프로카인아미드
Procainamide
Procainamide hydrochloride
다른 이름: Pronestyl · Procanbid · Biocoryl · novocainamidum · procainamidi chloridum · procainamidi hydrochloridum
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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 |
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
프로카인아미드는 국소 마취제인 프로카인과 구조적으로 관련된 Class 1A 항부정맥제입니다. 수의학에서는 주로 심실성 빈맥성 부정맥(심실조기수축[VPC] 및 심실빈맥 등)과 특정 상심실성 빈맥(SVT)을 관리하는 데 사용됩니다.
심방 및 심실 부정맥 모두에 대한 광범위한 활성 스펙트럼 때문에, 넓은 QRS군을 동반한 빈맥이 상심실성인지 심실성인지 명확히 식별할 수 없을 때 이상적인 1차 정맥 주사 치료제로 간주되는 경우가 많습니다.
임상 요점: 사람과 달리 개는 아세틸화 능력이 떨어져 활성 대사산물인 N-아세틸프로카인아미드(NAPA)를 충분히 생성하지 못합니다. 따라서 개의 치료 약물 모니터링은 프로카인아미드 농도에만 초점을 맞춰야 합니다.
작용 기전
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.
안전성·주의사항
금기사항
- 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)
부작용
- 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
주의
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.
약물 상호작용
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
모니터링
- 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)
약동학
반감기
흡수
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.
분포
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.
대사
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.
배설
In dogs, approximately 90% (50-70% unchanged) of an intravenous dose is excreted in the urine as procainamide and metabolites within 24 hours.
과다투여
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.
제품
제형
- Injection solution
- Oral capsules
- Extended-release oral tablets
인용의약품
- 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)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
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.
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