FLECAINIDE ACETATE (TAMBOCOR)

FLECAINIDE ACETATE (TAMBOCOR)

CLASSIFICATION

� Class 1 antiarrhythmic

MODE OF ACTION

Main action is to inhibit the fast sodium channel responsible for the rapid upstroke of myocardial action potential in cardiac conducting tissue. Flecainide depresses conduction in all parts of the heart with its greatest effect on his Purkinje system. It also has some mild negative effects Peak plasma levels 3 hours after oral dose. Plasma half life 20 hours.

INDICATIONS

� SVT Due to pre excitation syndrome.

� Due to A V nodal pathways.

� Paroxysmal AF /flutter

 � Life threatening ventricular arrhythmias not controlled by other drugs.

CONTRA INDICATIONS

� Cardiogenic shock

 � Second or third degree AV block unless a pacemaker is insitu

� R.B.B.B. with left anterior hemiblock

� Asymptomatic ventricular ectopics or non sustained V.T in patients with a history of myocardial infarction.

� Known hypersensitivity to the drug

 � Patients with severe renal or hepatic impairment

� Digitalis toxicity

� Left ventricular dysfunction

� Ischaemic heart disease.

NURSING CONSIDERATIONS

� Correct k abnormalities before using drug

� Due to Flecainide increasing pacing threshold and may suppress ventricular escape rhythms. This should be precent a permanent pacemaker from gaining capture.

 � Add Flecainide to 5 % Dextrose as normal saline can cause precipitation.

� Change flask every 24 hours.

ADVERSE REACTIONS

� New or exacerbated S.V.T ventricular arrhythmias

� New or exacerbated C.C.F

� Unresuscitatable V.F/V.T

 � First/second/third degree heart block

 � Sinus brady, sinus pause and sinus arrest.

 � Increase in P.R interval and Q R S duration ( up to 25 % ) and Q.T interval (up to 8 %).

 � Dizziness, visual disturbances, headache, nausea, dyspnoea.

� Palpitations, chest pain and fatigue.

DRUG INTERACTION

� Levels of Digoxin increase 15 %

� Levels of propranolol increase 30 % with administration

� Avoid using g negative Inotrope such as beta blockers.

PRESENTATION

150 mg per 15 ml ampoule. 50 mg and 100 mg tablet.

DOSAGE AND ADMINISTRATION

I.V LOADING

2 mg /kg diluted in 5 % Dextrose over 15 minutes (50 mls of 5 % Dextrose)

INFUSION

Add 300 mg Flecainide to 500 ml 5 % Dextrose (= 0.6 mg/ml) infuse at 0.25 mg/kg/hr.

ie flask volume x 0.25 x patients weight = mls/hr flask mg drug

Titrate dosage to individual needs based on therapeutic response and tolerance.

TRANSFER TO ORAL

Transfer to oral by administering initial oral dose of 100 g tablet, then wean infusion over 4 hours by hourly increments of 20 % give the second oral dose of 100 mg 12 hours after first oral dose.

ORAL MAINTENACE

Usual maintenance dose is 100 mg B.D if necessary the dosage maybe increased in increments of 50 mg B.D every 4 days until efficacy is achieved or to a maximum of 300 mg B.D.