Flecainide chemical structure
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Flecainide

Flecainide acetate is a class Ic antiarrhythmic agent used to prevent and treat tachyarrhythmias (abnormal fast rhythms of the heart). It is used to treat a variety of cardiac arrhythmias including paroxysmal atrial fibrillation (episodic irregular heartbeat originating in the upper chamber of the heart), paroxysmal supraventricular tachycardia (episodic rapid but regular heartbeat originating in the atrium), and ventricular tachycardia (rapid rhythms of the lower chambers of the heart). Flecainide works by regulating the flow of sodium in the heart, thus slowing nerve impulses. more...

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Flecainide was originally sold under the trade name Tambocor® (manufactured by 3M pharmaceuticals). Flecainide went off-patent on February 10th, 2004, and is now available under the trade names Almarytm®, Apocard®, Ecrinal®, and Flécaine®. It is also available generically.

Uses

Flecainide is used in the treatment of many types of supraventricular tachycardias, including AV nodal reciprocating tachycardia (AVNRT) and Wolff-Parkinson-White syndrome (WPW). This is because of the action of flecainide on the His-Purkinje system.

It also has limited use in the treatment of certain forms of ventricular tachycardia (VT). In particular, flecainide has been useful in the treatment of ventricular tachycardias that are not in the setting of an acute ischemic event. It has use in the treatment of right ventricular outflow tract (RVOT) tachycardia1 and in the suppression of arrhythmias in arrhythmogenic right ventricular dysplasia (ARVD)2. However, studies have shown an increased mortality when flecainide is used to suppress ventricular extrasystoles in the setting of acute myocardial infarction.3,4

In individuals suspected of havings the Brugada syndrome, the administration of flecainide may help reveal the ECG findings that are characteristic of the disease process. This may help make the diagnosis of the disease in equivocal cases.5

Flecainide has been introduced into the treatment of arrhythmias in the pediatric population.

Dosing

The dosing of flecainide is varied, with consideration made to the individual's other medications and comorbid conditions and how they may affect the metabolism of flecainide. Individuals with significant renal impairment may require measurement of the plasma level of flecainide to insure that the drug level remains within the therapeutic range (ie: that toxic levels do not occur). In addition, lower drug levels may be sought for the treatment of benign arrhythmias, to lower the chance of inducing a toxic effect of the drug. When used in the pediatric population, the dose of flecainide may be adjusted to the individual's body surface area.

Given the variable half life of flecainide and the characteristic QT prolongation on ECG elicited in flecainide toxicity, starting flecainide or changing the level of the drug is done under telemetry monitoring (preferably in a hospital telemetry unit) until a steady state plasma level has been achieved, typically three to five days after the dose has been increased.

For the treatment of supraventricular tachycardias and paroxysmal atrial fibrillation or flutter in individuals without significant structural heart disease, a starting dose of 50 mg twice a day may be appropriate. The dose may be increased (once a steady state level has been reached) if breakthrough arrhythmias occur.

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Use of flecainide in atrial fibrillation - Tips from Other Journals
From American Family Physician, 9/1/91

Flecainide is a class IC antiarrhythmic drug that has potent sodium channel blocking properties and little effect on the duration of the action potential. Several studies have shown that flecainide has an effect on ventricular arrhythmias, but less is known about its effect on supraventricular arrhythmias. The prevalence of atrial fibrillation is about 0.4 percent in patients under 70 years of age and is 2 to 4 percent in patients over 70. Pietersen and associates conducted a double-blind, controlled, crossover study to evaluate the efficacy of flecainide in the prevention of paroxysmal atrial fibrillation and flutter.

The study included 23 men and 20 women. The patients ranged in age from 21 to 73 years (mean age: 33 year). The main criterion for inclusion in the study was at least three symptomatic attacks of atrial fibrillation or flutter, or both, on three different days in the preceding three months. At least one of the attacks had to be documented by electrocardiography.

Patients were randomized to receive either placebo or 150 mg of flecainide twice daily for a three-month period, after which they were switched to the alternate therapy for a second three-month period. One patient who weighed less than 60 kg (132 lb) received a lower dose of flecainide, 100 mg twice daily. Supra-ventricular arrhythmias were verified by a minielectrocardiogram event recorder. If symptoms became intolerable, the protocal allowed patients to cross over to the alternate treatment before the end of the first three-month period. Four patients crossed over after the first week in the first period (one-week interval), and 15 other patients crossed over after the first month (one-month interval). The remaining 24 patients completed both of the three-month treatment periods (three-month interval).

In all three treatment intervals, a significant reduction in the number of episodes of supraventricular arrhythmias occurred in patients receiving flecainide. Arrythmias were completely suppressed in 15 (25 percent) of 43 patients treated for one week, 18 (46 percent) of 39 treated for one month and 12 (50 percent) of 24 patients who completed both three-month periods. Adverse effects occurred in 32 (74 percent) of the 43 patients, but only two of these patients were withdrawn from the study. One patient died suddenly. In comparison, three (7 percent) of 43 patients reported adverse effects during the placebo period.

The authors conclude that treatment with flecainide significantly suppresses the number of episodes of paroxysmal atrial fibrillation of flutter. Adverse effects were frequent but tolerable. (American Journal of Cardiology, April 1, 1991, vol. 67, p. 713.)

COPYRIGHT 1991 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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