Pronestyl


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Related to Pronestyl: Procainamide

Pronestyl

 [pro-nes´til]
trademark for preparations of procainamide, a cardiac depressant.

procainamide

(proe-kane-ah-mide) ,

Pronestyl

(trade name)

Classification

Therapeutic: antiarrhythmics
Pregnancy Category: C

Indications

Treatment of a wide variety of ventricular and atrial arrhythmias, including:
  • Atrial premature contractions,
  • Premature ventricular contractions,
  • Ventricular tachycardia,
  • Paroxysmal atrial tachycardia.
Maintenance of normal sinus rhythm after conversion from atrial fibrillation or flutter.

Action

Decreases myocardial excitability.
Slows conduction velocity.
May depress myocardial contractility.

Therapeutic effects

Suppression of arrhythmias.

Pharmacokinetics

Absorption: Well absorbed (75–90%) following IM administration.
Distribution: Rapidly and widely distributed.
Metabolism and Excretion: Converted by the liver to N-acetylprocainamide (NAPA), an active antiarrhythmic compound. Remainder (40–70%) excreted unchanged by the kidneys.
Half-life: 2.5–4.7 hr (NAPA—7 hr); ↑ in renal impairment.

Time/action profile (antiarrhythmic effects)

ROUTEONSETPEAKDURATION
IVimmediate25–60 min3–4 hr
IM10–30 min15–60 min3–4 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;AV block;Myasthenia gravis.
Use Cautiously in: MI or digoxin toxicity;HF, renal dysfunction, or hepatic dysfunction (dose ↓ recommended); Geriatric: Dose ↓ recommended); Obstetric / Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (life-threatening)
  • confusion
  • dizziness

Cardiovascular

  • asystole (life-threatening)
  • heart block (life-threatening)
  • ventricular arrhythmias (life-threatening)
  • hypotension

Gastrointestinal

  • diarrhea (most frequent)
  • anorexia
  • bitter taste
  • nausea
  • vomiting

Dermatologic

  • rash

Hematologic

  • agranulocytosis (life-threatening)
  • eosinophilia
  • leukopenia
  • thrombocytopenia

Miscellaneous

  • chills
  • drug-induced systemic lupus syndrome
  • fever

Interactions

Drug-Drug interaction

May have additive or antagonistic effects with other antiarrhythmics.Additive neurologic toxicity (confusion, seizures) with lidocaine.Antihypertensives and nitrates may potentiate hypotensive effect.Potentiates neuromuscular blocking agents.May partially antagonize the therapeutic effects of anticholinesterase agents in myasthenia gravis.↑ risk of arrhythmias with pimozide.Additive anticholinergic effects with other drugs possessing anticholinergic properties, including antihistamines, antidepressants, atropine, haloperidol, and phenothiazines.Effects of procainamide may be ↑ by cimetidine, quinidine, or trimethoprim.

Route/Dosage

Intramuscular (Adults) 50 mg/kg/day in divided doses q 3–6 hr.
Intravenous (Adults) 100 mg q 5 min until arrhythmia is abolished or 1000 mg have been given; wait at least 10 min until further dosing or loading infusion of 500–600 mg over 30–60 min followed by maintenance infusion of 1–4 mg/min.

Availability (generic available)

Injection: 100 mg/mL, 500 mg/mL

Nursing implications

Nursing assessment

  • Monitor ECG, pulse, and BP continuously throughout IV administration. Parameters should be monitored periodically during oral administration. IV administration is usually discontinued if any of the following occur: arrhythmia is resolved, QRS complex widens by 50%, PR interval is prolonged, BP drops >15 mm Hg, or toxic side effects develop. Patient should remain supine throughout IV administration to minimize hypotension.
  • Lab Test Considerations: Monitor CBC every 2 wk during the first 3 mo of therapy. May cause ↓ leukocyte, neutrophil, and platelet counts. Therapy may be discontinued if leukopenia occurs. Blood counts usually return to normal within 1 mo of discontinuation of therapy.
    • Monitor ANA periodically during prolonged therapy or if symptoms of lupus-like reaction occur. Therapy is discontinued if a steady increase in ANA titer occurs.
    • May cause ↑ AST, ALT, alkaline phosphatase, LDH, bilirubin, and a positive Coombs’ test result.
  • Serum procainamide and N-acetylprocainamide levels may be monitored periodically during dosage adjustment. Therapeutic blood level of procainamide is 4–8 mcg/mL.
    • Toxicity may occur with procainamide blood levels of 8–16 mcg/mL or greater.
    • Signs of toxicity include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachyarrhythmias.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)

Implementation

  • Intramuscular: Used only when IV route is not feasible.
  • Intravenous Administration
  • pH: 4.0–6.0.
  • (only to be used for life-threatening arrhythmias).Diluent: Dilute each 100 mg of procainamide with 10 mL of 0.9% NaCl.
  • Rate: Not to exceed 25 mg/min. Rapid administration may cause ventricular fibrillation or asystole.
  • Intermittent Infusion: (preferred route of administration)Diluent: Add 2 g of procainamide to 250 mL of 0.9% NaCl. Concentration: 8 mg/mL.
  • Rate: Administer initial infusion over 30–60 min. Administer maintenance infusion at rate of 1–4 mg/min to maintain control of arrhythmia.
  • Y-Site Compatibility: alemtuzumab, alfentanil, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, caspofungin, cefazolin, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chlorpromazine, cisatracurium, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin, doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, idarubicin, ifosfamide, indomethacin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylprednisolone, metoclopramide, metoprolol, midazolam, mitoxantrone, morphine, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, pemetrexed, penicillin G, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium chloride, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vancomycin, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid
  • Y-Site Incompatibility: acyclovir, azathioprine, carboplatin, carmustine, chloramphenicol, dantrolene, diazepam, diazoxide, ganciclovir, hydralazine, metronidazole, milrinone, phenytointrimethoprim/sulfamethoxazole.

Patient/Family Teaching

  • May cause dizziness. Caution patient to request assistance with ambulation until response to medication is known.
  • Advise patient to notify health care professional immediately if signs of drug-induced lupus syndrome (fever, chills, joint pain or swelling, pain with breathing, skin rash), leukopenia (sore throat, mouth, or gums), or thrombocytopenia (unusual bleeding or bruising) occur. Medication may be discontinued if these occur.
  • Advise patient to carry identification at all times describing disease process and medication regimen.
  • Emphasize the importance of routine follow-up exams to monitor progress.

Evaluation/Desired Outcomes

  • Resolution of cardiac arrhythmias without detrimental side effects.

Pronestyl

A brand name for the ANTIARRHYTHMIC drug PROCAINAMIDE.