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  • use of flecainide in patients with structural heart disease, and particularly those with ejection fraction < 40% has been associated with life threatening and occasionally fatal ventricular arrhythmias.
  • thus flecainide should be avoided unless there is echocardiographic evidence of absence of structural heart disease or severe LVF
  • not recommended for Mx of chronic atrial fibrillation as it increases the risk of fatal ventricular arrhythmias
  • not recommended for patients with sick sinus syndrome as risk of sinus bradycardia, sinus pause or sinus arrest requiring pacemaker intervention
  • not recommended for use in digoxin toxicity
  • not recommended in patients with pacemakers as it may increase endocardial pacing thresholds
  • correct any electrolyte disturbances prior to use
  • should not be used during pregnancy unless as a drug of last resort in life threatening arrhythmias
  • flecainide has a mild negative inotropic effect
  • intravenous flecainide should only be used in a resuscitation facility with cardiac monitoring and availability of defibrillation (and preferabbly external pacing)


  • flecainide belongs to the membrane stabilising (class I) group of anti-arrhythmic agents
  • it depresses conduction in all parts of the heart with the greatest effect on the His-Purkinje system
  • does not usually alter heart rate
  • may prolong the PR interval, QRS duration and the QTc
  • flecainide has a long plasma half life of 12-27hrs after multiple oral doses

potential indications for iv flecainide

contra-indications for iv flecainide

  • structural heart disease
  • ejection fraction < 40%
  • sick sinus syndrome
  • 2nd or 3rd degree AV block unless a pacemaker is present
  • cardiogenic shock
  • known HS to flecainide
  • severe renal or liver impairment

iv dosing

  • usual adult dose for emergent situations in resuscitation facilities:
    • slow injection of 2 mg/kg over not less than ten minutes (can be diluted in 5% glucose)
    • NOT compatible with chloride (ie. saline solutions!!)
flecainide.txt · Last modified: 2012/09/18 08:53 by

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