(ACLS/PALS): SVT, Ventricular Fibrillation/Tachycardia, monomorphic Ventricular Tachycardia with preseved heart function, Polymorphic Ventricular Tachycardia with normal baseline QTI.
Hypersensitivity, myasthenia gravis, severe heart block, CHF, TCA overdose, Prolonged QTI, No baseline ECG obtained. Prior Recent Administration of Amiodarone.
Headache, dizziness, hypotension
Potentially Lethal Side Effects:
Heart block, cardiovascular collapse, thrombocytopenia, neutropenia, hemolytic anemia.
Ventricular Fibrillation/Tachycardia(ACLS):
IV Infusion: 30mg/min to max 17mg/kg or three stopping points listed in Notes.
Urgent situations (ACLS):
IV Infusion: 50mg/min
SVT (ACLS):
IV Infusion: 20mg/min
Maintenence IV Infusion: 1-4mg/min
Recurrent or refractory Ventricular Tachycardia/SVT (PALS):
IV Infusion: 15mg/kg/30-60 min.
Stopping points for procainamide: QRS widening by 50% from baseline, hypotension, max dose reached: 17mg/kg, resolution of dysrhythmia.
Procainamide should be avoided in patients with a prolonged QT interval.
Rapid administration of procainamide can result in toxic concetrations and lethal precipitous hypotension.
Per ALCS 2000 ECC, "(The) delay resulting from the need to infuse procainamide slowly presents the major barrier to its use in life threatening situations, such as persistent or recurrent VF/pulseless VT...the level of evidence keeps it Class IIb for recurrent VF/pulseless VT."
Note also that procainamide is Class Indeterminent for persistent/refractory VF/Pulseless VT, and the more appropriate Class II intervention is Amiodarone in this setting.
Therapeutic range for Procainamide is 4-10 mcg/ml (U of MN, College of Pharmacy)
Loading:
Add 1g to 50ml NaCl
Using 60gtt/ml set: 90gtt/min=30mg/min; 150gtt/min=50mg/min
Maintenence:
Add 1g to 250ml NaCl
Using 60gtt/ml set: 15gtt/min=1mg/min; 30gtt/min=2mg/min; 45gtt/min=3mg/min; 60gtt/min=4mg/min