Last reviewed 2026-04-20 · How we verify

PROCAINAMIDE

At a glance

Approved indications

No approved indications tracked.

Boxed warnings

• WARNING: The prolonged administration of procainamide often leads to the development of a positive anti-nuclear antibody (ANA) test, with or without symptoms of a lupus erythematosus-like syndrome. If a positive ANA titer develops, the benefit versus risks of continued procainamide therapy should be assessed. Mortality: In the National Heart, Lung and Blood Institute's Cardiac Arrhythmia Suppression Trial (CAST), a long-term, multicentered, randomized, double-blind study in patients with asymptomatic non-life-threatening ventricular arrhythmias who had a myocardial infarction more than six days but less than two years previously, an excessive mortality or non-fatal cardiac arrest rate (7.7%) was seen in patients treated with encainide or flecainide compared with that seen in patients assigned to matched placebo-treated group (3.0%). The average duration of treatment with encainide or flecainide in this study was ten months. The applicability of the CAST results to other populations (e.g., those without recent myocardial infarctions) is uncertain. Considering the known proarrhythmic properties of procainamide and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of procainamide as well as other antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias. Blood Dyscrasias: Agranulocytosis, bone marrow depression, neutropenia, hypoplastic anemia and thrombocytopenia in patients receiving procainamide hydrochloride have been reported at a rate of approximately 0.5%. Most of these patients received procainamide within the recommended dosage range. Fatalities have occurred (with approximately 20–25 percent mortality in reported cases of agranulocytosis). Since most of these events have been noted during the first 12 weeks of therapy, it is recommended that complete blood counts including white cell, differential and platelet counts be performed at weekly intervals for the first three months of therapy, and periodically thereafter. Complete blood counts should be performed promptly if the patient develops any signs of infection (such as fever, chills, sore throat or stomatitis), bruising or bleeding. If any of these hematologic disorders are identified, procainamide therapy should be discontinued. Blood counts usually return to normal within one month of discontinuation. Caution should be used in patients with pre-existing marrow failure or cytopenia of any type. (See ADVERSE REACTIONS ).

Common side effects

• Lupus erythematosus-like syndrome
• Nausea
• Vomiting
• Anorexia
• Diarrhea
• Abdominal pain
• Bitter taste
• Dizziness
• Giddiness
• Weakness
• Arthralgia
• Pleural pain

Serious adverse events

• Agranulocytosis
• Ventricular fibrillation
• Ventricular asystole
• Hypotension
• Hemolytic anemia
• Thrombocytopenia
• Neutropenia
• Liver failure
• Pericarditis
• Pleural effusion

Key clinical trials

• EQUITA - A Feasibility Trial of a Faith-placed Intervention to Increase Screening Uptake in Black Adults (NA)
• RAFF4 Trial: Vernakalant vs. Procainamide for Acute Atrial Fibrillation in the Emergency Department (PHASE4)
• Prevention of Post-Operative Cardiac Arrhythmias (PHASE4)
• Sexual and Urological Rehabilitation to Men Operated for Prostate Cancer and Their Partners (NA)
• Trial of Electrical Versus Pharmacological Cardioversion for RAFF in the ED (NA)
• Acute Mechanical Response to Anti-arrhythmic Drug Therapy (NA)
• Management of Supraventricular Tachycardia of Children
• ST-segment Elevation as an AF Endophenotype (NA)

Primary sources

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