Flecainide (Tambocor) Considerations for Use*

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

Click here to view a Print Quality PDF of this table

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).

Dosing

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

Contraindications
  • 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.

    Counseling

    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.


    Sources:

    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/