FLECAINIDE (fle-kay'nide) Tambocor Classifications: cardiovascular agent; antiarrhythmic, class ic Pregnancy Category: C
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50 mg, 100 mg, 150 mg tablets
Local (membrane) anesthetic and antiarrhythmic with electrophysiologic properties similar to other class IC antiarrhythmic
drugs. Slows conduction velocity throughout myocardial conduction system, increases ventricular refractoriness; little effect
on repolarization. Prolongs His-ventricular (HQ) and QRS intervals at therapeutic doses.
Clinically, causes both hypotension and negative entropy (in higher dose ranges) and is an effective suppressant of PVCs and
a variety of atrial and ventricular arrhythmias.
Life-threatening ventricular arrhythmias.
Atrial tachycardia and other arrhythmias unresponsive to standard agents (e.g., quinidine), Wolff-Parkinson-White syndrome,
and recurrent ventricular tachycardias.
Hypersensitivity to flecainide; preexisting second- or third-degree AV block, right bundle branch block when associated with
a left hemiblock unless a pacemaker is present; cardiogenic shock, significant hepatic impairment. Safety during pregnancy
(category C), lactation, or in children <18 y is not established.
CHF, sick sinus syndrome, renal impairment.
Life-threatening Ventricular Arrhythmias Adult: PO 100 mg q12h, may increase by 50 mg b.i.d. q4d (max: 400 mg/d) Child: PO 13 mg/kg/d in 3 divided doses (max: 8 mg/kg/d)
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Oral
- Do not increase dosage more frequently than every 4 d.
- Store in tightly covered, light-resistant containers at 15°30° C (59°86° F) unless otherwise
directed.
CNS: Dizziness, headache, light-headedness, unsteadiness, paresthesias, fatigue. CV: Arrhythmias, chest pain, worsening of CHF. Special Senses: Blurred vision, difficulty in focusing, spots before eyes. GI: Nausea, constipation, change in taste perception. Body as a Whole: Dyspnea, fever, edema.
Drug: Cimetidine may increase flecainide levels; may increase digoxin levels 1525%; beta blockers may have additive negative inotropic effects.
Absorption: Readily absorbed from GI tract. Peak: 23 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: Metabolized in liver. Elimination: Excreted mainly in urine. Half-Life: 722 h.
Assessment & Drug Effects
- Correct preexisting hypokalemia or hyperkalemia before treatment is initiated.
- Note: ECG monitoring, including Holter monitor for ambulating patients, is essential because of the possibility of drug-induced
arrhythmias.
- Determine pacing threshold for patients with pacemakers before initiation of therapy, after 1 wk of therapy, and at regular
intervals thereafter.
- Monitor plasma level recommended, especially in patients with severe CHF or renal failure because drug elimination may be
delayed in these patients.
- Note: Effective trough plasma levels are between 0.71 mcg/mL. The probability of adverse reactions increases when trough levels
exceed 1 mcg/mL.
- Attempt dosage reduction with caution after arrhythmia is controlled.
Patient & Family Education
- Note: It is VERY important to take this drug at the prescribed times.
- Report visual disturbances to physician.
- Do not breast feed while taking this drug without consulting physician.