From the Guidelines
Procainamide should be mixed by diluting the appropriate dose in a compatible solution, such as 5% dextrose in water (D5W), for intravenous administration, with careful consideration of the dose and administration rate to minimize risks and ensure efficacy, as guided by the ACC/AHA guidelines for the management of patients with acute myocardial infarction 1. When preparing procainamide for intravenous use, it is essential to follow specific guidelines to ensure the solution is stable and effective.
- The loading dose of procainamide is typically initiated with 10 to 15 mg/kg, given at a rate of 20 mg/min, as outlined in the ACC/AHA guidelines 1.
- For maintenance infusions, procainamide can be administered at a rate of 1 to 4 mg/min, with the solution diluted in a larger volume of D5W, such as 1-4 grams in 250-500 mL.
- It is crucial to avoid mixing procainamide with other medications in the same solution to prevent potential interactions or incompatibilities.
- Healthcare providers should handle procainamide with care, wearing gloves to avoid skin contact, which can cause local irritation.
- The mixed solution should be clear and colorless to slightly yellow; any discoloration or precipitation indicates the solution should be discarded.
- Given its relatively short stability once mixed, procainamide solutions should be prepared shortly before administration, with a general stability of 24 hours at room temperature or 48 hours if refrigerated. The careful preparation and administration of procainamide are critical due to its use as a Class IA antiarrhythmic drug for treating ventricular arrhythmias and certain supraventricular tachycardias, as noted in the management guidelines 1.
From the FDA Drug Label
DESCRIPTION Procainamide Hydrochloride Injection, USP is a sterile, nonpyrogenic solution of procainamide hydrochloride in water for injection. In both formulations, the solution may contain hydrochloric acid and/or sodium hydroxide for pH adjustment.
The procainamide hydrochloride is mixed in water for injection. The solution may also contain hydrochloric acid and/or sodium hydroxide for pH adjustment 2.
From the Research
Preparation and Administration of Procainamide
- Procainamide can be administered intravenously, with a recommended dose of 10 mg/kg given at an injection speed of 100 mg/min 3.
- For sustained release, procainamide can be given every 6-8 hours 4.
- The dosage of procainamide must be titrated in each patient, with electrocardiographic monitoring serving as the most useful method of evaluating efficacy 4.
- Procainamide can be mixed with other class I agents, such as mexiletine or tocainide, to prevent recurrent ventricular tachycardia or symptomatic nonsustained ventricular tachycardia 5.
Interaction with Other Medications
- Amiodarone has pharmacokinetic and electrophysiologic interactions with procainamide, and the intravenous dose of procainamide should be reduced by 20% to 30% during concurrent drug administration 6.
- Procainamide and amiodarone have been compared in the treatment of atrial fibrillation, with similar rates of cardioversion to sinus rhythm, but procainamide acts quicker in the loading phase 7.
Monitoring and Precautions
- Patients being started on antiarrhythmic therapy with procainamide should be admitted to the hospital for monitoring to ensure that their QT interval is not excessively prolonged 5.
- Procainamide levels can be useful in initial dose titrations, and QRS and QT interval measurements can help prevent drug toxicity 5.