Alternate Name(s):
PRONESTYL®
Classification:
Antiarrhythmic
Original Date:
August 2005
Revised Date:
November 2015
Indications:
- Used to maintain normal sinus rhythm of ventricular arrhythmias and supraventricular arrhythmias (atrial fibrillation or flutter)
Reconstitution and Stability:
- Available as 100 mg/mL vials. Stable at room temperature, protect from light
- Solutions that are a slight yellow colour may be used
- Solutions that are a dark yellow colour must be discarded
- Stable in NS and D5W for 24 hours at room temperature and 7 days in the fridge
Compatibility:
- Solutions Compatible: D5W, NS
- Additive/buretrol Compatible: no information
- Y-site Compatible: amiodarone, dobutamine, dopamine, epinephrine, fentanyl, heparin, lidocaine, midazolam, morphine, nitroprusside, KCl (up to 40 mmoL/L), ranitidine, verapamil
- Incompatible: milrinone, esmolol, phenytoin
- No data on compatibility with TPN
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | YES |
| IV Push |
YES, cardiac and BP monitoring |
| IV Intermittent Infusion | YES, cardiac and BP monitoring Usual dilution: 20 mg/mL Infusion time: 25-30 minutes |
| IV Continuous Infusion | YES Usual dilution: 2-4 mg/mL |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- 20 - 30 mg/kg/day IM ÷ Q 4 -6 hours (Maximum: 4000 mg/day)
- Loading dose: 3 - 15 mg/kg/dose IV over 30 - 60 minutes (Maximum: 1000 mg/dose)
- Maintenance dose: 20 - 80 mcg/kg/min by IV continuous infusion (Maximum: 2000 mg/day)
Adult:
- 0.5-1 g IM Q 4 - 8 hours or 50 mg/kg IM ÷ Q 3 - 6 hours
- Loading dose: 15 - 18 mg/kg IV infused over 1 hour (Maximum: 1000 mg/dose)
- Maintenance dose: 3 - 4 mg/minute IV continuous infusion (Range: 1-6 mg/min); do not exceed 3 mg/min for >24 hours in patients with renal failure.
DOSING ADJUSTMENT IN RENAL IMPAIRMENT:
- CrCl 10-50 mL/minute: Administer normal dose Q 6-12 hours
- CrCl <10 mL/minute: Administer normal dose Q 8-24 hours
Potential hazards of parenteral administration:
- May cause severe hypotension with rapid IV administration; monitor BP (Antidote: IV phenylephrine or levarterenol bitartrate)
- Bradycardia, heart block, extrasystoles, ventricular tachycardia or fibrillation, QT prolongation, widening QRS complex
- Agranulocytosis, neutropenia, thrombocytopenia, hypoplastic anemia
- Hepatomegaly, elevated liver enzymes
- Nausea and vomiting
- Systemic lupus erythematosis syndrome
Notes:
- Administer with patient in supine position to avoid hypotension
- Patient must be continuously monitored by ECG during IV administration, observe for widening of QRS complex, QT prolongation: If excessive slowing of conduction occurs, a dosage adjustment may be necessary or infusion may need to be stopped.
- Levels:
- Procainamide: 20-40 micromol/L (toxicity at >40)
- N-acetylprocainamide: 30-70 micromol/L (toxicity at >90)
(should be determined in patients with renal insufficiency) - Use with caution in patients who have had occlusive coronary episodes, with AV block, digitalis intoxication
- Contraindicated in patients with myasthenia gravis, pre-existing QT prolongation, an unusual ventricular tachycardia, "torsade de pointes" and complete heart block
- Potentiates neuromuscular blocking agents