Flecainide (Tambocor) Considerations for Use*

US/FDA Approved Indications: Heart Rhythm Control for Atrial Fibrillation

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Black Box Warning* Proarrhythmic. Increased mortality in patients with non - life - threatening ventricular arrhythmias, structural heart disease (ie, MI, LV dysfunction); not recommended for use with chronic atrial fibrillation.

Mechanism of Action

Depresses phase 0 depolarization significantly, slows cardiac conduction significantly (Class 1C).


Cardioversion: 200 to 300 mg PO‡1

Maintenance: 50 to 150 mg PO every 12 hrs

Hepatic Impairment: Reduce initial dosage. Monitor serum level frequently. Allow at least 4 days after dose changes to reach steady state level before adjusting dosage.

Renal Impairment:
CrCl > 35 ml/min: No dosage adjustment is required.
CrCl <= 35 ml/min: Initially, 100 mg PO once daily or 50 mg PO twice daily.
Adjust dosage at intervals > 4 days, since steady - state conditions may take longer to achieve in these patient

  • cardiogenic shock
  • sick sinus syndrome or significant conduction delay
  • 2nd/3rd degree heart block or bundle brand block without pacemaker
  • acquired/congenital QT prolongation
  • patients with history of torsade de pointes
  • Major Side Effects

    hypotension, atrial flutter with high ventricular rate, ventricular tachycardia, HF

    Dosage forms and Strengths

    PO: 50, 100, 150mg tablets

    Special Notes

    Close monitoring of this drug is required.

    When starting a patient on flecainide, it is prudent to do a treadmill stress test after the patient is fully loaded.4

    Do not use in patients with ischemic heart disease or LV dysfunction; increases risk of arrhythmias.

    Additional AV nodal blocking agent may be required to maintain rate control when AF recurs.


    Report signs/symptoms of new or worsening cardiac failure, arrhythmias, or chest pain.

    * Refer to prescribing information for more complete information.
    †Dosages given in the table may differ from those recommended by the manufacturers.


    1. American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC). ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Washington, DC: American College of Cardiology.
    2. Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
    3. Tarascon Pocket Pharmacopoeia® 2012.
    4. Razavi, M. 2005. Safe and Effective Pharmacologic Management of Arrhythmias. Texas Heart Institute Journal, 2005; 32 (2): 209–211. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1163475/