Antiarrhythmic drugs: Procainamide (Class 1A)


Procainamide is a medication primarily used in the treatment of cardiac arrhythmias, which are irregular heart rhythms. It belongs to the class of antiarrhythmic agents known as Group I or Class 1A medications. This class of drugs works by blocking sodium channels in cardiomyocytes, which are the cells in the heart muscle that generate and conduct electrical impulses. By doing so, procainamide helps to restore normal heart rhythm and improve heart function in various arrhythmic conditions.

Specifically, procainamide is effective in managing and treating ventricular arrhythmias (abnormal rhythms originating from the heart’s lower chambers), supraventricular arrhythmias (those starting in the upper chambers), atrial flutter and fibrillation (rapid, irregular heartbeats in the atria), and Wolf-Parkinson-White syndrome (a condition where there is an extra electrical pathway in the heart)

Cardiac Effects

  • Procainamide blocks sodium channels, slowing the upstroke of the action potential, slowing conduction, and prolonging the QRS duration on the ECG.
  • It also prolongs the action potential duration (APD) by blocking potassium channels.
  • It has direct depressant actions on SA and AV nodes.


Extracardiac Effects

  • Procainamide has ganglion-blocking properties that can reduce peripheral vascular resistance and cause hypotension, especially with intravenous use.


  • Cardiotoxic effects include excessive APD prolongation, QT-interval prolongation, and induction of torsades de pointes arrhythmia.
  • Long-term use can lead to a syndrome resembling lupus erythematosus, consisting mainly of arthralgia and arthritis.
  • Other adverse effects include nausea, diarrhea, rash, fever, hepatitis, and agranulocytosis.

Pharmacokinetics & Dosage

  • Procainamide can be administered intravenously, intramuscularly, or orally.
  • It has a half-life of 3–4 hours, requiring frequent dosing or the use of a slow-release formulation.
  • Dosage must be reduced in patients with renal failure due to its renal elimination.
  • Plasma levels of both procainamide and its metabolite NAPA should be monitored, especially in patients with circulatory or renal impairment.

Therapeutic Use

  • Effective against most atrial and ventricular arrhythmias.
  • Often considered the drug of second or third choice for treating sustained ventricular arrhythmias associated with acute myocardial infarction.
  • Long-term therapy is generally avoided due to frequent dosing requirements and the risk of lupus-related effects.

In summary, Procainamide is a potent antiarrhythmic drug with a range of effects and potential toxicities. It is generally not the first choice for long-term therapy due to its side effect profile and the need for frequent dosing.

Note: This article is intended for educational purposes and should not be considered as medical advice. Always consult with a healthcare professional for medical advice and treatment.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of a healthcare provider with any questions regarding a medical condition.

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