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Flecainide
Aka: Flecainide, Tambocor, Flecainide Overdose, Flecainide Toxicity, Flecainide Poisoning
- See Also
- Unknown Ingestion
- Class Ic Antiarrhythmic Drug
- Mechanism
- Class Ic Antiarrhythmic Drug
- Blocks cardiac Sodium channels
- Slows cardiac conduction and decreases cardiac contractility
- Indications: Atrial Fibrillation Cardioversion
- Time to Cardioversion: 3-8 hours
- Conversion Rate: 68-91%
- Chronic Efficacy: 40-74%
- Dose
- Load: 300-400 mg orally single bolus dose
- Maintenance: 50-150 mg orally twice daily
- 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
- Precautions
- Narrow therapeutic range
- Risk of toxicity (esp. in renal dysfunction)
- Acute ingestion >1 gram
- Chronic dosing error
- Adverse Effects: General
- Neurologic
- Dizziness
- Visual Disturbance
- Headache
- Dyspnea
- Nausea or Vomiting
- Tremor
- Fatigue
- Paresthesias
- Adverse Effects: Toxicity or Overdose
- See general adverse effects above
- Seizures
- Hypotension
- Bradycardia
- Wide Complex Tachycardia
- Diagnostics: Toxicity or Overdose
- Electrocardiogram (EKG)
- QRS Widening
- Prolonged PR Interval
- Terminal R Wave in aVR (last 40 ms)
- Labs: Toxicity or Overdose
- See Unknown Ingestion
- Bedside Glucose
- Basic chemistry panel with Electrolytes
- Serum Calcium
- Serum Magnesium
- Toxicology labs (including Acetaminophen level)
- 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)
- Wide QRS
- Hypertonic Sodium Bicarbonate IV with target pH 7.44 to 7.55
- Ventricular Tachycardia
- Consider Amiodarone or Lidocaine
- References
- Tomaszewski (2022) Crit Dec Emerg Med 36(3): 28
- Vu (2015) HeartRhythm Case Rep 2(3):228-31+PMID:28491675 [PubMed]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419747/