Procainamide (Procan, Procanbid, Pronestyl)

Treats recurrent or sustained hemodynamically stable monomorphic VT (IIa/C)/(IIa/C). ^∗

∗ The first number and lowercase letter refer to the ACC/AHA system of classifying guidelines while the uppercase letter refers to the level of evidence.

Not indicated for asymptomatic PVCs.

Treats focal atrial tachycardia in hemodynamically stable pts (IIa/C).

Treats recurrent atrial flutter (only in combination with AV-nodal-blocking agent) (IIb/A).

Treats SVT during pregnancy.

As a backup drug in hemodynamically stable pt with SVT (if adenosine is not successful).

Potential for hypotension secondary to ganglionic blockade more likely than myocardial depression.

Nausea in pts on oral procainamide (related to levels of N-acetyl procainamide?).

Chronic use can cause lupus-like syndrome; 25–50% of pts develop rash, small-joint arthralgias positive ANA. Resolves with cessation or administration of N-acetyl procainamide.

Ventricular dysrhythmias if plasma concentration of N-acetyl procainamide (NAPA) >30 μg/mL.

QT _c prolongation.

CNS toxicity.

Hypotension.

Procainamide-induced lupus syndrome.

Bone marrow aplasia in 0.5% of pts; may be fatal, mechanism unknown.

Hypokalemia may exacerbate toxicity.

Avoid use in pts with myasthenia gravis; it can exacerbate symptoms.