What is the procainamide (anti-arrhythmic medication) dosage for adult tachycardia (rapid heart rate) with a palpable pulse?

From the Guidelines

For adult tachycardia with a pulse, procainamide should be administered as a loading dose of 20-50 mg/minute IV infusion, up to a maximum total dose of 17 mg/kg, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.

Key Considerations

• The infusion should be stopped if hypotension occurs, the arrhythmia resolves, the maximum dose is reached, or QRS widens by >50% of baseline.
• After the loading dose, a maintenance infusion of 1-4 mg/minute can be started if needed.
• Procainamide works by blocking sodium channels and prolonging the refractory period in cardiac tissue, making it effective for various supraventricular and ventricular tachycardias.

Important Warnings and Precautions

• Procainamide should be used with caution in patients with renal or hepatic impairment, as dose adjustments may be necessary 1.
• Monitor blood pressure, ECG, and QRS duration continuously during administration.
• Procainamide is contraindicated in patients with torsades de pointes, complete heart block, or known hypersensitivity to the drug.
• Be aware that procainamide can cause QT prolongation, so careful cardiac monitoring is essential during administration 1.

Administration Details

• The loading dose typically translates to about 1-1.5 grams total for most adults.
• Avoid using procainamide in patients with prolonged QT or congestive heart failure (CHF) 1.

From the FDA Drug Label

Initial arrhythmia control, under ECG monitoring, may usually be accomplished safely within a half-hour by either of the two methods which follows: Direct injection into a vein or into tubing of an established infusion line should be done slowly at a rate not to exceed 50 mg per minute It is advisable to dilute either the 100 mg per mL or the 500 mg per mL concentrations of procainamide hydrochloride prior to intravenous injection to facilitate control of dosage rate Doses of 100 mg may be administered every 5 minutes at this rate until the arrhythmia is suppressed or until 500 mg has been administered, after which it is advisable to wait 10 minutes or longer to allow for more distribution into tissues before resuming Alternatively, a loading infusion containing 20 mg of Procainamide Hydrochloride per mL (1 g diluted to 50 mL with 5% Dextrose Injection, USP) may be administered at a constant rate of 1 mL per minute for 25 to 30 minutes to deliver 500 to 600 mg of PA The maximum advisable dosage to be given either by repeated bolus injections or such loading infusion is 1 gram

The recommended procainamide dosage for adult tachycardia with a pulse is:

• Initial dose: 100 mg administered every 5 minutes at a rate not to exceed 50 mg per minute, until the arrhythmia is suppressed or until 500 mg has been administered
• Alternative loading infusion: 20 mg of Procainamide Hydrochloride per mL administered at a constant rate of 1 mL per minute for 25 to 30 minutes to deliver 500 to 600 mg of PA
• Maximum dosage: 1 gram given either by repeated bolus injections or loading infusion 2

From the Research

Procainamide Dosage in Adult Tachycardia with a Pulse

• The dosage of procainamide for adult tachycardia with a pulse is not explicitly stated in the provided studies, but the administration and efficacy of procainamide in various studies are discussed 3, 4, 5.
• In the study by 4, patients were randomly assigned to receive intravenous procainamide (10 mg/kg/20 min) or amiodarone (5 mg/kg/20 min) for the acute treatment of tolerated wide QRS complex tachycardia.
• The study by 5 compared the individual and combined effects of procainamide and amiodarone in patients with sustained ventricular tachyarrhythmias, with a mean procainamide concentration of 8.7 +/- 2.8 micrograms/ml.
• Another study 6 discussed the strategies for safe and effective use of amiodarone, lidocaine, and procainamide in the intensive care unit, but did not provide specific dosage information for procainamide in adult tachycardia with a pulse.

Efficacy and Safety of Procainamide

• The efficacy of procainamide in terminating sustained ventricular tachycardia (VT) was compared to amiodarone in several studies 3, 4, 5.
• The study by 4 found that procainamide therapy was associated with less major cardiac adverse events and a higher proportion of tachycardia termination within 40 min compared to amiodarone.
• However, the study by 3 found that procainamide was not more effective than amiodarone for the termination of sustained VT, but the ability to detect a significant difference was limited by the study design and potential confounding.
• The safety of procainamide was also discussed in the study by 6, which highlighted the importance of monitoring for adverse effects and drug-drug interactions when using procainamide in the critical care setting.