Drug Name
Generic Name : flecainide acetate
Brand Name: Tambocor
Classification: Antiarrhythmic
Pregnancy Category C
Dosage & Route
Available forms :Tablets—50, 100, 150 mg
Dosages : Evaluation with close monitoring of cardiac response necessary for determining the correct dosage.
ADULTS
- PSVT and PAF: Starting dose of 50 mg q 12 hr PO; may be increased in increments of 50 mg bid q 4 days until efficacy is achieved; maximum dose is 300 mg/day.
- Sustained ventricular tachycardia: 100 mg q 12 hr PO. Increase in 50-mg increments twice a day every fourth day until efficacy is achieved. Maximum dose is 400 mg/day.
- CHF: Initial dose of no more than 100 mg q 12 hr PO. May increase in 50-mg increments bid every fourth day to a maximum of 200 mg/day; higher doses associated with increased CHF.
- Transfer to flecainide: Allow at least 2–4 plasma half-lives to elapse after other antiarrhythmic drugs discontinued before starting flecainide. Consider hospitalization since withdrawal of a previous antiarrhythmic is likely to produce life-threatening arrhythmias.
PEDIATRIC PATIENTS
- Safety and efficacy in patients < 18 yr have not been established.
GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT
- Initial dose, 100 mg daily PO or 50 mg q 12 hr. Wait about 4 days to reach a steady state, then increase dose cautiously. For creatinine clearance < 20 mL/min, decrease dose by 25%–50%.
Therapeutic actions
- Flecainide markedly slows the rate of change of the depolarisation phase of the action potential, has little effect on the repolarisation phase and markedly prolongs the PR and QRS intervals. It also has local anesth properties.
Indications
- Prevention and treatment of life-threatening ventricular arrhythmias, such as sustained ventricular tachycardia (not recommended for less severe ventricular arrhythmias)
- Prevention of paroxysmal atrial fibrillation or flutter (PAF) associated with symptoms and paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal and atrioventricular reentrant tachycardia; other supraventricular tachycardias of unspecified mechanism with disabling symptoms in patients without structural heart disease
Adverse effects
- Dizziness, visual disturbances, lightheadedness and other CNS effects, nausea, vomiting, headache, tremor, peripheral neuropathy, corneal deposits, blurred vision or seeing spots, pulmonary fibrosis, pneumonitis, chest pain, ataxia, skin reactions; liver function disturbances.
- Potentially Fatal: Ventricular or supraventricular arrhythmias, congestive heart failure, 2nd or 3rd ° AV block, sinus bradycardia, sinus pause, sinus arrest.
Contraindications
- Preexisting 2nd or 3rd AV block without pacemaker. Right bundle branch block associated with a left hemiblock without pacemaker. Recent MI, cardiogenic shock.
Nursing considerations
Assessment
- History: Allergy to flecainide, CHF, MI, cardiogenic shock, cardiac conduction abnormalities, sick sinus syndrome, endocardial pacemaker, hepatic or renal disease, potassium imbalance, lactation, pregnancy
- Physical: Weight; orientation, reflexes, vision; P, BP, auscultation, ECG, edema, R, adventitious sounds; bowel sounds, liver evaluation; urinalysis, CBC, serum electrolytes, LFTs, renal function tests
Interventions
- BLACK BOX WARNING: In patients with recent MI, treatment increases risk of nonfatal cardiac arrest and death.
- Monitor patient response carefully, especially when beginning therapy.
- Reduce dosage in patients with renal disease or hepatic failure.
- Check serum K+ levels before giving.
- BLACK BOX WARNING: Monitor cardiac rhythm carefully; risk of potentially fatal proarrhythmias.
- WARNING: Evaluate for therapeutic serum levels of 0.2–1 mcg/mL.
- WARNING:Keep life support equipment, including pacemaker, readily available in case serious CVS, CNS effects occur—also keep dopamine, dobutamine, isoproterenol, or other positive inotropics nearby.
Teaching points
- You will need frequent monitoring of cardiac rhythm.
- Do not stop taking this drug for any reason without checking with your health care provider. Drug is taken at 12-hour intervals; work out a schedule so you take the drug as prescribed without waking up at night.
- Return for regular follow-up visits to check your heart rhythm and have a blood test to check your blood levels of this drug.
- You may experience these side effects: Drowsiness, dizziness, numbness, visual disturbances (avoid driving or using dangerous machinery); nausea, vomiting (frequent small meals may help); diarrhea, polyuria; sweating, night sweats, hot flashes, loss of libido (reversible after stopping the drug); palpitations.
- Report swelling of ankles or fingers, palpitations, fainting, chest pain.