Flecainide Acetate: Brands, Price & Uses in Bangladesh

Flecainide Acetate is a Class IC antiarrhythmic medicine used to prevent certain abnormal fast heart rhythms. Its use is classified below by strength of evidence.

Established / FDA-approved uses

• Prevention of paroxysmal supraventricular tachycardia (PSVT) associated with disabling symptoms in patients without structural heart disease, including AV-nodal re-entrant tachycardia and AV re-entrant tachycardia (e.g., via an accessory pathway).
• Prevention of paroxysmal atrial fibrillation/atrial flutter (PAF) associated with disabling symptoms in patients without structural heart disease.
• Prevention of documented, life-threatening sustained ventricular arrhythmias (e.g., sustained ventricular tachycardia). Because of an increased risk of proarrhythmia and death shown in patients with structural heart disease, Flecainide Acetate for ventricular arrhythmias is reserved for patients with these severe, life-threatening rhythm disturbances, generally after other options have been considered.

Off-label / specialist uses

• Used by cardiac electrophysiologists as part of the diagnostic "flecainide challenge" test for suspected Brugada syndrome.
• Used as an adjunct, in combination with beta-blockers, in selected patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) who remain symptomatic despite beta-blocker therapy.
• Used in a supervised, physician-directed "pill-in-the-pocket" strategy for termination of infrequent, symptomatic paroxysmal atrial fibrillation in selected patients without structural heart disease (typically combined with an AV-nodal blocking agent).

These off-label uses should only be undertaken under the direct supervision of a cardiologist experienced with Flecainide Acetate therapy.

Dosing of Flecainide Acetate must be individualized by a physician, generally starting at the lower end of the range with gradual titration, and often initiated in a monitored/hospital setting for patients with sustained ventricular arrhythmias or underlying heart disease.

Renal impairment

In patients with significant renal impairment (creatinine clearance ≤ 35 mL/min/1.73 m²), initiate at a lower dose (e.g., 100 mg once daily or 50 mg twice daily) with close clinical, ECG, and, where available, plasma-level monitoring, because clearance of Flecainide Acetate is reduced.

Hepatic impairment

Use with caution and at a reduced starting dose in significant hepatic impairment, with close monitoring of plasma levels where available, as metabolism may be significantly slowed.

See Precautions and Warnings for monitoring requirements and Contraindications for patients in whom Flecainide Acetate must not be used.

Side effects of Flecainide Acetate range from common and mild to rare but serious.

Common

• Dizziness or light-headedness
• Visual disturbances (blurred vision, spots before the eyes)
• Shortness of breath (dyspnea)
• Headache
• Nausea
• Fatigue or tiredness
• Tremor
• Palpitations

Serious (seek prompt medical attention)

• New or worsened abnormal heart rhythms (proarrhythmia), including fast or slow rhythms
• Worsening heart failure (swelling of legs/ankles, worsening shortness of breath)
• Heart block or marked slowing of the heart rate
• Fainting (syncope)