procainamide

[zzyzx]

I'm about to start a new job in a county that uses procainamide. I'm totally unfamiliar with this drug and don't know anyone who's used it. I've done a lot of Google research on it, but I'd like to get feedback from medics who've actually used this drug.

From what I understand, it's basically a second-line drug used for VT, uncontrolled AF, or SVT that don't respond to other drugs. Like amiodarone, it can also be used when you have a wide-complex tachycardia that you strongly suspect is SVT with aberrant conduction.

I understand that it can cause sudden hypotension, esp. if pushed too quickly.

What about it's use with someone having an MI? One sources said that it was relatively contraindicated with MI's because it may in that case be more likely to cause hypotension.

[Just Plain Ruff]

one thing to remember and one thing only -- PROJECTILE VOMITING

[AZCEP]

All of the antidysrhythmics tend to cause hypotension and projectile vomiting when given too fast. Bretylium anyone?

Procainamide is the drug of choice for stable VT, and is very effective at converting it. It fell out of favor a bit with amiodarone's rise to prominence, but procainamide is still a good drug to have available. It is a bit unusual in the prehospital environment because you only use it by infusion, and it can take a while to start working.

End points of infusion:

1. Hypotension

2. Dysrhythmia resolution

3. QRS widening by 50% or more

4. 17 mg/kg of the drug infused.

[MSDeltaFlt]

It can also be used, I believe, for symptomatic A-Fib with RVR. However, it's contraindicated for Dig Toxicity. Since we can't check Dig levels prehospital, you won't be able to give it at all if they take Dig. Know an ER MD who swears by it.

[Scaramedic]

Wow is that company still using Isukill?

[chbare]

A good rule of thumb: do not use it for any suspected drug induced arrhythmia. In addition, avoid using with high grade AV blocks, prolongation of QTI, lupus, and allergy to ester based substances. (procaine) Not lidocaine, it is an amide. Not all caines are the same.

Take care,

chbare.

[zzyzx]

The protocols actually say give a 100mg slow IVP, followed by a maintenance infusion.

So it's the best drug to use for stable VT? Would you not use lidocaine first (assuming you only had lidocaine and procainamide)?

[zzyzx]

Compared to lidocaine, is procainamide more likely to cause hypotension?

Is lidocaine better to use if the patient is having an MI? Some of what I Googled seemed to say that procainamide can be harmful with a patient having an MI, but I couldn't find a clear reason why.

[AZCEP]

For stable VT, I'd opt for the Procainamide. It is better suited for the situation than Lidocaine is. The dosing you describe sounds like Lidocaine. Procainamide is only used as an infusion. 10-20 mg/min is the rate of administration if I remember correctly.

Just a guess, but I'd think that because Procainamide is VW class Ia sodium channel blocker, it will be more likely to cause hypotension following administration. You probably wouldn't want to use it for typical ventricular ectopy associated with an MI anyway.

[firedoc5]

We gave Procainamide regularly, but only if Lido. was not working. Back then it was considered a back-up for that reason. That's what we did in the field, short term. I know it has it's own usefulness long term, as in ICU.