Names and pronunciation
(proe-kane-ah′mide)
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Drug reference
(proe-kane-ah′mide)
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Func. class.: Antidysrhythmic (class IA)
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Chem. class.: Procaine HCl amide analog
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ACTION: Depresses excitability of cardiac muscle to electrical stimulation and slows conduction velocity in atrium, bundle of His, and ventricle; increases refractory period
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USES: Life-threatening ventricular dysrhythmias
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Unlabeled uses: Atrial fibrillation/flut- ter, paroxysmal atrial tachycardia, PSVT, Wolff-Parkinson-White (WPW) syndrome
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CONTRAINDICATIONS: Hyper sensitivity, severe heart block, torsades de pointes
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Black Box Warning: Lupus erythema- tosus Precautions: Pregnancy, breastfeeding, children, renal/hepatic disease, HF, respiratory depression, cytopenia, dys- rhythmia associated with digoxin toxicity, myasthenia gravis, digoxin toxicity Black Box Warning: Bone marrow fail- ure, cardiac arrhythmias DOSAGE AND ROUTES—NTI Ventricular tachycardia during CPR • Adult: IV loading dose 20 mg/min; ei- ther ventricular tachycardia resolves or patient becomes hypotensive; QRS com- plex is widened by 50% of original width or total is 17 mg/kg (1.2 g for a 70-kg patient); may give up to 50 mg/min in urgent situations; maintenance: 1-4 mg/ min CONT IV INFUSION; IM 50 mg/kg/ day in divided doses q3-6hr • Child: IV PALS 15 mg/kg over 30-60 min Renal dose • Adult: IV CCr 35-59 mL/min, give 70% maintenance dose; CCr 15-34 mL/min, give 40%-60% maintenance dose; CCr <15 mL/min, individualize dose Black Box Warning: Cardiac dys- rhythmias: ECG continuously if using IV to determine increased PR or QRS seg- ments; discontinue immediately; watch for increased ventricular ectopic beats, maximum need to rebolus • Therapeutic blood levels, 4-10 mcg/ mL or NAPA levels 10-20 mcg/mL Black Box Warning: Bone marrow suppression: CBC q2wk × 3 mo; leu- kocyte, neutrophil, platelet counts may be decreased, treatment may need to be discontinued • I&O ratio; electrolytes (K, Na, Cl), weight weekly, report gain of >2 lb • Toxicity: confusion, drowsiness, nausea, vomiting, tachydysrhythmias, oliguria • ANA titer; during long-term treatment, watch for lupuslike symptoms • Respiratory status: rate, rhythm, char- acter, lung fields; bilateral crackles may occur in HF patient; watch for respiratory depression • CNS effects: dizziness, confusion, psy- chosis, paresthesias, seizures; product should be discontinued • Pregnancy/breastfeeding: use only if clearly needed; do not breastfeed Black Box Warning: To notify prescriber immediately if lupuslike symptoms ap- pear (joint pain, butterfly rash, fever, chills, dyspnea) Black Box Warning: To notify prescriber of leukopenia (sore mouth, gums, throat) or thrombocytopenia (bleeding, bruising) • How to take pulse and when to report to prescriber • To avoid driving, other hazardous ac- tivities until product effect is known
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SIDE EFFECTS CNS: Headache, dizziness, confusion, psychosis, restlessness, irritability, weak- ness, depression CV: Hypotension, heart block, cardiovas- cular collapse, arrest, torsades de pointes GI: Nausea, vomiting, anorexia, diarrhea, hepatomegaly, pain, bitter taste HEMA: SLE syndrome, agranulocytosis, thrombocytopenia, neutropenia, hemo- lytic anemia INTEG: Rash, urticaria, edema, swelling (rare), pruritus, flushing, angioedema SYST: SLE
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INTERACTIONS Increase: effects of neuromuscular blockers Increase: procainamide effects—cimeti- dine, quiNIDine, trimethoprim, β-blockers, raNITIdine Increase: toxicity—other antidysrhyth- mics, thioridazine, quinolones Drug/Lab Test Increase: ALT, AST, alk phos, LDH, bilirubin
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TREATMENT OF OVERDOSE: O2, artificial ventilation, ECG, administer DOPamine for circulatory depression, diazePAM or thiopental for seizures, isoproterenol HIGH ALERT
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Available forms: Inj 100, 500 mg/mL
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Administer: IM route • IM inj in deltoid; aspirate to avoid in- travascular administration; use only when unable to use IV Direct IV route • Dilute each 100 mg/10 mL of 0.9% NaCl; give at max 50 mg/min Intermittent IV INFUSION route • Dilute 0.2-1 g/50-500 mL of D5W (2-4 mg/mL); give over 30-60 min at max 25- 50 mg/min; use infusion pump Y-site compatibilities: Alfentanil, amikacin, aminocaproic acid, aminophylline, amio darone, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, ascorbic acid, atenolol, atracurium, atro- pine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, caspofungin, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefo- TEtan, cefOXitin, cefTAZidime, cefTRIAX- one, cefuroxime, cephalothin, chlorproM- AZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytara- bine, DACTINomycin, DAPTOmycin, dexa- methasone, digoxin, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epiRUBicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etopo- side, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fluda- rabine, fluorouracil, folic acid, furosemide, gatifloxacin, gemcitabine, gentamicin, gly- copyrrolate, granisetron, heparin, hydro- cortisone, HYDROmorphone, IDArubicin, ifosfamide, indomethacin, insulin (regu- lar), irinotecan, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metarami- nol, methicillin, methotrexate, methox- amine, methyldopate, methylPREDNISo- lone, metoclopramide, metoprolol, mezlocillin, miconazole, midazolam, mito- XANTRONE, morphine, moxalactam, multi- vitamins, mycophenolate, nafcillin, nalbu- phine, naloxone, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxyto- cin, PACLitaxel, palonosetron, pamidro- nate, pancuronium, pantoprazole, papav- erine, PEMEtrexed, penicillin G potassium/ sodium, pentamidine, pentazocine, PENTo- barbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin- P tazobactam, polymyxin B, potassium chlo- ride, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiNI- Dine, quinupristin-dalfopristin, raNITIdine, remifentanil, ritodrine, rocuronium, sodium bicarbonate, succinylcholine, SUF- entanil, tacrolimus, teniposide, theophyl- line, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofi- ban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex/C, voricon- azole, zoledronic acid
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Assess:
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Evaluate: • Therapeutic response: decreased dys- rhythmias
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That wax matrix may appear in stools • Not to discontinue without provider’s approval
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PHARMACOKINETICS Metabolized in liver to active metabolites, excreted unchanged by kidneys (60%), protein binding 15% IM: Peak 10-60 min, half-life 3 hr
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