II. Mechanism
-
Class Ic Antiarrhythmic Drug
- Blocks cardiac Sodium channels
- Slows cardiac conduction and decreases cardiac contractility
III. Indications: Atrial Fibrillation Cardioversion
- Time to Cardioversion: 3-8 hours
- Conversion Rate: 68-91%
- Chronic Efficacy: 40-74%
IV. Dose
- Load: 300-400 mg orally single bolus dose
- Maintenance: 50-150 mg orally twice daily
V. Pharmacokinetics
- Oral bioavailability: 90%
- Peak: 3 hours after ingestion
- Volume of Distribution (Vd): 8 to 9 L/kg (high)
- Not dialyzable
- Half-Life: 12 to 24 hours
- Metabolism: Hepatic
- Renal excretion: 30% unchanged
VI. Precautions
- Narrow therapeutic range
- Risk of toxicity (esp. in renal dysfunction)
- Acute ingestion >1 gram
- Chronic dosing error
VII. Adverse Effects: General
VIII. Adverse Effects: Toxicity or Overdose
- See general adverse effects above
- Seizures
- Hypotension
- Bradycardia
- Wide Complex Tachycardia
IX. Diagnostics: Toxicity or Overdose
-
Electrocardiogram (EKG)
- QRS Widening
- Prolonged PR Interval
- Terminal R Wave in aVR (last 40 ms)
X. Labs: Toxicity or Overdose
- See Unknown Ingestion
- Bedside Glucose
- Basic chemistry panel with Electrolytes
- Serum Calcium
- Serum Magnesium
- Toxicology labs (including Acetaminophen level)
XI. Management: Toxicity or Overdose
- Activated Charcoal in alert patient (no aspiration risk) and within one hour of ingestion
-
Electrolyte disturbance
- Potassium Replacement as needed for Hypokalemia
- Magnesium Replacement as needed
-
Hypotension
- Initial
- Intravenous Fluids
- Norepinephrine for Hypotension refractory to fluids
- Refractory Hypotension
- Intravenous Lipid Emulsion (Intralipid) 20% 1.5 ml/kg to 100 ml bolus (may be repeated)
- Extracorporeal Cardiopulmonary Resuscitation (ECMO)
- Initial
-
Wide QRS
- Hypertonic Sodium Bicarbonate IV with target pH 7.44 to 7.55
-
Ventricular Tachycardia
- Consider Amiodarone or Lidocaine
XII. References
- Tomaszewski (2022) Crit Dec Emerg Med 36(3): 28
- Vu (2015) HeartRhythm Case Rep 2(3):228-31+PMID:28491675 [PubMed]
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Related Studies
flecainide (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
FLECAINIDE ACETATE 100 MG TAB | Generic | $0.35 each |
FLECAINIDE ACETATE 150 MG TAB | Generic | $0.62 each |
FLECAINIDE ACETATE 50 MG TAB | Generic | $0.25 each |
Ontology: Flecainide (C0016229)
Definition (MSH) | A potent anti-arrhythmia agent, effective in a wide range of ventricular and atrial ARRHYTHMIAS and TACHYCARDIAS. |
Definition (NCI) | A synthetic agent derived from trifluoroethoxy-benzamide exhibiting antiarrhythmic and local anesthetic activity. As a class Ic antiarrhythmic that blocks sodium channels, flecainide depresses polarization phase 0 and decreases the induction velocity of the His-Purkinje system. It also decreases phase 4 slope and increases the depolarization threshold. (NCI04) |
Definition (NCI_NCI-GLOSS) | A drug that is used to treat abnormal heart rhythms. It may also relieve neuropathic pain, the burning, stabbing, or stinging pain that may arise from damage to nerves caused by some types of cancer or cancer treatment. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D005424 |
SnomedCT | 372751001, 46576005 |
LNC | LP16148-6, MTHU004259 |
English | Flecainide, Benzamide, N-(2-piperidinylmethyl)-2,5-bis(2,2,2-trifluoroethoxy)-, flecainide (medication), Flecainide [Chemical/Ingredient], FLECAINIDE, flecainide, Flecainide (product), Flecainide (substance) |
Swedish | Flekainid |
Czech | flekainid |
Finnish | Flekainidi |
Russian | FLEKAINIDA ATSETAT, FLEKAINID, ФЛЕКАИНИД, ФЛЕКАИНИДА АЦЕТАТ |
Polish | Flekainid |
Japanese | 酢酸フレカイニド, フレカイニド |
Spanish | flecainida (producto), flecainida (sustancia), flecainida, Flecainida |
French | Flécaïnide |
German | Flecainid |
Italian | Flecainide |
Portuguese | Flecainida |
Ontology: Tambocor (C0592158)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D005424 |
English | tambocor, Tambocor, Apocard, Flécaïne, Riker Brand of Flecainide Acetate, United Drug Brand of Flecainide Acetate, 3M Brand of Flecainide Acetate |
Ontology: flecainide toxicity (C2198292)
Concepts | Injury or Poisoning (T037) |
English | flecainide toxicity (diagnosis), flecainide toxicity |
Ontology: self-inflicted overdose of flecainide (C2204022)
Concepts | Injury or Poisoning (T037) |
English | self-inflicted overdose of flecainide (diagnosis), self-inflicted overdose of flecainide, toxicity from flecainide due to a self-inflicted overdose |