FLECAINIDE ACETATE

Indications & Dose:

 AV nodal reciprocating tachycardia, arrhythmias associated with accessory conducting pathways (e.g. Wolff-ParkinsonWhite syndrome), disabling symptoms of paroxysmal atrial fibrillation in patients without left ventricular dysfunction (arrhythmias of recent onset will respond more readily) (specialist supervision in hospital) | Ventricular tachyarrhythmias resistant to other treatment (specialist supervision in hospital) l INITIALLY BY SLOW INTRAVENOUS INJECTION Adult: Initially 2 mg/kg (max. per dose 150 mg), to be given over 10–30 minutes with ECG monitoring, followed by (by intravenous infusion) 1.5 mg/kg/ hour if required for 1 hour, then (by intravenous infusion) reduced to 100–250 micrograms/kg/hour for up to 24 hours, maximum cumulative dose of 600mg in first 24 hours, then transfer to oral treatment Supraventricular arrhythmias l BY MOUTH USING IMMEDIATE-RELEASE MEDICINES Adult: Initially 50 mg twice daily, increased if necessary up to 300 mg daily l BY MOUTH USING MODIFIED-RELEASE MEDICINES Adult: Initially 100 mg twice daily for 3–5 days, maximum 400mg daily reserved for rapid control or in heavily built patients; for maintenance, reduce to the lowest dose that controls the arrhythmia continued. 

Contraindications:

Abnormal left ventricular function atrial conduction defects (unless pacing rescue available) .bundle branch block (unless pacing rescue available) . control of arrhythmias in acute situations (for modifiedrelease forms only) . distal block (unless pacing rescue available) . haemodynamically significant valvular heart disease . heart failure . history of myocardial infarction and either asymptomatic ventricular ectopics or asymptomatic non-sustained ventricular tachycardia . long-standing atrial fibrillation where conversion to sinus rhythm not attempted . second-degree or greater AV block (unless pacing rescue available) . sinus nodedysfunction (unless pacing rescue available)  sinus node dysfunction (unless pacing rescue available) 

Side Effects:

Common or very common Asthenia . dizziness . dyspnoea . fatigue . fever . oedema . proarrhythmic effects . visual disturbances Rare Amnesia . confusion . convulsions . depression . dyskinesia . hallucinations . peripheral neuropathy . pneumonitis Frequency not known Anaemia . anorexia . anxiety . ataxia . corneal deposits . drowsiness . flushing . gastrointestinal disturbances . headache . hepatic dysfunction . hypersensitivity reactions . increased antinuclear antibodies . increased sweating . insomnia . leucopenia . paraesthesia . photosensitivity . rash . syncope . thrombocytopenia . tinnitus . tremor . urticaria . vertigo PREGNANCY Used in pregnancy to treat maternal and fetal arrhythmias in specialist centres; toxicity reported in animal studies; infant hyperbilirubinaemia also reported. BREAST FEEDING Significant amount present in milk but not known to be harmful. HEPATIC IMPAIRMENT Avoid or reduce dose in severe impairment. RENAL IMPAIRMENT Reduce initial oral dose to max. 100mg daily or reduce intravenous dose by 50%, if eGFR less than 35 mL/minute/1.73m2.

Cautions:

Atrial fibrillation following heart surgery. elderly (accumulation may occur) . patients with pacemakers (especially those who may be pacemaker dependent because stimulation threshold may rise appreciably) 

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