Procainamide
Stable wide-complex tachycardia, WPW with atrial fibrillation, Refractory VF/VT (alternative)
Indications
- Stable wide-complex tachycardia
- WPW with atrial fibrillation
- Refractory VF/VT (alternative)
Adult dosing
- loading: dose: 20; maxDose: 50; unit: mg/min IV (max 17 mg/kg); route: IV; fixed: true; maintenance: dose: 1; maxDose: 4; unit: mg/min; route: IV drip; fixed: true
Pediatric dosing
- loading: dose: 15; unit: mg/kg; maxDose: 1000; maxDoseAbsolute: true; route: IV over 30-60 min; weightBased: true; pedNote: Use with extreme caution — cardiac toxicity risk
Contraindications
- QT prolongation
- Torsades de Pointes
- Lupus (relative)
- Severe heart failure
Clinical pearls
- Load at 20-50 mg/min until: arrhythmia terminates, hypotension, QRS widens >50%, or max dose reached
- Stop infusion if QRS widens >50% or hypotension develops
- Drug of choice for WPW with atrial fibrillation — avoid AV nodal blockers
- Monitor QT interval — can cause Torsades
Source and review
- AHA ACLS Guidelines 2020; Brugada et al., Circulation 1991. Last reviewed: 2024-11-01