Formulary
Flecainide acetate: Indications, Dosing, Side Effects and Interactions
Flecainide acetate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Flecainide acetate: Indications, Dosing, Side Effects and Interactions
Flecainide acetate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Supraventricular arrhythmias (initiated under direction of hospital consultant)**
- **Adult** (By Mouth): Initially 50 mg twice daily, dose can be increased if necessary up to 300 mg per day.
**Ventricular arrhythmias (initiated under direction of hospital consultant)**
- **Adult** (By Mouth): Initially 100 mg twice daily for 3-5 days, maximum dose of 400 mg per day can be used for rapid control or in heavily built patients; for maintenance, reduce to the lowest dose that controls the arrhythmia.
**Resistant re-entry supraventricular tachycardia (initiated under direction of hospital consultant), Ventricular ectopic beats or ventricular tachycardia (initiated under direction of hospital consultant), Arrhythmias associated with accessory conduction pathways (e.g. Wolff-Parkinson-White syndrome) (initiated under direction of hospital consultant), Paroxysmal atrial fibrillation (initiated under direction of hospital consultant) for flecainide acetate**
- **Neonate** (By mouth): 2 mg/kg 2-3 times a day, dose to be adjusted according to response and plasma-flecainide concentration.
- **Child 1 month-5 years** (By mouth): 2 mg/kg 2-3 times a day, dose to be adjusted according to response and plasma-flecainide concentration; maximum 8 mg/kg per day.
- **Child 6-11 years** (By mouth): 2 mg/kg 2-3 times a day, dose to be adjusted according to response and plasma-flecainide concentration; maximum 8 mg/kg per day or 300 mg per day (whichever is lower).
- **Child 12-17 years** (By mouth): Initially 50-100 mg twice daily, dose can be increased if necessary up to 300 mg per day (maximum dose of 400 mg per day can be used for ventricular arrhythmias in heavily built children).
Cautions
Atrial fibrillation following heart surgery; elderly (accumulation may occur); patients with pacemakers (especially those who may be pacemaker dependent because stimulation threshold may rise appreciably)
Contraindications
Abnormal left ventricular function; atrial conduction defects (unless pacing rescue available); bundle branch block (unless pacing rescue available); distal block (unless pacing rescue available); haemodynamically significant valvular heart disease; heart failure; history of myocardial infarction and either asymptomatic ventricular ectopics or asymptomatic non-sustained ventricular tachycardia; long-standing atrial fibrillation where conversion to sinus rhythm not attempted; second-degree or greater AV block (unless pacing rescue available); sinus node dysfunction (unless pacing rescue available)
Side effects
Common or very common Arrhythmias; asthenia; dizziness; dyspnoea; fever; oedema; vision disorders Uncommon Alopecia; appetite decreased; constipation; diarrhoea; flatulence; gastrointestinal discomfort; nausea; skin reactions; vomiting Rare or very rare Anxiety; confusion; corneal deposits; depression; drowsiness; flushing; hallucination; headache; hepatic disorders; hyperhidrosis; inflammation; insomnia; interstitial lung disease; memory loss; movement disorders; peripheral neuropathy; photosensitivity reaction; seizure; sensation abnormal; syncope; tinnitus; tremor; vertigo Frequency not known Altered pacing threshold; atrioventricular block; cardiac arrest; chest pain; heart failure; hypotension; palpitations; pulmonary fibrosis; QT interval prolongation
Interactions
**Other interactions (16):**
- Class II antiarrhythmics: The possibility of additive negative inotropic effects of Class II antiarrhythmics, i.e.
- Class III antiarrhythmics: If flecainide is given in the presence of amiodarone the usual flecainide dosage should be reduced by 50% and the patient monitored closely for adverse effects.
- Class IV antiarrhythmics: The use of flecainide with calcium channel blockers, e.g.
- Flecainide is metabolized by CYP2D6 to a large extent, and concurrent use of drugs inhibiting (e.g.
- Hypokalaemia may result from the concomitant use of diuretics, corticosteroids or laxatives.
- Antihistamines: Increased risk of ventricular arrhythmias with mizolastine, astemizole and terfenadine (avoid concomitant use).
Pregnancy
Used in pregnancy to treat maternal and fetal arrhythmias in specialist centres; toxicity reported in animal studies; infant hyperbilirubinaemia also reported.
Breast feeding
Significant amount present in milk but not known to be harmful.
Hepatic impairment
Dose adjustments Avoid or reduce dose in severe impairment.
Renal impairment
Dose adjustments Reduce initial oral dose to max. 100 mg daily if eGFR less than 35 mL/minute/1.73 m 2 .
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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