Flecainide
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Flecainide
Tambocor (US brand discontinued)
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Summary
Common uses
Atrial fibrillation rhythm control (pill-in-pocket or chronic)0, Recurrent supraventricular tachycardia in structurally normal hearts0, Catecholaminergic polymorphic VT (off-label)0
Pharmacy
Starting dose
50 mg PO BID; titrate to 100-200 mg BID; pill-in-pocket 200-300 mg PO single dose for AF conversion
Preparations
50, 100, 150 mg tablets
US FDA Max
400 mg/d
Pharmacology
Routes
Oral
Onset
AF conversion within hours of single PO dose
Duration
12 hours
Half-life
~14 hours (adults); longer in elderly and renal impairment[1]
Bioavailability
~90% (oral)[1]
Pregnancy
Use in fetal SVT (transplacental antiarrhythmic therapy) is established; otherwise weigh against alternatives.[citation needed]
Legal status
Purported mechanism
Flecainide is a potent voltage-gated sodium channel blocker (class IC); it slows phase 0 depolarization with strong use-dependence and slow dissociation kinetics, prolonging conduction and the refractory period particularly in atrial tissue and accessory pathways.0 Concomitant β-blocker or CCB is required when used for AF to prevent 1:1 atrial flutter conduction (flecainide can slow atrial rate to a level where AV conduction allows dangerous ventricular rates). CYP2D6 substrate[1].
References
edit- ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, flecainide acetate, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/018830s056lbl.pdf