Can Flecainide Tablets Be Split?
Yes, flecainide tablets can be split—the 100 mg and 150 mg strengths are specifically manufactured with score lines to facilitate tablet splitting. 1
FDA-Approved Tablet Formulations
The FDA-approved flecainide tablets are designed with the following features: 1
- 50 mg tablets: Plain on one side (no score line)
- 100 mg tablets: Scored on one side to allow splitting
- 150 mg tablets: Scored on one side to allow splitting
The presence of score lines on the 100 mg and 150 mg formulations indicates manufacturer intent for these tablets to be divisible when clinically appropriate.
Clinical Context for Splitting
Flecainide dosing requires careful titration starting at 50 mg twice daily and increasing by 50 mg increments every 4 days up to a maximum of 150 mg twice daily. 2 The scored 100 mg tablets allow patients to achieve the 50 mg dose by splitting, which is the recommended starting dose for atrial fibrillation. 2
Important Caveats About Tablet Splitting
While the tablets are designed to be split, several practical considerations apply:
- Dose uniformity concerns: Research demonstrates that even scored tablets may not split into perfectly equal halves, with many commonly split medications failing uniformity testing. 3
- Patient capability: Not all patients possess the manual dexterity or cognitive ability to split tablets accurately, particularly elderly patients. 4
- Narrow therapeutic window: Flecainide has significant proarrhythmic potential and requires precise dosing with careful ECG monitoring for QRS widening ≥25% from baseline. 5 This narrow margin of safety makes dose precision more critical than with medications that have wider therapeutic windows.
Practical Recommendations
When prescribing split flecainide tablets:
- Use a tablet splitting device rather than hand-splitting to improve dose uniformity 3
- Assess the patient's physical ability and willingness to split tablets accurately 4
- Consider prescribing the exact strength needed (50 mg tablets) rather than requiring patients to split 100 mg tablets, especially for long-term maintenance therapy
- Ensure patients understand proper splitting technique if this approach is necessary 4
The scored design permits splitting when clinically indicated, but the preference should be to prescribe the appropriate tablet strength whenever possible to avoid dose variability concerns with this narrow therapeutic index medication.