Flecainide

Aka: Flecainide, Tambocor, Flecainide Overdose, Flecainide Toxicity, Flecainide Poisoning

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II. Mechanism

  1. Class Ic Antiarrhythmic Drug
    1. Blocks cardiac Sodium channels
    2. Slows cardiac conduction and decreases cardiac contractility

III. Indications: Atrial Fibrillation Cardioversion

  1. Time to Cardioversion: 3-8 hours
  2. Conversion Rate: 68-91%
  3. Chronic Efficacy: 40-74%

IV. Dose

  1. Load: 300-400 mg orally single bolus dose
  2. Maintenance: 50-150 mg orally twice daily

V. Pharmacokinetics

  1. Oral bioavailability: 90%
  2. Peak: 3 hours after ingestion
  3. Volume of Distribution (Vd): 8 to 9 L/kg (high)
    1. Not dialyzable
  4. Half-Life: 12 to 24 hours
  5. Metabolism: Hepatic
    1. Renal excretion: 30% unchanged

VI. Precautions

  1. Narrow therapeutic range
  2. Risk of toxicity (esp. in renal dysfunction)
    1. Acute ingestion >1 gram
    2. Chronic dosing error

VII. Adverse Effects: General

  1. Neurologic
    1. Dizziness
    2. Visual Disturbance
    3. Headache
  2. Dyspnea
  3. Nausea or Vomiting
  4. Tremor
  5. Fatigue
  6. Paresthesias

VIII. Adverse Effects: Toxicity or Overdose

  1. See general adverse effects above
  2. Seizures
  3. Hypotension
  4. Bradycardia
  5. Wide Complex Tachycardia

IX. Diagnostics: Toxicity or Overdose

  1. Electrocardiogram (EKG)
    1. QRS Widening
    2. Prolonged PR Interval
    3. Terminal R Wave in aVR (last 40 ms)

X. Labs: Toxicity or Overdose

  1. See Unknown Ingestion
  2. Bedside Glucose
  3. Basic chemistry panel with Electrolytes
  4. Serum Calcium
  5. Serum Magnesium
  6. Toxicology labs (including Acetaminophen level)

XI. Management: Toxicity or Overdose

  1. Activated Charcoal in alert patient (no aspiration risk) and within one hour of ingestion
  2. Electrolyte disturbance
    1. Potassium Replacement as needed for Hypokalemia
    2. Magnesium Replacement as needed
  3. Hypotension
    1. Initial
      1. Intravenous Fluids
      2. Norepinephrine for Hypotension refractory to fluids
    2. Refractory Hypotension
      1. Intravenous Lipid Emulsion (Intralipid) 20% 1.5 ml/kg to 100 ml bolus (may be repeated)
      2. Extracorporeal Cardiopulmonary Resuscitation (ECMO)
  4. Wide QRS
    1. Hypertonic Sodium Bicarbonate IV with target pH 7.44 to 7.55
  5. Ventricular Tachycardia
    1. Consider Amiodarone or Lidocaine

XII. References

  1. Tomaszewski (2022) Crit Dec Emerg Med 36(3): 28
  2. Vu (2015) HeartRhythm Case Rep 2(3):228-31+PMID:28491675 [PubMed]
    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419747/

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Related Studies

Cost: Medications

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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: flecainide toxicity (C2198292)

Concepts Injury or Poisoning (T037)
English flecainide toxicity (diagnosis), flecainide toxicity
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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