Flecainide

Class Ic·Cardiovascular - Antiarrhythmics

Prevention and termination of paroxysmal AF, SVT, and life-threatening VT

PBSANTIARRHYTHMICTambocor, Flecatab50 mg tabletS4+1

Max Dose

300 mg/day

Half-life

12–27 h

Arrhythmia

PROARRHYTHMIC

Renal Adj.

DOSE RED.

Rapid Summary

Overview

Potent sodium-channel blocker used for rhythm control. Excellent for structurally normal hearts, but lethal if structural heart disease is present.

Maximum Dose

Max 300 mg/day (given in divided doses).

Clinical Focus

Never prescribe to a patient with a history of MI, ischaemic heart disease, or heart failure (CAST trial demonstrated increased mortality).

Bottom Line

Flecainide is highly effective for pharmacological cardioversion of AF in structurally normal hearts, but is absolutely contraindicated in structural heart disease due to pro-arrhythmic risk.

Formulation & Access

Brand Names

Tambocor, Flecatab

Oral Routes

Tablets (50 mg, 100 mg). CR Capsules (200 mg).

Parenteral

Ampoule (150 mg/15 mL) for IV use.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Prevention and termination of paroxysmal AF, SVT, and life-threatening VT.

Clinical Place

First-line rhythm control agent for young, healthy patients without structural heart disease.

Quick reference

Class & Role

Class Ic — Potent sodium-channel blocker used for rhythm control.

Route / Formulation

Tablets (50 mg, 100 mg). CR Capsules (200 mg). (Tambocor, Flecatab)

Usual Dose & Max

Start PO 50 mg BD. Titrate slowly to Max 150 mg BD (300 mg/day).

Key Indication Doses

AF Rhythm Control: Start PO 50 mg BD. Titrate slowly to Max 150 mg BD (300 mg/day). Pill-in-the-Pocket (AF): PO 200-300 mg as a single STAT dose to terminate acute AF (Requires prior safety testing in hospital). Renal Impairment: Reduce dose to max 100 mg/day if eGFR < 35.

Best Uses

Flecainide is highly effective for pharmacological cardioversion of AF in structurally normal hearts, but is absolutely contraindicated in structural heart disease due to pro-arrhythmic risk.

Avoid / Cautions

Structural heart disease (previous MI, HFrEF, LVH), 2nd/3rd degree AV block, bundle branch blocks. Pregnancy Category B2.

Key Risks

Cardiovascular: Highly proarrhythmic (can cause fatal VT/VF), broadens QRS complex, negative inotrope (worsens HF). Neurological: Dizziness, visual disturbances (blurring), tremor, metallic taste.

Key Interactions

Beta-blockers/CCBs (additive negative inotropy and bradycardia). CYP2D6 inhibitors (fluoxetine, amiodarone) significantly increase flecainide levels.

Monitoring

Baseline and follow up ECG. QRS broadening > 25% requires immediate dose reduction or cessation. Routine U&E and eGFR. Measure TDM (Flecainide levels) in renal failure.

Clinical Pearl

Flecainide can organize AF into Atrial Flutter. Because it slows atrial rates, the AV node might suddenly conduct every beat (1:1 conduction), causing the ventricular rate to jump to 200+ bpm. Always co-prescribe an AV nodal blocker (like Metoprolol) to prevent this.

Access

Tambocor, Flecatab50 mg tablet

Brand: Tambocor, Flecatab
Formulation: Tablets (50 mg, 100 mg)

Flecainide

Class Ic·Cardiovascular - Antiarrhythmics

Prevention and termination of paroxysmal AF, SVT, and life-threatening VT

PBSANTIARRHYTHMICTambocor, Flecatab50 mg tabletS4+1

Max Dose

300 mg/day

Half-life

12–27 h

Arrhythmia

PROARRHYTHMIC

Renal Adj.

DOSE RED.

Rapid Summary

Overview

Potent sodium-channel blocker used for rhythm control. Excellent for structurally normal hearts, but lethal if structural heart disease is present.

Maximum Dose

Max 300 mg/day (given in divided doses).

Clinical Focus

Never prescribe to a patient with a history of MI, ischaemic heart disease, or heart failure (CAST trial demonstrated increased mortality).

Bottom Line

Flecainide is highly effective for pharmacological cardioversion of AF in structurally normal hearts, but is absolutely contraindicated in structural heart disease due to pro-arrhythmic risk.

Formulation & Access

Brand Names

Tambocor, Flecatab

Oral Routes

Tablets (50 mg, 100 mg). CR Capsules (200 mg).

Parenteral

Ampoule (150 mg/15 mL) for IV use.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Prevention and termination of paroxysmal AF, SVT, and life-threatening VT.

Clinical Place

First-line rhythm control agent for young, healthy patients without structural heart disease.

Quick reference

Class & Role

Class Ic — Potent sodium-channel blocker used for rhythm control.

Route / Formulation

Tablets (50 mg, 100 mg). CR Capsules (200 mg). (Tambocor, Flecatab)

Usual Dose & Max

Start PO 50 mg BD. Titrate slowly to Max 150 mg BD (300 mg/day).

Key Indication Doses

Best Uses

Flecainide is highly effective for pharmacological cardioversion of AF in structurally normal hearts, but is absolutely contraindicated in structural heart disease due to pro-arrhythmic risk.

Avoid / Cautions

Structural heart disease (previous MI, HFrEF, LVH), 2nd/3rd degree AV block, bundle branch blocks. Pregnancy Category B2.

Key Risks

Cardiovascular: Highly proarrhythmic (can cause fatal VT/VF), broadens QRS complex, negative inotrope (worsens HF). Neurological: Dizziness, visual disturbances (blurring), tremor, metallic taste.

Key Interactions

Beta-blockers/CCBs (additive negative inotropy and bradycardia). CYP2D6 inhibitors (fluoxetine, amiodarone) significantly increase flecainide levels.

Monitoring

Baseline and follow up ECG. QRS broadening > 25% requires immediate dose reduction or cessation. Routine U&E and eGFR. Measure TDM (Flecainide levels) in renal failure.

Clinical Pearl

Access

Tambocor, Flecatab50 mg tablet

Brand: Tambocor, Flecatab
Formulation: Tablets (50 mg, 100 mg)