Adult: 2 mg/kg for 10-30 min. Max: 150 mg. For longer term parenteral therapy, start w/ 2 mg/kg over 30 min, continue w/ infusion at 1.5 mg/kg over the 1st hr and 100-250 mcg/kg/hr thereafter. Max total in the 1st 24 hr: 600 mg. Avoid infusing for >24 hr; shift to oral therapy as soon as possible.
Oral Ventricular arrhythmias
Adult: Initially, 100 mg bid for 3-5 days, reduced to the lowest dose that controls the arrhythmia. Max: 400 mg daily. Elderly: Max initial dose: 100 mg daily. Child: <6 mth Initially, 50 mg/m2 daily in divided doses; >6 mth Initially, 100 mg/m2 daily; Max: 200 mg/m2.
Max initial dose: 100 mg daily. Dose may be adjusted after 6-7 days as tolerated.
Intravenous:
CrCl (mL/min)
Dosage
≤35
Reduce dose to 50%.
Hepatic Impairment
Oral: Max: 100 mg daily.
Administration
May be taken with or without food.
Contraindications
Pre-existing 2nd- or 3rd-degree AV block w/o pacemaker, right bundle branch block associated w/ left hemiblock w/o pacemaker, cardiogenic shock, heart failure, history of MI, known Brugada syndrome.
Special Precautions
Patient w/ pacemakers, atrial fibrillation following cardiac surgery, atrial flutter, and structural heart disease. Renal (CrCl ≤35 mL/min) and significant hepatic impairment. Elderly. Childn. Pregnancy and lactation.
This drug may cause dizziness and visual disturbances, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor ECG, BP, plasma levels, and resp function.
Overdosage
Symptoms: Nausea and vomiting, convulsion, hypotension, bradycardia, widening of PR and QT intervals, ventricular tachycardia, AV nodal block, bundle branch block, asystole, cardiac and resp failures. Management: Symptomatic and supportive treatment. Inotropics (e.g. dopamine, dobutamine, isoproterenol), mechanical ventilation, and circulatory assistance (e.g. balloon pumping) may also be given.
Drug Interactions
Increased incidence of cardiac arrhythmias w/ other antiarrhythmics or arrhythmogenic drugs. Additive negative inotropic effects w/ Class II antiarrhythmics. Increased plasma conc w/ amiodarone, cimetidine quinidine, and ritonavir. Hypokalaemia may result w/ diuretics, corticosteroids, and laxatives.
Food Interaction
Decreased absorption w/ admin of milk.
Action
Description: Mechanism of Action: Flecainide, an amide anaesthetic, belongs to Class Ic antiarrhythmic agents. It inhibits the transmembrane influx of extracellular Na ions via fast channels on cardiac tissues resulting to a decrease in rate of depolarisation of the action potential, prolonging the PR and QRS intervals. At high concentrations, it exerts inhibitory effects on slow Ca channels, accompanied by moderate negative inotropic effect. Pharmacokinetics: Absorption: Almost completely absorbed. Decreased absorption w/ milk. Bioavailability: Approx 90%. Time to peak plasma concentration: Approx 3 hr. Distribution: Crosses the placenta and distributed in breast milk. Volume of distribution: 5.5 -8.7 L/kg (oral); approx 10 L/kg (IV). Plasma protein binding: Approx 40%. Metabolism: Converted into m-O-dealkylated flecainide and m-O-dealkylated lactam of flecainide by CYP2D6 isoenzyme, subjected to genetic polymorphism. Excretion: Via urine (30% as unchanged drug and the remainder as metabolites) and faeces (5%). Elimination half-life: Approx 20 hr.
Chemical Structure
Flecainide Source: National Center for Biotechnology Information. PubChem Database. Flecainide, CID=3356, https://pubchem.ncbi.nlm.nih.gov/compound/Flecainide (accessed on Jan. 21, 2020)
C01BC04 - flecainide ; Belongs to class Ic antiarrhythmics.
References
Anon. Flecainide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/06/2016.Buckingham R (ed). Flecainide Acetate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/06/2016.Flecainide Acetate Tablet (Ranbaxy Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 15/06/2016.Joint Formulary Committee. Flecainide Acetate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/06/2016.McEvoy GK, Snow EK, Miller J et al (eds). Flecainide Acetate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 15/06/2016.
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