Complete dosing information for procainamide hydrochloride
Medical guidance required: Dosing information here is for educational purposes. Your healthcare provider will determine the appropriate dose based on your specific condition, kidney function, other medications, and medical history. Never adjust your dose without consulting your doctor or pharmacist.
Life-threatening ventricular arrhythmias (IV): Loading dose of 10–17 mg/kg (commonly given as 100 mg every 5 minutes by slow IV push, or 20–50 mg/min infusion) until the arrhythmia is suppressed, hypotension occurs, the QRS widens by more than 50%, or a maximum of 17 mg/kg (about 1 g) is reached. Maintenance infusion: 1–4 mg/min titrated to effect and plasma levels. ACLS for stable wide-complex tachycardia: 20–50 mg/min until arrhythmia suppressed, hypotension, QRS widens >50%, or 17 mg/kg given; then 1–4 mg/min. IM: 50 mg/kg/day divided every 3–6 hours. Oral (where available): 50 mg/kg/day in divided doses every 3–6 hours (immediate-release) or every 6–12 hours (sustained-release); titrate to plasma levels.
Specialist use only. Children >1 year: IV loading 10–15 mg/kg over 30–60 minutes (maximum 100 mg/dose), followed by infusion 20–80 mcg/kg/min (maximum 2 g/day). Infants <1 year: lower weight-based loading (approximately 7–10 mg/kg) with continuous ECG and blood pressure monitoring. Oral 15–50 mg/kg/day divided every 3–6 hours.
Procainamide and its active metabolite NAPA accumulate in renal impairment. Reduce loading dose and slow the maintenance infusion; extend oral dosing intervals. Monitor procainamide and NAPA plasma concentrations closely and watch for QT prolongation and torsades de pointes. In severe impairment or dialysis-dependent patients, substantial dose reduction is required.
Acetylation to NAPA occurs in the liver; in hepatic impairment, reduce the dose and monitor procainamide levels, since the parent drug may accumulate. Use cautiously and titrate slowly.