Flecainide-Induced Tremor

Evidence and Management

The American College of Cardiology, American Heart Association, and Heart Rhythm Society recommend considering tremor as a known adverse effect of flecainide in the management of patients with ventricular arrhythmias 1
Alternative antiarrhythmic options, including beta-blockers, calcium channel blockers, propafenone, amiodarone, or sotalol, may be considered when discontinuing flecainide due to tremor 2

Flecainide should not be used in patients with structural heart disease, reduced left ventricular ejection fraction, or significant coronary artery disease due to increased risk of serious cardiac adverse effects 1, 3
Regular monitoring of ECG is recommended during flecainide therapy to detect potential cardiac conduction abnormalities 3
Drug interactions that increase flecainide levels may potentially increase the risk of adverse effects including tremor 2