NEODOSE

INDICATIONS

Acute treatment of supraventricular tachycardia (SVT) refractory to vagal maneuvers and adenosine. Acute treatment of ventricular tachycardia unresponsive to cardioversion and adenosine. Ectopic tachycardia, junctional ectopic tachycardia, and atrial flutter. Consider obtaining expert consultation before use.

CONTRAINDICATIONS

Contraindicated in patients with complete heart block and torsades de pointes

ADVERSE EFFECTS

Severe hypotension with rapid infusion, bradycardia, A-V block, and ventricular fibrillationhave been reported in adult patients. Normal procainamide concentrations widen the QRScomplex due to slowing of conduction in the Purkinje system and ventricular muscle. Thedrug should be discontinued if the QRS duration increases by more than 35 to 50 percent toavoid serious toxicity. Adverse effects are reversible with discontinuation of drug.

ADMINISTRATION

• Intravenous/Intraosseous: Administer loading dose over 30 to 60 minutes at a concentration of 20 mg/mL. For continuous infusion, administer at a concentration of 2 to 4 mg/mL

BLACK BOX WARNING

The use of procainamide hydrochloride as well as other antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias. The prolonged administration of procainamide often leads to the development of a positive ANA test, with or without symptoms of a lupus erythematosus-like syndrome. Agranulocytosis, bone marrow depression, neutropenia, hypoplastic anemia, and thrombocytopenia in patients receiving procainamide hydrochloride have been reported (in adults), some of which were fatal. Discontinue procainamide if hematologic disorders are identified.

MONITORING

Continuous monitoring of the EKG, blood pressure and heart rate. Measureprocainamide and N-acetyl procainamide (NAPA) concentrations at 2, 12, and 24 hours after starting the loading dose infusion. Increasing frequency of toxicity associated with procainamide levels greater than 10 mcg/mL