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flecainide
generic
Black Box Warnings .
Increased Mortality
excessive mortality or nonfatal cardiac arrest rate (5.1% flecainide vs. 2.3% matched placebo) in asymptomatic non-life-threatening ventricular arrhythmias w/ MI 6 days - 2 years prior
Proarrhythmic Effects
restrict use to life-threatening ventricular arrhythmias, no survival benefit in pts w/o life-threatening arrhythmias; ventricular proarrhythmic effects in atrial fibrillation/flutter, not recommended for chronic atrial fibrillation
Adult Dosing .
Dosage forms: TAB: 50 mg, 100 mg, 150 mg
atrial fibrillation/flutter
- [maintenance rhythm control]
- Dose: 50-300 mg/day PO divided q8-12h; Start: 50 mg PO q12h, incr. 100 mg/day q4 days; Max: 300 mg/day; Info: adjust dose based on serum levels
- [cardioversion, <70 kg (off-label)]
- Dose: 200 mg PO x1
- [cardioversion, >70 mg (off-label)]
- Dose: 300 mg PO x1
PSVT
- [50-300 mg/day PO divided q8-12h]
- Start: 50 mg PO q12h, incr. 100 mg/day q4 days; Max: 300 mg/day; Info: adjust dose based on serum levels
ventricular arrhythmias
- [100-400 mg/day PO divided q8-12h]
- Start: 100 mg PO q12h, incr. 100 mg/day q4 days; Max: 400 mg/day; Info: adjust dose based on serum levels
renal dosing
- [atrial fibrillation/flutter, cardioversion]
- renal impairment: not defined
- HD/PD: not defined
- [all other indications]
- CrCl <36: start 100 mg qd or 50 mg bid
- HD/PD: not defined
hepatic dosing
- [see below]
- significant impairment: avoid use
Peds Dosing .
- Dosage forms: TAB: 50 mg, 100 mg, 150 mg
PAF/PSVT
- [<6 mo]
- Dose: 100-150 mg/m^2/day PO divided q8-12h; Start: 50 mg/m^2/day, incr. dose q4 days; Max: 200 mg/m^2/day; Alt: start 1-3 mg/kg/day PO divided q8h, incr. to 3-6 mg/kg/day; Info: adjust dose based on serum levels
- [>6 mo]
- Dose: 100-150 mg/m^2/day PO divided q8-12h; Start: 100 mg/m^2/day, incr. dose q4 days; Max: 200 mg/m^2/day; Alt: start 1-3 mg/kg/day PO divided q8h, incr. to 3-6 mg/kg/day; Info: adjust dose based on serum levels
ventricular arrhythmias
- [<6 mo]
- Dose: 100-150 mg/m^2/day PO divided q8-12h; Start: 50 mg/m^2/day, incr. dose q4 days; Max: 200 mg/m^2/day; Alt: start 1-3 mg/kg/day PO divided q8h, incr. to 3-6 mg/kg/day; Info: adjust dose based on serum levels
- [>6 mo]
- Dose: 100-150 mg/m^2/day PO divided q8-12h; Start: 100 mg/m^2/day, incr. dose q4 days; Max: 200 mg/m^2/day; Alt: start 1-3 mg/kg/day PO divided q8h, incr. to 3-6 mg/kg/day; Info: adjust dose based on serum levels
renal dosing
- [adjust dose amount, frequency]
- CrCl <35: give 50% usual dose q12h
- HD/PD: not defined
hepatic dosing
- [see below]
- significant impairment: avoid use