From the Guidelines
Flecainide is recommended at an initial oral dose of 50-100 mg twice daily for adults with irregular heartbeat conditions, with a maximum daily dose of 400 mg, and should be used with caution in patients with structural heart disease or reduced left ventricular ejection fraction (LVEF) 1.
Dosage and Administration
The dosage of Flecainide may be gradually increased every 4 days as needed, with most patients responding to 200-300 mg daily divided into two doses. Patients with severe renal impairment or reduced cardiac function may require lower doses.
- Flecainide should be taken consistently at the same times each day with or without food.
- It's essential to take this medication exactly as prescribed and not to stop suddenly without medical supervision, as this could worsen arrhythmias.
- Regular monitoring of heart rhythm, ECG, and blood levels is necessary during treatment.
Mechanism of Action and Side Effects
Flecainide works by slowing electrical conduction in the heart, which helps restore normal rhythm by blocking sodium channels in cardiac cells.
- Common side effects include dizziness, visual disturbances, and nausea.
- This medication is contraindicated in patients with certain structural heart diseases or severe heart failure, so a thorough cardiac evaluation is required before starting treatment.
Precautions and Contraindications
Upon initiation of Flecainide therapy, regular ECG monitoring is recommended to assess for potential proarrhythmic effects, and precautions should be observed when using Flecainide in the presence of intraventricular conduction delay, particularly left bundle branch block 1.
- Concomitant atrioventricular node blockade is recommended because of the potential of Flecainide to convert AF to atrial flutter, which then may be conducted rapidly to the ventricles.
- Flecainide should not be used in patients with coronary artery disease or in those with reduced LVEF.
From the FDA Drug Label
For patients with PSVT and patients with PAF the recommended starting dose is 50 mg every 12 hours. Flecainide doses may be increased in increments of 50 mg bid every four days until efficacy is achieved For PAF patients, a substantial increase in efficacy without a substantial increase in discontinuations for adverse experiences may be achieved by increasing the flecainide dose from 50 mg to 100 mg bid. The maximum recommended dose for patients with paroxysmal supraventricular arrhythmias is 300 mg/day.
The recommended dosage and usage of Flecainide for treating irregular heartbeat is as follows:
- Starting dose: 50 mg every 12 hours for patients with PSVT and PAF
- Dose increments: 50 mg bid every four days until efficacy is achieved
- Maximum dose: 300 mg/day for patients with paroxysmal supraventricular arrhythmias
- Dose adjustment: May be increased to 100 mg bid for PAF patients to achieve substantial increase in efficacy 2
From the Research
Recommended Dosage and Usage of Flecainide
- The initial flecainide dose is 100 mg twice daily, which can be increased by 50 mg twice daily every 4 days to a maximum of 200 mg twice daily 3.
- Flecainide has been shown to be effective in treating supraventricular arrhythmias, including atrial tachycardias, atrial-ventricular tachycardias, paroxysmal atrial fibrillation/flutter, and chronic atrial fibrillation 3, 4.
- The efficacy of flecainide is highest for patients with paroxysmal supraventricular tachycardia (PSVT) and lowest for patients with chronic atrial fibrillation (CAF) 3.
- Flecainide is recommended as a first-line therapy for pharmacological conversion and maintenance of sinus rhythm in patients with atrial fibrillation and/or supraventricular tachycardias, but not in patients with structural heart disease due to high proarrhythmic risk 5, 6.
Safety and Efficacy
- Flecainide has been shown to be safe and effective in treating patients with supraventricular arrhythmias, with a low incidence of cardiac adverse experiences 3, 4.
- Noncardiac adverse experiences, such as abnormal vision, dizziness, and headaches, are common but usually mild and transient 3, 4.
- The risk of proarrhythmic events is higher in patients with structural heart disease, and flecainide should be used with caution in these patients 3, 6.
Clinical Use
- Flecainide is mostly used for sinus rhythm maintenance in atrial fibrillation patients without structural cardiomyopathy 7.
- Recent studies have demonstrated a good effectiveness and safety profile of flecainide in different patient populations, suggesting a potential expansion of its indications 7.
- Flecainide can be used in combination with non-pharmacological therapies, such as transcatheter ablation, for the treatment of symptomatic drug-refractory patients with supraventricular arrhythmias 7.