Title: Procainamide Dosing<br/>Author: Ellen Lemkin<br/><a href='http://umem.org/profiles/faculty/182/'>[Click to email author]</a><hr/><p dir="ltr" style="font-family: arial, sans-serif; font-size: 13px; line-height: 1.2954545454545454; margin-top: 0pt; margin-bottom: 0pt;">
<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">ACLS recommendation for procainamide in tachycardic rhythms is:</span></p>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">Loading dose 20 mg/minute (up to 50 mg/minute for more urgent situations) until:</span></p>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">Arrhythmia is controlled </span></li>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">Hypotension occurs </span></li>
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<span style="color: rgb(68, 68, 68); font-family: Arial; font-size: 16px; white-space: pre-wrap; line-height: 1.2954545454545454;">QRS complex widens by 50% of its original width </span></li>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">or total of 17 mg/kg is given</span></li>
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<span style="vertical-align: baseline; font-size: 16px; white-space: pre-wrap; background-color: transparent; font-family: Arial;">Maintenance infusion is 1 to 4 mg/min.</span></p>
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<span style="vertical-align: baseline; font-size: 16px; white-space: pre-wrap; background-color: transparent; font-family: Arial;">An easier method for dosing acute onset atrial fibrillation in stable patients was used in the Ottawa Aggressive Protocol, in which they administered 1 gm over 60 min, which was interrupted if BP < 100 mmHg; if corrected by a 250 ml IV bolus, the infusion was resumed. This was not used, however if the patient was to be admitted.</span></p>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">A strategy for treating stable monomorphic VT with procainamide used: </span></p>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">100 mg IV over 1-2 minutes, repeat as necessary until an endpoint of </span></p>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">Termination of tachycardia</span></li>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">Drug induced hemodynamic deterioration</span></li>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">Completion of 800 mg maximal dose</span></li>
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<span style="font-size: 16px; font-family: Arial; color: rgb(68, 68, 68); vertical-align: baseline; white-space: pre-wrap;">If no slowing of the tachycardia occurred with a dose of 400 mg, the administration was ceased.</span></p>
<fieldset><legend>References</legend>
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1. Steil IG, Clement CM, Perry JJ et al. Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. CJEM 2010;12(3):181-91.</p>
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2. Komura S, Chinushi M, Furushima H. et al. Efficacy of Procainamide and Lidocaine in Terminating Sustained Monomorphic Ventricular Tachycardia. Circulation May 2010 Vol 72</p>
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