普魯卡因胺
Procainamide
Procainamide hydrochloride
別名: Pronestyl · Procanbid · Biocoryl · novocainamidum · procainamidi chloridum · procainamidi hydrochloridum
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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 |
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
普魯卡因胺 (Procainamide) 是一種 1A類抗心律不整藥物，結構上與局部麻醉劑普魯卡因 (procaine) 相關。在獸醫學中，主要用於控制 心室性心律不整（如心室提早收縮 [VPCs] 和心室性心搏過速）以及某些 心房性心搏過速 (SVTs)。
由於其對心房和心室心律不整具有廣泛的活性，當出現寬 QRS 波心搏過速且無法明確判定為心房性或心室性來源時，它通常被視為理想的第一線靜脈注射治療藥物。
臨床要點： 與人類不同，犬隻是較差的乙醯化者，無法形成足量具活性的代謝物 N-乙醯普魯卡因胺 (NAPA)。因此，犬隻的治療藥物濃度監測應僅針對普魯卡因胺的濃度。
作用機轉
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.
安全性與警告
禁忌症
- 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)
不良反應
- 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
注意事項
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.
藥物交互作用
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
監測
- 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)
藥物動力學
半衰期
吸收
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.
分佈
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.
代謝
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.
排除
In dogs, approximately 90% (50-70% unchanged) of an intravenous dose is excreted in the urine as procainamide and metabolites within 24 hours.
過量
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.
可用產品
劑型
- Injection solution
- Oral capsules
- Extended-release oral tablets
人用標示
- 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)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
- 給藥方式： 口服藥物應在白天和夜間以平均間隔的時間給予，以維持穩定的血液濃度。
- 餵食： 除非獸醫師另有指示，否則請在動物空腹時（至少飯前 1 小時）給予藥物。
- 監測： 如果您寵物的病情惡化，或出現中毒的臨床症狀（例如：嘔吐、腹瀉、嚴重嗜睡或虛弱），請立即通知您的獸醫師。
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