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 treatment protocol for Tambocor (flecainide) in managing irregular heartbeat is to start with a dose of 50 mg every 12 hours and increase as needed in increments of 50 mg bid every four days until efficacy is achieved, with a maximum recommended dose of 300 mg/day for patients with paroxysmal supraventricular arrhythmias 1.
- The dose may be increased to 100 mg bid for PAF patients to achieve a substantial increase in efficacy.
- Frequent plasma level monitoring is required to guide dosage adjustments, especially in patients with severe renal impairment.
- Caution should be used when increasing the dose, as higher doses may increase the risk of proarrhythmic events and CHF.
From the Research
Flecainide (Tambocor) treatment for irregular heartbeat should be initiated with 50-100 mg taken orally twice daily, with gradual increases if needed to a maximum of 400 mg daily, as supported by the most recent study 2. The dosage should be individualized based on the specific arrhythmia being treated, patient response, and cardiac function.
- For atrial fibrillation, a common starting dose is 50 mg twice daily, while ventricular arrhythmias may require 100 mg twice daily initially.
- Patients with renal impairment or elderly patients often need lower doses. ECG monitoring is essential during initiation and dose adjustments to assess QRS duration, which should not increase by more than 20-25% 3. Flecainide works as a Class IC antiarrhythmic by blocking sodium channels, slowing conduction in cardiac tissue. It should not be used in patients with structural heart disease, heart failure, or recent myocardial infarction due to increased risk of proarrhythmic effects 4. Common side effects include dizziness, visual disturbances, and nausea, but recent data suggest that flecainide is well-tolerated and effective in patients with atrial fibrillation at 12 months 2. Regular follow-up with a cardiologist is necessary to monitor effectiveness and adjust treatment as needed. Key considerations for the use of flecainide include its efficacy in maintaining symptomatic control, with 61.8% of patients remaining symptom-free at 12 months 2, and its favorable safety profile in patients without significant left ventricular disease or coronary heart disease 5.