- citalopram
procainamide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- crizotinib
crizotinib and procainamide both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- dabrafenib
dabrafenib and procainamide both increase QTc interval. Use Caution/Monitor.
- deutetrabenazine
procainamide and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- dulaglutide
dulaglutide, procainamide. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.
- eliglustat
eliglustat increases levels of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- erdafitinib
erdafitinib increases levels of procainamide by decreasing renal clearance. Modify Therapy/Monitor Closely. Consider alternatives that are not OCT2 substrates or consider reducing the dose of OCT2 substrates based on tolerability.
- etrasimod
etrasimod, procainamide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Transient decrease in heart rate and AV conduction delays may occur when initiating etrasimod. Owing to potential of additive effect on heart rate, etrasimod may increase risk of QT prolongation and Torsades de Pointes when coadministered with Class Ia or Class III antiarrhythmic drugs, or other drugs that prolong the QT interval. .
- ezogabine
ezogabine, procainamide. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
- ferric maltol
ferric maltol, procainamide. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).
- floxuridine
floxuridine and procainamide both increase QTc interval. Use Caution/Monitor.
- fostemsavir
procainamide and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemtuzumab
procainamide and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- gepirone
gepirone and procainamide both increase QTc interval. Modify Therapy/Monitor Closely.
- hawthorn
hawthorn increases effects of procainamide by pharmacodynamic synergism. Use Caution/Monitor.
- henbane
henbane, procainamide. unspecified interaction mechanism. Use Caution/Monitor. Combination not recommended by British Herbal Medicine Association.
- hydrochlorothiazide
hydrochlorothiazide will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- indacaterol, inhaled
indacaterol, inhaled, procainamide. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- itraconazole
itraconazole and procainamide both increase QTc interval. Use Caution/Monitor.
- lenvatinib
procainamide and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- lidocaine
lidocaine, procainamide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Either suppresses myocardial conduction by increasing electrical stimulation threshold of the ventricle and His-Purkinje fibers.
- lofexidine
procainamide and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.
- lorcaserin
lorcaserin will increase the level or effect of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- memantine
memantine will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- metformin
metformin will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- methyclothiazide
methyclothiazide will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- midodrine
midodrine will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- mifepristone
mifepristone, procainamide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- mipomersen
mipomersen, procainamide. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- mirabegron
mirabegron will increase the level or effect of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- ofloxacin
ofloxacin will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- olodaterol inhaled
procainamide and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
- osilodrostat
osilodrostat and procainamide both increase QTc interval. Use Caution/Monitor.
- osimertinib
osimertinib and procainamide both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- oxaliplatin
oxaliplatin will increase the level or effect of procainamide by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- ozanimod
ozanimod and procainamide both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- pasireotide
procainamide and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pazopanib
pazopanib and procainamide both increase QTc interval. Modify Therapy/Monitor Closely.
- ponesimod
ponesimod, procainamide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class Ia (eg, quinidine, procainamide) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.
- pramipexole
pramipexole will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- quetiapine
quetiapine, procainamide. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.
- quinine
procainamide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
procainamide and quinine both increase QTc interval. Use Caution/Monitor. - quizartinib
quizartinib, procainamide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.
- rilpivirine
rilpivirine increases toxicity of procainamide by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.
- selpercatinib
selpercatinib increases toxicity of procainamide by QTc interval. Use Caution/Monitor.
- sevelamer
sevelamer decreases levels of procainamide by increasing elimination. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of procainamide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of procainamide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
- solifenacin
solifenacin and procainamide both increase QTc interval. Use Caution/Monitor.
- sorafenib
sorafenib and procainamide both increase QTc interval. Use Caution/Monitor.
- sulfamethoxazole
sulfamethoxazole will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- teduglutide
teduglutide increases levels of procainamide by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.
- tenofovir DF
tenofovir DF increases levels of procainamide by decreasing renal clearance. Use Caution/Monitor. Potential for increased toxicity. .
- triamterene
procainamide will increase the level or effect of triamterene by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- triclabendazole
triclabendazole and procainamide both increase QTc interval. Use Caution/Monitor.
- trimethoprim
procainamide will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- trospium chloride
procainamide, trospium chloride. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- ustekinumab
ustekinumab, procainamide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.
- valbenazine
valbenazine and procainamide both increase QTc interval. Use Caution/Monitor.
- vandetanib
vandetanib increases levels of procainamide by Other (see comment). Modify Therapy/Monitor Closely. Comment: Vandetanib inhibits the uptake of substrates of organic cation transporter type 2 (OCT2).
- verapamil
procainamide will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- voclosporin
voclosporin, procainamide. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- vorinostat
vorinostat and procainamide both increase QTc interval. Use Caution/Monitor.
Minor (15)
- bethanechol
procainamide decreases effects of bethanechol by pharmacodynamic antagonism. Minor/Significance Unknown.
- carbachol
procainamide decreases effects of carbachol by pharmacodynamic antagonism. Minor/Significance Unknown.
- cevimeline
procainamide decreases effects of cevimeline by pharmacodynamic antagonism. Minor/Significance Unknown.
- donepezil
procainamide decreases effects of donepezil by pharmacodynamic antagonism. Minor/Significance Unknown.
- echothiophate iodide
procainamide decreases effects of echothiophate iodide by pharmacodynamic antagonism. Minor/Significance Unknown.
- entecavir
procainamide, entecavir. Either increases levels of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.
- galantamine
procainamide decreases effects of galantamine by pharmacodynamic antagonism. Minor/Significance Unknown.
- huperzine A
procainamide decreases effects of huperzine A by pharmacodynamic antagonism. Minor/Significance Unknown.
- isavuconazonium sulfate
isavuconazonium sulfate will increase the level or effect of procainamide by Other (see comment). Minor/Significance Unknown. Isavuconazonium sulfate, an OCT2 inhibitor, may increase the effects or levels of OCT2 substrates.
- lily of the valley
procainamide, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.
- neostigmine
procainamide decreases effects of neostigmine by pharmacodynamic antagonism. Minor/Significance Unknown.
- physostigmine
procainamide decreases effects of physostigmine by pharmacodynamic antagonism. Minor/Significance Unknown.
- pilocarpine
procainamide decreases effects of pilocarpine by pharmacodynamic antagonism. Minor/Significance Unknown.
- pyridostigmine
procainamide decreases effects of pyridostigmine by pharmacodynamic antagonism. Minor/Significance Unknown.
- succinylcholine
procainamide decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
>10%
Increased antinuclear antibodies (50%)
SLE-like syndrome (30%)
1-10%
Hypotension (5%)
Frequency Not Defined
Arrhythmias
Asystole
Heart block
Wide PR or QRS
Asthenia
Ataxia
Depression
Chills
Psychosis
Abdominal pain
Bitter taste
N/V
Myopathy
Rash
Leukopenia
Warnings
Black Box Warnings
Positive ANA Titer
- Long-term administration often leads to positive antinuclear antibody (ANA) test result
- Positive result may occur with or without lupus erythematosus-like syndrome symptoms If a positive ANA titer develops, assess benefits vs risks of continuing procainamide
Mortality
- National Heart, Lung, and Blood Institute's Cardiac Arrhythmia Suppression Trial (CAST): Excessive mortality or nonfatal cardiac arrest (7.7%) shown with encainide or flecainide compared with placebo (3%)
- CAST was a long-term, multicenter, randomized, double-blind study in patients with asymptomatic non-life-threatening ventricular arrhythmias who had a myocardial infarction >6 days but <2 yr previously
- Average duration of treatment w/ encainide or flecainide in CAST was 10 months
- Applicability of CAST results to other populations (eg, patients without recent MI) is uncertain
- Reserve use of Class IC antiarrhythmics for life-threatening ventricular arrhythmias: Considering the known proarrhythmic properties of procainamide & lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, procainamide use, as well as other antiarrhythmic agents, should be reserved for patients with life-threatening ventricular arrhythmias
Blood Dyscrasias
- Agranulocytosis, bone marrow depression, leukopenia, neutropenia, aplastic/hypoplastic anemia, thrombocytopenia, & sequelae such as septicemia & septic shock have been reported at a rate of ~0.5%
- Most reported within recommended dosage range and within initial 3 months of treatment
- Fatalities have occurred (~20-25% mortality rate in reported agranulocytosis cases)
- Perform complete blood counts, including white cell, differential, & platelet counts at weekly intervals for the first 3 months & then frequently thereafter
- Check blood count if the patient develops any signs of infection (eg, fever, chills, sore throat, stomatitis), bruising, or bleeding.
- If any of these hematologic disorders is identified, discontinue drug & initiate appropriate treatment
- Blood counts usually return to normal within 1 month of discontinuation
- Caution in patients with preexisting marrow failure or cytopenia
Contraindications
Hypersensitivity to procainamide or other ingredients
Complete heart block, 2°/3° AV block, SLE, torsade de pointes
Cautions
May produce life-threatening hematologic disorders (leukopenia, agranulocytosis)
Consider toxicity if serum level >12 mg/L [51 umol/L]
May exacerbate arrhythmias or produce paradoxical ventricular tachycardia in AFib/AFlutter patients
Exercise caution in arrhythmias associated with digitalis intoxication; drug can suppress digitalis-induced arrhythmias; however, concomitant marked disturbance of atrioventricular conduction may result in additional depression of conduction and ventricular asystole or fibrillation; consider use only if discontinuation of digitalis and therapy with potassium, lidocaine, or phenytoin are ineffective
Exercise caution if patient exhibits or develops first-degree heart block while receiving therapy; reduce dose if it occurs; if block persists despite dose reduction, evaluate whether to continue therapy by weighing benefit versus risk of increased heart block
Prior to therapy, cardiovert or digitalize patients with atrial flutter or fibrillation to avoid enhancement of A-V conduction which may result in ventricular rate acceleration beyond tolerable limits; adequate digitalization reduces but does not eliminate possibility of sudden increase in ventricular rate as atrial rate is slowed by drug in these arrhythmias
Use caution in patients with congestive heart failure, and those with acute ischemic heart disease or cardiomyopathy, when administering therapy; even slight depression of myocardial contractility may further reduce cardiac output of damaged heart
May produce enhanced prolongation of conduction or depression of contractility and hypotension when used concurrently with other Group 1A antiarrhythmic agents such as quinidine or disopyramide, especially in patients with cardiac decompensation; reserve such use for patients with serious arrhythmias unresponsive to single drug and administer only if close observation is possible
Renal insufficiency may lead to accumulation of high plasma levels from conventional doses of drug, with effects similar to those of overdosage, unless dosage is adjusted for individual patient
Worsening of symptoms of myasthenia gravis may occur from therapy due to its procaine-like effect on diminishing acetylcholine release at skeletal muscle motor nerve endings; administration of therapy may be hazardous without optimal adjustment of anticholinesterase medications and other precautions
Injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people; overall prevalence of sulfite sensitivity in general population is unknown and probably low; sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people
Closely observe patients for possible hypersensitivity reactions Immediately after initiation of therapy
Bear in mind that in conversion of atrial fibrillation to normal sinus rhythm by any means, may cause dislodgement of mural thrombi, which may lead to embolization
QRS monitoring
- Continued frequent periodic monitoring of vital signs and electrocardiograms advised after achieving and maintaining therapeutic plasma concentrations and satisfactory electrocardiographic and clinical responses
- If evidence of QRS widening of more than 25 percent or marked prolongation of Q-T interval occurs, overdosage should be considered, and interruption of the infusion is advisable if a 50 percent increase occurs
- Elevated serum creatinine or urea nitrogen, reduced creatinine clearance or history of renal insufficiency, as well as use in older patients (over age 50), provide grounds to anticipate that less than the usual dosage or infusion rate may suffice, since the urinary elimination of PA and NAPA may be reduced, leading to gradual accumulation beyond normally-predicted amounts
- If facilities are available for measurement of plasma procainamide and NAPA, or acetylation capability, individual dose adjustment for optimal therapeutic levels may be easier, but close observation of clinical effectiveness is the most important criterion
Blood pressure and ECG monitoring
- Monitor blood pressure with patient supine during parenteral, especially intravenous, administration of drug
- There is a possibility that relatively high although transient plasma levels of drug may be attained and cause hypotension before the drug can be distributed from plasma volume to its full apparent volume of distribution which is approximately 50 times greater
- Caution should be exercised to avoid overly rapid administration of drug If blood pressure falls 15 mm Hg or more; temporarily discontinue therapy if it occurs; electrocardiographic (ECG) monitoring is advisable as well, both for observation of the progress and response of the arrhythmia under treatment, and for early detection of any tendency to excessive widening of the QRS complex, prolongation of the P-R interval, or signs of heart block
- Parenteral therapy with should be limited to use in hospitals in which monitoring and intensive supportive care are available, or to emergency situations in which equivalent observation and treatment can be provided
Pregnancy & Lactation
Pregnancy Category: C
Lactation: crosses into breast milk, discontinue drug or do not nurse
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Class IA (membrane stabilizing) antiarrhythmic agent; inhibits recovery after repolarization resulting in decreasing myocardial excitability and conduction velocity
Direct membrane depressant that decreases conduction velocity, prolongs refractoriness, decreases automaticity and reduces repolarization abnormalities
Absorption
Bioavailability: 75-95%
Peak Plasma Time: 15-60 min (IV/IM)
Distribution
Protein Bound: 15-20%
Vd: 2 L/kg (1.5 L if CHF)
Metabolism
Acetylated in liver to form N-acetylprocainamide (NAPA) (active); ratio of procainamide/NAPA depends upon acetylator phenotype and renal function
Metabolites (active): N-acetylprocainamide (NAPA)
Elimination
Half-Life: 2.5-4.7 hr (parent drug), 6-8 hr (NAPA); increased in renal impairment and geriatrics
Renal Clearance: 150-600 mL/min
Excretion: Urine (30-60%), minimal in bile
Dialyzable: Yes (HD); no (PD)
Administration
IV Incompatibilities:
Additive: bretylium, esmolol, milrinone
Y-site: milrinone
IV Compatibilities
Additive: dobutamine, lidocaine, netilmicin
Y-site: famotidine, heparin, KCl, ranitidine, Vit B/C and Amiodarone
IV Preparation
Solution: 2 g/250 mL D5W or NS (8 mg/mL)
Administration: infusion requires use of an infusion pump; run at 1-6 mg/min (7.5-45 mL/hr)
Slight yellow color of soln will not alter potency; however,
- Do not use when darker than light amber or if soln contains precipitate
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| procainamide injection - | 100 mg/mL vial |  | |
| procainamide injection - | 500 mg/mL vial |  | |
| procainamide injection - | 500 mg/mL vial |  | |
| procainamide injection - | 500 mg/mL vial |  | |
| procainamide injection - | 100 mg/mL vial |  | |
| procainamide injection - | 100 mg/mL vial |  | |
| procainamide injection - | 100 mg/mL vial |  | |
| procainamide intravenous - | 100 mg/mL solution |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
procainamide injection
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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