Flecainide-Associated Risks and Considerations

Cardiac Risks

Atrial flutter with 1:1 AV conduction can develop, potentially leading to dangerously rapid ventricular rates, according to the American Heart Association, as reported in Circulation 1
QRS complex widening and PR interval prolongation are expected pharmacologic effects, as noted in Circulation 1
Flecainide is absolutely contraindicated in patients with structural heart disease, reduced left ventricular function, or history of myocardial infarction due to increased risk of serious cardiac adverse effects, as stated in Circulation 1
The American College of Cardiology recommends avoiding flecainide in Brugada syndrome due to risk of idiopathic ventricular fibrillation, as reported in Circulation 1

Flecainide levels are increased by amiodarone, digoxin, ritonavir, saquinavir, and tipranavir, as noted in Circulation 1
Regular ECG monitoring is essential during therapy to detect cardiac conduction abnormalities, as recommended by the American Heart Association, and reported in Praxis Medical Insights: Practical Summaries of Clinical Guidelines 2
Baseline ECG should be obtained prior to initiating therapy, and serum electrolyte levels should be monitored and maintained within normal ranges, as recommended by Praxis Medical Insights: Practical Summaries of Clinical Guidelines 4

Dose adjustment is needed in hepatic dysfunction, as noted in Circulation 1
Baseline and regular monitoring of liver function tests is recommended, particularly in patients with pre-existing liver disease, as stated in Praxis Medical Insights: Practical Summaries of Clinical Guidelines 3