Procainamide (HCl)

Procainamide(HCl) is a potent class I antiarrhythmic agent used in the treatment of several cardiac arrhythmias including atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia, and ventricular tachycardia. A derivative of the local anesthetic procaine, differs from procaine only in that it conatin an amide structure rather than an ester linkage. This difference protects it from enzymatic hydrolysis resulting in comperatively longer duration of action and less central nervous sytem effects. Procainamide is similar in action to quinidine and disopyramide. It can be administered both orally and parenterally. Procainamide was given FDA approval in 1950 and has been used in clinical medicine since 1951. Procainamide inhibits the influx of sodium through membrane pores. It exerts its effects on "fast" channels of the myocardial cell membrane, prolonging the recovery period after repolarizatio, Thereby decreasing myocardial automaticity, excitability, conduction velocity, and possibly contractility.

Brands
VIVIOPTAL PRONESTYL CITROFTALMINA NEUROPLEX
Adult Dose
Dose: 50 mg/kg
Single Dose: 50 (50)
Frequency: 24 hourly
Route: PO
Instructions: In div.doses.
Neonatal
Dose: 0.5 mg/kg.hr
Single Dose: 0.5 (0.5)
Frequency: As recommended.
Route: IV Infusion
Instructions: Maintenance, As Required
Paedriatic
Dose: 0.5 mg/kg.hr
Single Dose: 0.5 (0.5)
Frequency: As recommended.
Route: IV Infusion
Instructions: Maintenance, As Required
Characteristics
. It is of Synthetic origin and belongs to Benzamide. It belongs to Na-Channel Antiarrhythmic antagonist pharmacological group on the basis of mechanism of action and also classified in Anti arrhythmic agents pharmacological group.The Molecular Weight of Procainamide (HCl) is 271.80. Its pKa is 9.2.
Contraindications
Procainamide (HCl) is contraindicated in conditions like Heart failure,Myasthenia gravis,Heart block,Digitalis toxicity.
Effects
Procainamide (HCl) produces potentially life-threatening effects which include Anemia, Agranulocytosis, Thrombocytopenia, Lupus erythematosus, Neutropenia, Pancytopenia, Leucopenia, Ventricular tachycardia. which are responsible for the discontinuation of Procainamide (HCl) therapy.The signs and symptoms that are produced after the acute overdosage of Procainamide (HCl) include Hypotension, Vomiting, Tachycardia, Oliguria.The symptomatic adverse reactions produced by Procainamide (HCl) are more or less tolerable and if they become severe, they can be treated symptomatically, these include Anorexia, Diarrhea, Confusion, Depression, Taste disturbance, Nausea and vomiting, Giddiness, Convulsions.
Indications
Procainamide (HCl) is primarily indicated in conditions like Atrial arrhythmias, Cardiac arrhythmia, Prophylaxis of NSAID-induced duodenal ulcer, Sinus rhythm, Ventricular arrhythmias.
Interactions
Procainamide (HCl) is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAlcoholAlcuronium (Cl)Amiodarone (HCl)Procainamide may enhance the QTc-prolonging effect of Amiodarone. Amiodarone may increase the metabolism, via CYP isoenzymes, of Procainamide. MajorRapidMonitor for decreased cardiac conduction (ie, prolonged QTc) if amiodarone and Procainamide are used concomitantly. Such would increase the risk of developing torsade de pointes. In addition, monitor for increased serum concentrations/toxicity of Procainamide if amiodarone is initiated/dose increased, or decreased serum concentrations/effects if amiodarone is discontinued/dose decreased.Amitriptyline (HCl)Amphotericin BArtemisininAtracurium (Besylate)Bethanechol (Cl)CaptoprilProcainamide increases risk of toxicity with captopril, especially in renal impairment.Cimetidine (HCl)Co-TrimoxazoleDistigmine (Br)Edrophonium (Cl)Halofantrine (HCl)Metformin (HCl)Procainamide reduces the excretion of metformin by competing for renal tubular transport results in increased level of metforminmay lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Closely monitor the blood glucose level. Patient should notify to physician if experience signs of lactic acidosis.MetrizamideThe use of iodine-containing contrast media for coronary angiography in patients treated with certain antiarrhythmics such as amiodarone may result in significant prolongation of the QT interval. These contrast agents can be arrhythmogenic when injected into the coronary arteries and may have additive effects on cardiac repolarization when coadministered with antiarrhythmic agents that prolong the QT interval.ModerateCaution is advised if iodine-containing contrast media are used for coronary angiography in patients treated with class IA (e.g., disopyramide, quinidine, procainamide) or class III (e.g., amiodarone, dofetilide, ibutilide, sotalol) antiarrhythmic agents. Increased surveillance and ECG monitoring may be appropriate. Patients who receive outpatient angiographies should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of arrhythmia such as dizziness, palpitations, or syncope.MexiletineMivacurium (Cl)NadololNeostigmineOfloxacinPericyazineThese drugs shouldnot be taken concurrently without doctors prescription.Propranolol (HCl)Pyridostigmine (Br)Pyridostigmine (Br)Antiarrythmic drugs such as procainamide block the acetylcholine receptorRivastigmineRocuronium (Br)Sodium PhosphateShould not be use concurrently without doctors prescription.Sotalol (HCl)SulfapyridineConcurrent use with sulfapyridine may increase the potential for toxic side effectsSuxamethonium (Cl)VORICONAZOLEAdditive QTc prolongation may occur. Consider alternate therapy or monitor for QTc prolongation These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Risks
Drug should not be given to Paediatrics, Pregnant Mothers, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Inj Do not Freeze. Protect from Sunlight. Tab Store in a well closed container. Protect from Moisture.
Warnings
Procainamide should be used only if clearly needed during pregnancy or lactation. It should be used with caution in patients with any pre-existing kidney disease, heart disease, liver disease, myasthenia gravis, lupus erythematosus, blood disorders or if have any allergy especially to procaine, local anesthetic drugs or aspirin.
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