FlecainideFlecainide Acetate

About Flecainide

Flecainide blocks the sodium channels that carry the electrical impulse through heart muscle, slowing conduction so that abnormal circuits cannot keep a fast rhythm going. Its label covers paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation or flutter with disabling symptoms in people without structural heart disease, and documented, life-threatening sustained ventricular tachycardia; it is not for milder ventricular rhythm problems. Treatment for sustained ventricular tachycardia is started in hospital.

The boxed warning comes from the Cardiac Arrhythmia Suppression Trial, in which people who had survived a heart attack and were given flecainide for extra beats that were not life-threatening died or had cardiac arrest more often than those on placebo. The warning restricts it to life-threatening ventricular arrhythmias, keeps it away from people with structural heart disease, notes that in atrial fibrillation or flutter it can set off dangerous ventricular rhythms, and says it is not recommended for chronic atrial fibrillation. Like other antiarrhythmics it can cause new or worse rhythm disturbances, it can bring on or worsen heart failure, it can slow the heart dangerously in sick sinus syndrome, and it raises the energy a pacemaker needs. It is not used with second or third degree heart block or in cardiogenic shock.

Dizziness and visual disturbance such as blurring or spots are the most common side effects, followed by breathlessness, headache and nausea. Potassium is corrected before starting. The dose usually begins at 50 mg every 12 hours for atrial rhythms or 100 mg every 12 hours for ventricular tachycardia and is raised no more often than every four days, with an ECG to watch for widening of the PR and QRS intervals; blood levels are measured when kidney failure, liver disease, heart failure or amiodarone could push them too high.

Taking Flecainide

How to take it

Usually every 12 hours, at the same times each day, with or without food. Do not stop it or change the dose without talking to your prescriber.

If you miss a dose

Take it as soon as you remember, unless it is nearly time for the next dose; in that case skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in a tightly closed, light-resistant container, away from heat and moisture, out of reach of children.

Interactions to know about

Amiodarone roughly doubles flecainide levels, so the flecainide dose is halved. Digoxin, propranolol, cimetidine and quinidine raise its levels; verapamil, diltiazem and disopyramide are not recommended with it, and beta blockers add to its weakening effect on the heart. Carbamazepine, phenytoin and phenobarbital speed its removal, and very alkaline urine, as on a strict vegetarian diet, slows it.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Flecainide differs from pharmacy to pharmacy

Generic flecainide has many makers and costs pharmacies little, so the quote is mostly the dispensing fee and markup, which vary widely. Doses change in the early weeks, so a patient may fill more than one strength before settling, and a pharmacy that charges per tablet quotes more than one with a flat generic price. Not every pharmacy keeps all three strengths, and one that must order a strength in may price it as a slow-moving item.

Ways to pay less for Flecainide without insurance

• Ask whether flecainide is on the pharmacy’s flat-price generic list.
• Ask the prescriber whether your dose can be written as one tablet strength rather than a combination, and for a ninety-day prescription once the dose and ECG are stable.
• Call ahead to check that your strength is in stock so you never run out.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Flecainide

1. 1.Does it interact with my other heart medicines, such as amiodarone, digoxin, a beta blocker, verapamil or diltiazem?
2. 2.Which over-the-counter medicines, including cimetidine, should I avoid?
3. 3.What symptoms of a new rhythm problem or heart failure mean I should get help?
4. 4.When are my ECG and blood level checks due?

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