Flecainide (Tambocor) Considerations for Use*
US/FDA Approved Indications: Heart Rhythm Control for Atrial Fibrillation
|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.
|Major Side Effects||
hypotension, atrial flutter with high ventricular rate, ventricular tachycardia, HF
|Dosage forms and Strengths||
PO: 50, 100, 150mg tablets
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.
- 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.
- Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
- Tarascon Pocket Pharmacopoeia® 2012.
- 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/