Comprehensive medication guide to Procainamide including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
When administered in a hospital, procainamide costs are covered under hospital billing. Outpatient IV procainamide is billed under Medicare Part B J-code J2690 (patient typically owes 20% after deductible). Compounded oral procainamide coverage varies by plan and typically requires prior authorization.
Estimated Cash Pricing
Injectable procainamide (100 mg/mL) is listed at approximately $364.80 for 50 mL at retail pharmacies. Compounded oral procainamide typically costs $50–$200 or more per month depending on dose and compounding pharmacy. GoodRx and discount programs may reduce retail injectable prices.
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Procainamide (procainamide hydrochloride) is a Class IA antiarrhythmic drug used to treat life-threatening cardiac arrhythmias. Originally approved by the FDA in 1950 and marketed as Pronestyl by Bristol-Myers Squibb, procainamide is one of the oldest antiarrhythmic medications still in clinical use today. It is classified under the Vaughan Williams system as a Class IA agent—a sodium channel blocker that also inhibits potassium channels.
Procainamide is FDA-approved for sustained ventricular tachycardia, supraventricular tachycardias, atrial flutter, atrial fibrillation, and Wolff-Parkinson-White syndrome. It is currently available only as an injectable formulation in the US, as commercial oral tablets and capsules (Pronestyl, Procanbid) have been permanently discontinued.
Current manufacturers of procainamide injection include Amphastar Pharmaceuticals, Nexus Pharmaceuticals, and Pfizer. The drug carries two FDA boxed warnings: one for drug-induced lupus erythematosus and one for serious blood disorders including agranulocytosis.
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Procainamide works by blocking fast sodium channels (INa) in heart muscle cells, slowing the speed at which electrical impulses travel through the atria, His-Purkinje system, and ventricles. This reduces the excitability of heart cells and increases the effective refractory period—the time each cell must rest before it can fire again—making it harder for abnormal arrhythmia circuits to sustain themselves.
In addition to blocking sodium channels, procainamide also inhibits the rapid delayed rectifier potassium current (IKr), prolonging the action potential duration and the QT interval. This dual mechanism of action—Class IA activity—differentiates it from Class IB agents like lidocaine (which only affect ventricular tissue) and makes it effective for both atrial and ventricular arrhythmias.
Procainamide is metabolized in the liver to N-acetylprocainamide (NAPA), an active metabolite with Class III antiarrhythmic activity. The ratio of procainamide to NAPA in the bloodstream depends on the patient's acetylator phenotype (fast vs. slow) and renal function, as both compounds are renally cleared. The half-life of procainamide is 3–4 hours in normal renal function.
100 mg/mL — injection (10 mL vial)
Most commonly used concentration for IV infusion loading and maintenance
500 mg/mL — injection (2 mL vial)
More concentrated vial; used when smaller volume is clinically preferred
250 mg — compounded capsule
Oral compounded formulation available from PCAB-accredited compounding pharmacies only; commercial oral tablets are discontinued
500 mg — compounded capsule
Oral compounded formulation; strength varies per compounding prescription
Procainamide injectable formulations are currently available from multiple manufacturers (Amphastar, Nexus, Pfizer) with no active FDA-listed national shortage as of 2026. However, retail pharmacy availability is limited because most of the supply flows through hospital and specialty procurement channels—not standard retail pharmacy chains.
Patients seeking procainamide injection at a retail pharmacy will often find that chain pharmacies (CVS, Walgreens, Rite Aid) do not stock it. Hospital outpatient pharmacies and independent specialty pharmacies are better options. Additionally, commercial oral procainamide (Pronestyl tablets, Procanbid extended-release tablets) has been permanently discontinued, so patients needing oral therapy must use compounding pharmacies—further limiting access.
Rather than calling every pharmacy yourself, medfinder contacts pharmacies near you to find which ones have procainamide in stock and texts you the results. This significantly reduces the time and frustration of locating this specialty medication.
Procainamide is not a controlled substance, so any licensed physician can legally prescribe it. However, due to its complexity, serious toxicity risks, and the FDA requirement for in-hospital initiation under monitoring, it is prescribed almost exclusively by cardiac specialists and emergency physicians.
Cardiologists: General cardiologists manage arrhythmia patients and may prescribe and maintain procainamide therapy
Cardiac Electrophysiologists (EPs): The subspecialists most expert in arrhythmia management; often involved in complex or refractory cases
Emergency Medicine Physicians: Initiate IV procainamide in the emergency department for acute arrhythmia episodes
Critical Care / Intensivists: Manage arrhythmias in ICU settings, often in consultation with cardiology
Hospitalists: May continue procainamide therapy in hospitalized patients under cardiology guidance
Procainamide is not appropriate for telehealth initiation due to the FDA requirement for in-hospital monitoring. However, stable patients on long-term antiarrhythmic regimens may have follow-up visits conducted via telehealth with their cardiologist at some institutions.
No. Procainamide is not a controlled substance and is not scheduled under the DEA's Controlled Substances Act. Any licensed physician can prescribe procainamide without a DEA registration number or special prescribing authority.
However, despite not being a controlled substance, procainamide is a high-risk medication that carries two FDA boxed warnings. Because it is used exclusively for life-threatening cardiac arrhythmias and requires in-hospital initiation with ECG and hemodynamic monitoring, it is prescribed almost exclusively by cardiologists, electrophysiologists, and emergency medicine physicians. Prescriptions for outpatient use (injectable or compounded oral) are much less common.
Hypotension (low blood pressure), especially during IV infusion at rates above 20 mg/min
Bradycardia (slow heart rate)
QRS widening and QT/PR prolongation on ECG
Drug fever, rash, urticaria, or angioedema
Nausea, vomiting, diarrhea (with oral formulations)
Agranulocytosis / blood dyscrasias: Occurs in ~0.5% of patients; 20–25% mortality in reported agranulocytosis cases. Weekly CBC monitoring required for first 3 months.
Drug-induced lupus erythematosus (DILE): Positive ANA titers develop in many patients on long-term therapy; lupus-like syndrome (arthritis, pleuritis, fever) may occur. Symptoms typically resolve upon discontinuation.
Torsades de pointes: Life-threatening arrhythmia caused by excessive QT prolongation
Paradoxical proarrhythmia: Worsening of existing arrhythmia or new ventricular tachycardia
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Amiodarone
Class III antiarrhythmic; widely available IV and oral; broad-spectrum arrhythmia treatment; requires monitoring for multi-organ toxicity with long-term use
Lidocaine
Class IB antiarrhythmic; IV only; fast-acting for ventricular arrhythmias; no effect on atrial tissue; fewer drug interactions
Sotalol
Class III antiarrhythmic with beta-blocker properties; available IV and oral (generic, Betapace); used for AF rhythm control and VT prevention; QT monitoring required
Quinidine
Class IA antiarrhythmic (same class as procainamide); available orally; rarely used today due to side effects; niche use in Brugada syndrome
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Amiodarone
majorMajor interaction: amiodarone blocks renal clearance of procainamide, significantly raising procainamide levels. Additive QT prolongation creates high risk of torsades de pointes. Combination generally avoided.
Quinidine / Disopyramide
majorMajor interaction: combining Class IA antiarrhythmics amplifies QRS widening, QT prolongation, AV block, hypotension, and cardiac depression. Generally avoided.
Digoxin
majorMajor interaction: procainamide can suppress digitalis-induced arrhythmias but risks severe AV conduction depression and ventricular asystole.
Azithromycin
majorModerate-major interaction: azithromycin prolongs QT interval; additive risk of torsades de pointes with procainamide.
Cimetidine (Tagamet)
moderateModerate interaction: cimetidine blocks renal tubular secretion of procainamide, raising drug levels. Use famotidine or omeprazole instead if possible.
Trimethoprim (Bactrim)
moderateModerate interaction: trimethoprim competes with procainamide for renal excretion, raising procainamide blood levels.
Sotalol / Dofetilide / Ibutilide
majorMajor interaction: additive QT prolongation with procainamide creates significant risk of torsades de pointes.
Procainamide remains an important medication in the treatment of life-threatening cardiac arrhythmias, despite its age and complex safety profile. Clinical evidence from the PROCAMIO trial confirms it is more effective than amiodarone for stable ventricular tachycardia—validating its continued role in modern cardiology practice.
The biggest challenges for patients today are access and cost. The permanent discontinuation of commercial oral formulations, limited retail pharmacy stocking of the injectable form, and variable insurance coverage for compounded formulations create real barriers. Patients and providers need to be proactive about locating pharmacies that stock procainamide and planning ahead for continued access.
If you're struggling to find procainamide at a pharmacy near you, medfinder can help by calling pharmacies in your area to check which ones have your prescription in stock. Results are texted directly to you, saving you time and reducing the stress of navigating a complex drug supply chain.
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