procainamide (Rx)

Brand and Other Names:Pronestyl (SR)
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection solution

  • 100 mg/mL
  • 500mg/mL

Arrhythmia

Adjust dose to patient's response

IM Administration

  • 0.5-1 g IM q4-8hr

IV Administration

  • Loading dose: 100-200 mg/dose or 15-18 mg/kg; infuse slowly over 25-30 min not to exceed 50 mg/min; may repeat q5min PRN not to exceed 1 g  
  • Maintenance: 1-4 mg/min by continuous IV infusion
  • Renal impairment:

Renal Impairment

Reduce loading dose to 12 mg/kg

Reduce infusion to one third in moderate renal or cardiac impairment and two thirds in severe renal or cardiac 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

  • Loading dose: 3-6 mg/kg IV over 5 minutes, not to exceed 100 mg/dose; may repeat q5-10min PRN not to exceed 15 mg/kg/dose
  • Maintenance: 0.02-0.08 mg/kg/min IV infusion; not to exceed 2 g/24 hours  
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Interactions

Interaction Checker

and procainamide

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            Contraindicated (50)

            • 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.

            • 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 (72)

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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 (66)

            • 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. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.

            • 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.

            • 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).

            • 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.

            • 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.

            • 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. .

            • 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.

            • 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.

            Minor (16)

            • 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.

            • pilocarpine ophthalmic

              procainamide decreases effects of pilocarpine ophthalmic 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.

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            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

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            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
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            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.

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            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)

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            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
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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            procainamide injection
            -
            500 mg/mL vial
            procainamide injection
            -
            100 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.

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            Patient Handout

            Patient Education
            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) 2021 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.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.