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Procainamide

By: Dr. Karin Szust

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Overview

  • Cardiac arrhythmias are common in animals with heart disease. Irregular heart rhythms originating in the ventricles – the lower chambers of the heart – are potentially dangerous. These rhythm disturbances can lead to low blood pressure, fainting, or sudden death if particularly severe.
  • Drugs that make the heart less irritable and suppress abnormal electrical activity are classified as antiarrhythmic drugs. Procainamide is a Class IA antiarrhythmic drug, with properties similar to another heart drug called quinidine.
  • Procainamide affects the electrical activity of the heart cell membrane, impairing the entry of sodium ions and making heart cells less likely to be stimulated prematurely. The main use of procainamide is control of ventricular arrhythmias in dogs, though it can be used in cats.
  • Procainamide is a prescription drug and can only be obtained from a veterinarian or by prescription from a veterinarian.
  • This drug is not approved for use in animals by the Food and Drug Administration but it is prescribed legally by veterinarians as an extra-label drug.

    Brand Names and Other Names

  • This drug is registered for use in humans only.
  • Human formulations: Pronestyl® (Princeton Pharm), Procanbid® (Parke-Davis) and various generic preparations
  • Veterinary formulations: None

    Uses of Procainamide

  • Procainamide is used in the treatment of premature ventricular complexes (PVCs or VPCs), ventricular tachycardia and some supraventricular tachycardias. These are heart rhythms originating outside of the normal pacemaker sites.
  • Procainamide can be administered by injection in the hospital and is often done so in the treatment of cardiac arrhythmias associated with metabolic illness, infections and surgery. Oral procainamide – typically a long acting form – is sometimes used in the treatment of dogs with heart muscle disease (cardiomyopathy).

    Precautions and Side Effects

  • While generally safe and effective when prescribed by a veterinarian, procainamide can cause side effects in some animals.
  • Procainamide should not be used in animals with known hypersensitivity or allergy to the drug.
  • Procainamide should not be given when there is an electrical disturbance called second-degree or third-degree heart block.
  • The drug should be avoided in animals diagnosed with the neuromuscular disease myasthenia gravis because procainamide can inhibit the anticholinestearease drugs used to treat this disorder.
  • It should be used with caution in animals diagnosed with diseases of the liver. In animals with congestive heart failure the drug can depress further the contraction of the heart muscle.
  • Procainamide may interact with other medications. Consult with your veterinarian to determine if other drugs your pet is receiving could interact with procainamide. Such drugs include digitalis, muscle relaxants and certain antihistamines.
  • Among the more common side effects seen are vomiting, diarrhea, anorexia, weakness and low blood pressure (hypotension).
  • Procainamide can cause an allergic type reaction or an autoimmune disease called systemic lupus erythematosus. Though more common in people, it has been observed in dogs.
  • Procainamide treatment can change the hair color of dogs undergoing chronic treatment.

    How Procainamide Is Supplied

  • Procainamide is available in 100 mg/ml and 500 mg/ml concentrations for injection.
  • Procainamide is available in 250 mg, 375 mg and 500 mg tablets and capsules. It is available in 250 mg, 500 mg, 750 mg and 1,000 mg sustained release capsules.

    Dosing Information

  • Medication should never be administered without first consulting your veterinarian.
  • The dose of procainamide in dogs is 3 to 10 mg per pound (6 to 20 mg/kg) intravenous or as a constant intravenous drip dosed at 6 to 12 mcg/lb/min (12 to 25 mcg/kg/minute).
  • Procainamide is also dosed at 5 to 10 mg per pound (10 to 20 mg/kg) orally every six to eight hours depending on the preparation used.
  • Administer on an empty stomach, one-half hour before feeding when possible.
  • The duration of administration depends on the condition being treated, response to the medication and the development of any adverse effects. Be certain to complete the prescription unless specifically directed by your veterinarian. Even if your pet feels better, the entire treatment plan should be completed to prevent relapse or prevent the development of resistance.





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