Drug information of Flecainide
Mechanism of effect
Flecainide acts on sodium channels on the neuronal cell membrane, limiting the spread of seizure activity and reducing seizure propagation. The antiarrhythmic actions are mediated through effects on sodium channels in Purkinje fibers. Flecainide is a sodium channel blocker, binding to voltage gated sodium channels. It stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses. Ventricular excitability is depressed and the stimulation threshold of the ventricle is increased during diastole.
Flecainide acetate has local anesthetic activity and belongs to the membrane stabilizing (Class 1) group of antiarrhythmic agents; it has electrophysiologic effects characteristic of the IC class of antiarrhythmics.
Following oral administration, the absorption of Flecainide acetate is nearly complete. Peak plasma levels are attained at about three hours in most individuals (range, 1 to 6 hours). Food or antacid do not affect absorption. Milk, however, may inhibit absorption in infants. The apparent plasma half-life averages about 20 hours. The elimination of Flecainide from the body depends on renal function (i.e., 10 to 50% appears in urine as unchanged drug). Protein binding: 40%, Metabolism: Hepatic
Drug indicationsparoxysmal supraventricular tachycardias (PSVT) , paroxysmal atrial fibrillation/flutter , prevention of documented ventricular arrhythmias, such as sustained ventricular tachycardia
Usual Adult Dose for Ventricular Tachycardia
Initial dose: 100 mg orally every 12 hours.
Maintenance dose: May be increased in increments of 50 mg bid every 4 days until efficacy is achieved. Most patients with SUSTAINED VT do not require more than 150 mg every 12 hours (300 mg/day), and the maximum dose recommended is 400 mg/day.
Usual Pediatric Dose for Supraventricular Tachycardia
less than 1 month:
Supraventricular tachycardia: Limited data available: Initial: 2 mg/kg/day orally divided every 12 hours; titrate to clinical response, monitor serum concentration; mean dose required to suppress SVT: 3.35 Â± 1.35 mg/kg/day in 17 neonates (n=20 treated neonates; mean PNA: 11.5 days; mean GA: 36.8 weeks; mean birthweight: 2.8 kg); study did not report resultant serum concentrations.
1 month or older:
Initial: 1 to 3 mg/kg/day orally or 50 to 100 mg/m2/day orally in 3 divided doses; usual: 3 to 6 mg/kg/day or 100 to 150 mg/m2/day in 3 divided doses; up to 8 mg/kg/day or 200 mg/m2/day for uncontrolled patients with subtherapeutic levels; higher doses have been reported, however they may be associated with an increased risk of proarrhythmias; a review of world literature reports the average effective dose to be 4 mg/kg/day or 140 mg/m2/day.
Drug contraindicationshypersensitivity to drug or its components. , cardiogenic shock , Second- or third-degree AV block , atrial flutter , atrial fibrillation , Myocardial infarction
Side effectsnausea , Headache , chest pain , constipation , abdominal pain , dizziness , fatigue , Dyspnea , asthenia , palpitations , edema , Tremor , Visual abnormalities
InteractionsBupropion , Duloxetine , Salbutamol , Nortriptyline , Aripiprazole , Amiodarone , Octreotide acetate , Propranolol , Diltiazem , Zonisamide , Verapamil , Quinidine , Cimetidine , Citalopram , Fluoxetine , Phenobarbital , Phenytoin , Nifedipine , ritonavir , saquinavir , Dolasetron , Arbutamine , vandetanib , sparfloxacin , Procainamide , Indapamide , Dofetilide , Ibutilide , Inotuzumab , Anagrelide , probucol , Peginterferon alfa-2b , Arsenic trioxide , Tipranavir , Halofantrine , Grepafloxacin , cobicistat , Bendroflumethiazide , lenvatinib , Entrectinib , Sodium lactate , Eliglustat , Bepridil , bedaquiline , Gemtuzumab , vemurafenib , Vernakalant , dichlorphenamide , cyclopenthiazide , Asunaprevir , Remoxipride , Halaven
1-Flecainide should be used cautiously in patients with a history of CHF or myocardial dysfunction.
2-Electrolyte disturbances (i.e., potassium, sodium) should be corrected before initiating flecainide treatment.
3- In patients with less severe renal dysfunction: Initial dose: 100 mg every 12 hours
Points of recommendation
1-The maximum recommended dose for patients with PSVT is 300 mg/day.
2-The maximum recommended dose for patients with Sustained VT is 400 mg/day.
3-Monitoring of electrolytes (i.e., potassium, sodium) periodically has been recommended in high-risk patients in order to prevent flecainide cardiotoxicity.