FLECAINIDE
(fle-kay'nide)
Tambocor
Classifications: cardiovascular agent; antiarrhythmic, class ic
Pregnancy Category: C

Availability

50 mg, 100 mg, 150 mg tablets

Actions

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.

Therapeutic Effects

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.

Uses

Life-threatening ventricular arrhythmias.

Unlabeled Uses

Atrial tachycardia and other arrhythmias unresponsive to standard agents (e.g., quinidine), Wolff-Parkinson-White syndrome, and recurrent ventricular tachycardias.

Contraindications

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.

Cautious Use

CHF, sick sinus syndrome, renal impairment.

Route & Dosage

Life-threatening Ventricular Arrhythmias
Adult: PO 100 mg q12h, may increase by 50 mg b.i.d. q4d (max: 400 mg/d)
Child: PO 1–3 mg/kg/d in 3 divided doses (max: 8 mg/kg/d)

Administration

Oral

Adverse Effects (1%)

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.

Interactions

Drug: Cimetidine may increase flecainide levels; may increase digoxin levels 15–25%; beta blockers may have additive negative inotropic effects.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Peak: 2–3 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: Metabolized in liver. Elimination: Excreted mainly in urine. Half-Life: 7–22 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug