Procainamida
Procainamide
Procainamide hydrochloride
También conocido como: Pronestyl · Procanbid · Biocoryl · novocainamidum · procainamidi chloridum · procainamidi hydrochloridum
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Dosis por especie
🌎 NA — North America🌍 EU — Europe
Perros
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Ventricular tachyarrhythmias | 2-4 mg/kg IV slowly (over two minutes) up to a total dose of 12-20 mg/kg until arrhythmia controlled and then a CRI may be started at 10-40 micrograms/kg/minute | IV | Intermittent boluses then CRI | — | 🌎 NA |
| Ventricular tachyarrhythmias | 20-30 mg/kg PO q6-8h | PO | q6-8h | — | 🌎 NA |
| Acute management of SVTs | 6-8 mg/kg IV over 3 minutes or 6-20 mg/kg IM | IV/IM | Once | — | 🌎 NA |
| Chronic management of SVTs | 10-20 mg/kg PO q6-8h | PO | q6-8h | — | 🌎 NA |
| Acute treatment of ventricular tachycardia | 10-15 mg/kg IV bolus over 1-2 minutes; if continued parenteral administration required may use a constant rate IV infusion at 25-50 micrograms/kg/minute | IV | Bolus then CRI | — | 🌎 NA |
| Chronic treatment of ventricular tachycardia | 10-20 mg/kg PO q6h | PO | q6h | — | 🌎 NA |
| Ventricular tachycardia | 6.6-8.8 mg/kg slowly IV over 5 minutes, then give as a CRI at 40-100 micrograms/kg/minute | IV | Bolus then CRI | — | 🌎 NA |
| Chronic treatment of ventricular arrhythmias | 20-23 mg/kg PO q8h | PO | q8h | — | 🌎 NA |
| Arrhythmias (using sustained-release tablets) | 20 mg/kg PO q8h | PO | q8h | — | 🌎 NA |
| Arrhythmias (intravenous therapy) | 6-8 mg/kg IV bolus, 20-40 micrograms/kg/min CRI | IV | Bolus then CRI | — | 🌎 NA |
| Acute treatment of atrial fibrillation | 5-15 mg/kg IV slowly to effect | IV | To effect | — | 🌎 NA |
| Ventricular tachycardia (if lidocaine ineffective) | 20-50 micrograms/kg/min IV or 6-15 mg/kg IM q4-6h | IV/IM | CRI or q4-6h | — | 🌎 NA |
- Ventricular tachyarrhythmias: Previous recommendations of 8-20 mg/kg PO q6-8h are almost certainly too low
- Acute management of SVTs: After drugs have been used to slow AV nodal conduction (i.e., diltiazem)
- Chronic management of SVTs: Higher dosages of up to 40 mg/kg q6h have been necessary to treat junctional SVTs in some dogs
Gatos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Chronic management of SVTs | 3-8 mg/kg PO q6-8h | PO | q6-8h | — | 🌎 NA |
| Chronic management of SVTs | 1-2 mg/kg slowly IV; 10-20 micrograms/kg/minute constant rate IV infusion | IV | Bolus then CRI | — | 🌎 NA |
| Chronic management of SVTs | 7.5-20 mg/kg q 6-8h | PO | q6-8h | — | 🌎 NA |
Caballos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Atrial fibrillation / Ventricular tachycardia | 1 mg/kg/min IV, not too exceed 20 mg/kg (20 minutes) total dose | IV | Once | 20 minutes max | 🌎 NA |
| Atrial fibrillation / Ventricular tachycardia | 25-35 mg/kg PO q8h | PO | q8h | — | 🌎 NA |
| V-Tach | 1 mg/kg/minute IV up to a total dose of 20 mg/kg; or 25-35 mg/kg PO q8h | IV/PO | Once or q8h | — | 🌎 NA |
- Atrial fibrillation / Ventricular tachycardia: Not as effective as quinidine for atrial fibrillation
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
La procainamida es un agente antiarrítmico de Clase 1A estructuralmente relacionado con el anestésico local procaína. Se utiliza principalmente en medicina veterinaria para el manejo de taquiarritmias ventriculares (como complejos ventriculares prematuros [CVP] y taquicardia ventricular) y ciertas taquicardias supraventriculares (TSV).
Debido a su amplio espectro de actividad tanto para arritmias auriculares como ventriculares, a menudo se considera un agente terapéutico IV de primera línea ideal cuando una taquicardia de complejo QRS ancho no puede identificarse definitivamente como de origen supraventricular o ventricular.
Perla Clínica: A diferencia de los humanos, los perros son acetiladores deficientes y no forman cantidades apreciables del metabolito activo N-acetil-procainamida (NAPA). Por lo tanto, el monitoreo terapéutico en perros debe centrarse únicamente en los niveles de procainamida.
Mecanismo de acción
Procainamide acts primarily as a fast sodium channel blocker (Class 1A), similar to quinidine.
- Phase 0 Blockade: Slows the influx of sodium during Phase 0 depolarization of the cardiac action potential.
- → Prolongs the refractory period in both the atria and ventricles.
- → Decreases myocardial excitability and depresses automaticity and conduction velocity.
- Anticholinergic Effects: Exhibits mild vagolytic properties which may cause slight increases in heart rate or unpredictable rate changes.
- ECG Effects: Commonly causes widening of the QRS complex and prolongation of the PR and QT intervals.
Seguridad y advertencias
Contraindicaciones
- Myasthenia gravis
- Hypersensitivity to procainamide, procaine, or chemically related drugs
- Systemic lupus erythematosus (SLE) in humans (unknown in dogs)
- Torsade de pointes
- 2nd or 3rd degree heart block (unless artificially paced)
- Doberman pinschers and boxers with dilated cardiomyopathy (relative - proarrhythmic risk)
- Dogs with subaortic stenosis (relative - proarrhythmic risk)
Efectos adversos
- Anorexia
- Vomiting
- Diarrhea
- Weakness
- Hypotension (especially with rapid IV injection)
- Negative inotropism
- Widened QRS complex
- Prolonged QT interval
- AV block
- Multiform ventricular tachycardias
- Fevers
- Leukopenias
Precauciones
Use with extreme caution in patients with cardiac glycoside intoxication. Use with caution in patients with significant hepatic or renal disease, or congestive heart failure (CHF). Dosages should usually be reduced in patients with renal failure, CHF, or those who are critically ill.
Warning: Profound hypotension can occur if injected too rapidly IV. Do not use in Doberman pinschers and boxers with dilated cardiomyopathy or dogs with subaortic stenosis as it may be proarrhythmic and induce sudden death.
Interacciones farmacológicas
May increase procainamide levels; procainamide dose may need to be reduced
Procainamide may antagonize effects in patients with myasthenia gravis
May increase procainamide levels
Procainamide may enhance hypotensive effects
Toxic effects may be additive, and cardiac effects unpredictable
Procainamide may potentiate or prolong the neuromuscular blocking activity
Toxic effects may be additive, and cardiac effects unpredictable
Toxic effects may be additive, and cardiac effects unpredictable
Toxic effects may be additive, and cardiac effects unpredictable
May increase procainamide levels
May increase procainamide levels
Monitorización
- ECG (continuously with IV dosing)
- Blood pressure (during IV administration)
- Clinical signs of toxicity (GI signs, weakness)
- Serum drug levels (Trough levels for oral therapy. Note: Request lab to not run NAPA for dogs. Target range: 3-8 to 8-20 mcg/mL in dogs; 4-10 mcg/mL in horses)
Farmacocinética
Vida media
Absorción
Onset of action is practically immediate after IM or IV administration. Oral bioavailability in dogs is approximately 85% with an absorption half-life of 0.5 hours, though highly variable. Food, delayed gastric emptying, or decreased stomach pH may delay oral absorption.
Distribución
Highest distribution into the CSF, liver, spleen, kidneys, lungs, heart, and muscles. Volume of distribution in dogs is approximately 1.4-3 L/kg. Protein binding is low (approximately 15% in dogs). Crosses the placenta and is excreted into milk.
Metabolismo
In humans, metabolized to the active metabolite N-acetyl-procainamide (NAPA). Dogs, however, do not form appreciable amounts of NAPA as they are unable to appreciably acetylate aromatic and hydrazine amino groups.
Eliminación
In dogs, approximately 90% (50-70% unchanged) of an intravenous dose is excreted in the urine as procainamide and metabolites within 24 hours.
Sobredosis
Clinical signs of overdosage can include hypotension, lethargy, confusion, nausea, vomiting, and oliguria. Cardiac signs may include widening of the QRS complex, junctional tachycardia, ventricular fibrillation, or intraventricular conduction delays.
- Oral Ingestion: Emptying of the gut and charcoal administration may be beneficial to remove unabsorbed drug.
- Hypotension: IV fluids, plus dopamine, phenylephrine, or norepinephrine could be considered.
- Cardiotoxicity: A 1/6 molar intravenous infusion of sodium lactate may be used in an attempt to reduce cardiotoxic effects.
- Elimination: Forced diuresis using fluids and diuretics along with reduction of urinary pH can enhance renal excretion.
- AV Block: Temporary cardiac pacing may be necessary should severe AV block occur.
Productos disponibles
Formulaciones
- Injection solution
- Oral capsules
- Extended-release oral tablets
Etiquetado para humanos
- Procainamide HCl Injection Solution: 100 mg/mL in 10 mL multi-dose vials and 500 mg/mL in 2 mL vials
- Procainamide HCl Oral Capsules: 250 mg & 375 mg
- Procainamide HCl Extended-Release Oral Tablets: 250 mg, 500 mg, & 1000 mg (Note: Not recommended for initial therapy in veterinary medicine)
Estado regulador
Sin datos reguladores para: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Store at room temperature. Refrigeration may retard the development of oxidation, but the solution may be stored at room temperature. The solution may be used if the color is no darker than a light amber.
Información para el cliente
- Administración: Los productos orales deben administrarse a intervalos uniformes durante el día y la noche para mantener niveles sanguíneos estables.
- Alimentación: A menos que su veterinario indique lo contrario, administre el medicamento con el estómago vacío (al menos 1 hora antes de comer).
- Monitoreo: Notifique a su veterinario de inmediato si la condición de su mascota empeora o si nota signos de toxicidad como vómitos, diarrea, letargo severo o debilidad.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.