General Toxicity Notes
Blood levels most often the best guide to therapy. Half-life may be prolonged in heart failure or with reduced hepatic blood flow.
Excreted Unchanged %
59-75
Half-Life (Normalesrd) Hours
2.5-3.6/9.6-11.3
Plasma Protein Binding %
11-21
Volume Of Distribution L/Kg
1.6-2.2
Dose For Normal Renal Function
1,000-2,500 mg q12h
Adjustment For Renal Failure Method
I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
q4h [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
q6-12h [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
q8-24h [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Follow levels, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: None, [A]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50,monitor serum concentration, [D]
References
Bauer LA, Black D, Gensler A, Sprinkle J. Influence of age, renal function and heart failure on procainamide clearance and N-acetylprocainamide serum concentrations. Int J Clin Pharmacol Ther Toxicol. 1989; 27: 213-6. [PMID: 2472362] / Drayer DE, Lowenthal DT, Woosley RL, Nies AS, Schwartz A, Reidenberg MM. Cumulation of N-acetylprocainamide, an active metabolite of procainamide, in patients with impaired renal function. Clin Pharmacol Ther. 1977; 22: 63-9. [PMID: 872496] / Gibson TP, Lowenthal DT, Nelson HA, Briggs WA. Elimination of procainamide in end stage renal failure. Clin Pharmacol Ther. 1975; 17: 321-9. [PMID: 1120398] / Kroboth PD, Mitchum K, Puschett JB. Use of procainamide in chronic ambulatory peritoneal dialysis: report of a case. Am J Kidney Dis. 1984; 4: 78-9. [PMID: 6204527] / Low CL, Phelps KR, Bailie GR. Relative efficacy of haemoperfusion, haemodialysis and CAPD in the removal of procainamide and NAPA in a patient with severe procainamide toxicity. Nephrol Dial Transplant. 1996; 11: 881-4. [PMID: 8671917] / Raehl CL, Moorthy AV, Beirne GJ. Procainamide pharmacokinetics in patients on continuous ambulatory peritoneal dialysis. Nephron. 1986; 44: 191-4. [PMID: 2431330] / Sica DA, Yonce C, Small R, Cefali E, Harford A, Poynor W. Pharmacokinetics of procainamide in continuous ambulatory peritoneal dialysis. Int J Clin Pharmacol Ther Toxicol. 1988; 26: 59-64. [PMID: 2457560]
Toxicity Notes
Lupus-like syndrome. Half-life is acetylator phenotype dependent. Active metabolite is N-acetyl-procainamide (q.v.). Renal excretion accounts for >80% of the elimination of NAPA. Hemofiltration useful in poisoning.