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Procainamide Medication: Uses, Dosage, Side Effects & Interactions
Summary of Key Points
Procainamide is a prescription medication used to manage various abnormal heart rhythms (arrhythmias). It helps the heart maintain a regular, steady rhythm. This medication is commonly prescribed for conditions such as ventricular tachycardia, atrial fibrillation, and Wolff-Parkinson-White syndrome. Always consult your healthcare provider before starting or adjusting your Procainamide dosage. You can also schedule a telemedicine appointment with one of our providers for personalized care.
Names of Medication
US Brand Name: Pronestyl
Generic Name: Procainamide
The generic name refers to the active ingredient in the medication. Generic medications are often more affordable while being just as effective as their brand-name counterparts.
Pharmacologic Category
Procainamide belongs to the Class I antiarrhythmic agents.
Other medications in this category include Quinidine, Disopyramide, and Lidocaine.
Procainamide Dosage
Procainamide is used to treat several heart conditions. The dosage and frequency depend on the specific condition being treated. Always follow your doctor’s instructions and never adjust your dose without consulting a healthcare provider. You can also schedule a telemedicine visit with us for guidance.
Arrhythmia
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Ventricular Tachycardia
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Atrial Fibrillation
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Atrial Flutter
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Supraventricular Tachycardia
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Wolff-Parkinson-White Syndrome
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Premature Ventricular Contractions
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Heart Failure
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Myocardial Infarction (Heart Attack)
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Paroxysmal Atrial Fibrillation
Initial dose: 100 mg to 200 mg orally every 3 to 4 hours.
Maintenance dose: Adjust based on response, typically 50 mg to 100 mg every 3 to 4 hours.
Duration: As directed by your healthcare provider.
Dosage Forms and Strengths
Procainamide is available in the following forms:
- Oral tablets: 250 mg, 500 mg
- Extended-release tablets: 500 mg, 750 mg, 1000 mg
- Injectable solution: 100 mg/mL, 500 mg/mL
Administration Instructions
Take Procainamide exactly as prescribed by your doctor. Swallow oral tablets whole with a glass of water. Do not crush or chew extended-release tablets. If using the injectable form, it will be administered by a healthcare professional. Take this medication at the same time each day to maintain consistent levels in your bloodstream. If you miss a dose, take it as soon as you remember unless it’s close to your next dose. In that case, skip the missed dose and continue with your regular schedule. Never double up on doses to make up for a missed one.
Contraindications for Procainamide
A contraindication is a specific situation where a medication should not be used because it may be harmful. Several conditions make Procainamide unsafe. Below is a list of contraindications for Procainamide, along with explanations for why it is not recommended in these situations.
Complete heart block: Procainamide can worsen heart block by affecting electrical signals in the heart. In patients with complete heart block, the heart’s electrical system is already impaired, and Procainamide could exacerbate this condition.
Severe heart failure: Procainamide can reduce the heart’s ability to pump blood effectively. In patients with severe heart failure, this could worsen symptoms like shortness of breath and fluid buildup.
Myasthenia gravis: This condition causes muscle weakness. Procainamide can worsen this weakness by affecting nerve-muscle communication.
Hypersensitivity to Procainamide: If you’ve had an allergic reaction to Procainamide in the past, avoid taking it again, as it could lead to severe allergic reactions, including anaphylaxis.
Lupus erythematosus: Procainamide can cause or worsen lupus-like symptoms, including joint pain, skin rashes, and inflammation. Patients with a history of lupus should avoid this medication.
Drug to Drug Interactions
Procainamide can interact with other medications, potentially increasing side effects or reducing its effectiveness. Below is a list of drugs that may interact with Procainamide:
Amiodarone (Pacerone, Cordarone): Combining Amiodarone with Procainamide can heighten the risk of arrhythmias and other heart-related complications.
Quinidine (Quinidex): Both Quinidine and Procainamide are antiarrhythmic medications, and using them together may increase the likelihood of heart rhythm disturbances.
Cimetidine (Tagamet): Cimetidine can raise Procainamide levels in the bloodstream, which may lead to side effects such as low blood pressure and dizziness.
Digoxin (Lanoxin): Procainamide can elevate Digoxin levels, potentially causing toxicity. Symptoms of Digoxin toxicity include nausea, vomiting, and irregular heart rhythms.
Warfarin (Coumadin): Procainamide may enhance the effects of blood thinners like Warfarin, increasing the risk of bleeding.
Procainamide in Pregnancy
Is it safe to take Procainamide during pregnancy?
Procainamide is classified as a Category C medication for pregnancy. This means that there is not enough well-controlled research in humans to determine its safety during pregnancy. While animal studies have shown some risk to the fetus, the potential benefits of using Procainamide in pregnant women may outweigh the risks in certain situations. If you are pregnant or planning to become pregnant, it is important to discuss the risks and benefits of taking Procainamide with your healthcare provider. Our telemedicine providers are also available to help you make an informed decision.
Procainamide while Breastfeeding
Is it safe to take Procainamide while breastfeeding?
Procainamide is excreted in breast milk, which may pose a risk of side effects in nursing infants, such as changes in heart rhythm or low blood pressure. If you are breastfeeding, consult your healthcare provider before taking Procainamide. They can help you weigh the risks and benefits and may recommend alternative treatments if necessary. You can also speak with one of our telemedicine providers to explore your options.
Estimated Cost of Procainamide Medication
The cost of a 30-day supply of Procainamide without insurance can vary depending on the pharmacy and location. With a GoodRX coupon, the estimated cost for a 30-day supply of Procainamide (500 mg tablets) ranges from $40 to $90. Be sure to check with your local pharmacy for the most accurate pricing, and consider using a prescription discount card to help reduce costs.
Possible Alternatives to Procainamide
If Procainamide is not suitable for you, or if you’re exploring alternative treatments, there are other medications and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to discuss these alternatives with you.
- Arrhythmia: Alternatives include beta-blockers (e.g., Metoprolol), calcium channel blockers (e.g., Diltiazem), or lifestyle modifications such as reducing caffeine and alcohol intake.
- Ventricular tachycardia: Amiodarone or Sotalol may be used as alternatives. In some cases, catheter ablation may be recommended.
- Atrial fibrillation: Medications like Warfarin or Apixaban (Eliquis) may be prescribed to prevent blood clots. Electrical cardioversion or catheter ablation are other potential treatment options.
- Atrial flutter: Similar to atrial fibrillation, treatment options include anticoagulants and procedures like cardioversion or ablation.
- Supraventricular tachycardia: Vagal maneuvers (such as holding your breath and bearing down) may help. Medications like Adenosine or Verapamil are also options.
- Wolff-Parkinson-White syndrome: Catheter ablation is often the preferred treatment. Medications like Flecainide may also be considered.
- Premature ventricular contractions: Beta-blockers or calcium channel blockers may be recommended. Reducing stress and avoiding stimulants can also help.
- Heart failure: ACE inhibitors (e.g., Lisinopril), beta-blockers, and lifestyle changes such as reducing salt intake and exercising regularly may help manage symptoms.
- Myocardial infarction (heart attack): Medications like Aspirin, beta-blockers, and statins are commonly used. Lifestyle changes, including quitting smoking and adopting a heart-healthy diet, are also important.
- Paroxysmal atrial fibrillation: Flecainide or Propafenone may be used to control heart rhythm. Avoiding triggers like alcohol and stress can also help reduce episodes.
Recent Updates on Procainamide Research
Recent studies have explored the use of Procainamide in treating various types of arrhythmias, particularly in emergency settings. A 2022 study found that Procainamide remains effective for the acute management of atrial fibrillation in patients with Wolff-Parkinson-White syndrome. Additionally, ongoing research is investigating the long-term safety of Procainamide in patients with chronic arrhythmias. While Procainamide continues to be a valuable option for certain heart rhythm disorders, newer medications and procedures are being developed that may offer fewer side effects and improved outcomes. Be sure to discuss the latest treatment options with your healthcare provider. You can also schedule a telemedicine appointment with one of our providers to learn more about how these updates may affect your treatment plan.
