Parenteral Manual

Procainamide HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Original Date: 
August 2005
Revised Date: 
November 2015
  • 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

- 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


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Push

YES, cardiac and BP monitoring
Usual dilution: 20 mg/mL
Infusion time: 5 minutes
Infusion rate: do not exceed 0.5 mg/kg/min (Max: 30 mg/min)

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

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  •   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)


  • 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.


  • 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    
  • 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

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