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Flecainide Disease Interactions

There are 6 disease interactions with flecainide.

Major

Antiarrhythmics (applies to flecainide) cardiovascular dysfunction

Major Potential Hazard, Low plausibility. Applicable conditions: Hypotension, Congestive Heart Failure

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

References

  1. Halkin H, Meffin P, Melmon KL, Rowland M "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther 17 (1975): 669-76
  2. Crouthamel WG "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J 90 (1975): 335-9
  3. Ravid S, Podrid PJ, Lampert S, Lown B "Congestive heart failure induced by six of the newer antiarrhythmic drugs." J Am Coll Cardiol 14 (1989): 1326-30
  4. Swiryn S, Kim SS "Quinidine-induced syncope." Arch Intern Med 143 (1983): 314-6
  5. Gottlieb SS, Packer M "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J 118 (1989): 611-2
  6. Ochs HR, Grube E, Greenblatt DJ, Arendt R "Intravenous quinidine in congestive cardiomyopathy." Eur J Clin Pharmacol 19 (1981): 173-6
  7. Prescott LF, Adjepon-Yamoah KK, Talbot RG "Impaired lignocaine metabolism in patients with myocardial infarction and cardiac failure." Br Med J 1 (1976): 939-41
  8. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
  9. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
  10. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
  11. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
  12. "Product Information. Adenocard (adenosine)." Fujisawa (2001):
  13. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
  14. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
  15. Singh SN, Fletcher RD, Fisher SG, et al. "Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia." N Engl J Med 333 (1995): 77-82
  16. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
  17. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):
View all 17 references
Major

Antiarrhythmics (applies to flecainide) proarrhythmic effects

Major Potential Hazard, High plausibility. Applicable conditions: Arrhythmias, Abnormal Electrocardiogram

Antiarrhythmic agents can induce or worsen ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation, and torsades de pointes have occurred in some patients. Patients with underlying cardiac dysfunction, bradycardia, hypokalemia, hypomagnesemia, or high antiarrhythmic serum concentrations are at increased risk for drug-induced arrhythmias. Therapy with antiarrhythmics should be used with extreme caution in patients with or predisposed to arrhythmias. Evidence of improved survival is lacking for use of antiarrhythmic therapy in asymptomatic, non-life-threatening arrhythmias. Therapy with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias.

References

  1. Anderson JL, Popat KD "Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy." Arch Intern Med 141 (1981): 801-2
  2. Sclarovsky S, Lewin RF, Kracoff O, Strasberg B, Arditti A, Agmon J "Amiodarone-induced polymorphous ventricular tachycardia." Am Heart J 105 (1983): 6-12
  3. Strasberg B, Sclarovsky S, Erdberg A, et al. "Procainamide-induced polymorphous ventricular tachycardia." Am J Cardiol 47 (1981): 1309-14
  4. Stratmann H, Walter K, Kennedy H "Torsade de pointes associated with elevated N-acetylprocainamide levels." Am Heart J 109 (1985): 375-6
  5. Lo KS, Gantz KB, Stetson PL, et al. "Disopyramide-induced ventricular tachycardia." Arch Intern Med 140 (1980): 413-4
  6. Kinney EL, Field EH, Salmon MP, Zelis R "Cardiac arrhythmias associated with disopyramide." N Engl J Med May (1990): 1146
  7. Chia BL "Disopyramide induced atypical ventricular tachycardia." Aust N Z J Med 10 (1980): 665-8
  8. Tzivoni D, Keren A, Stern S, Gottlieb S "Disopyramide-induced Torsade de pointes." Arch Intern Med 141 (1981): 946-7
  9. Schweitzer P, Mark H "Torsade de pointes caused by disopyramide and hypokalemia." Mt Sinai J Med 49 (1982): 110-4
  10. Riccioni N, Castiglioni M, Bartolomei C "Disopyramide-induced QT prolongation and ventricular tachyarrhythmias." Am Heart J 105 (1983): 870-1
  11. Andrivet P, Beaslay V, Canh VD "Torsades de pointe with flecainide-amiodarone therapy." Intensive Care Med 16 (1990): 342-3
  12. Cocco G, Strozzi C, Chu D, Pansini R "Torsades de pointes as a manifestation of mexiletine toxicity." Am Heart J 100 (1980): 878-80
  13. Nora MO, Chandrasekaran K, Hammill SC, Reeder GS "Prolongation of ventricular depolarization: ECG manifestation of mexiletine toxicity." Chest 95 (1989): 925-8
  14. Morganroth J, Pratt CM "Prevalence and characteristics of proarrhythmia from moricizine (themozine)." Am J Cardiol 63 (1989): 172-6
  15. Damle R, Levine J, Matos J, et al. "Efficacy and risks of moricizine in inducible sustained ventricular tachycardia." Ann Intern Med 116 (1992): 375-81
  16. Nathan AW, Hellestrand KJ, Bexton RS, Camm AJ "Fatal ventricular tachycardia in association with propafenone, a new class IC antiarrhythmic agent." Postgrad Med J 60 (1984): 155-6
  17. Stavens CS, McGovern B, Garan H, Ruskin JN "Aggravation of electrically provoked ventricular tachycardia during treatment with propafenone." Am Heart J 110 (1985): 24-9
  18. Hii JT, Wyse DG, Gillis AM, et al. "Propafenone-induced torsade de pointes: cross-reactivity with quinidine." Pacing Clin Electrophysiol 14 (1991): 1568-70
  19. Cheesman M, Ward DE "Exacerbation of ventricular tachycardia by tocainide." Clin Cardiol 8 (1985): 47-50
  20. Bauman JL, Bauernfeind RA, Hoff JV, et al. "Torsade de pointes due to quinidine: observations in 31 patients." Am Heart J 107 (1984): 425-30
  21. Koenig W, Schinz AM "Spontaneous ventricular flutter and fibrillation during quinidine medication." Am Heart J 105 (1983): 863-5
  22. Morganroth J, Horowitz LN "Incidence of proarrhythmic effects from quinidine in the outpatient treatment of benign or potentially lethal ventricular arrhythmias." Am J Cardiol 56 (1985): 585-7
  23. Au PK, Bhandari AK, Bream R, et al. "Proarrhythmic effects of antiarrhythmic drugs during programmed ventricular stimulation in patients without ventricular tachycardia." J Am Coll Cardiol 9 (1987): 389-97
  24. Engler RL, LeWinter M "Tocainide-induced ventricular fibrillation." Am Heart J 101 (1981): 494-6
  25. Wesley RC Jr, Turnquest P "Torsades de pointe after intravenous adenosine in the presence of prolonged QT syndrome." Am Heart J 123 (1992): 794-6
  26. Orebaugh SL, Handy M "Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia." Am J Emerg Med 10 (1992): 326-30
  27. Reed R, Falk JL, O'Brien J "Untoward reaction to adenosine therapy for supraventricular tachycardia." Am J Emerg Med 9 (1991): 566-70
  28. Meurer MK "A 21-year-old woman with rapid atrial fibrillation after adenosine administration." J Emerg Nurs 17 (1991): 135-6
  29. Dougherty AH, Gilman JK, Wiggins S, Jalal S, Naccarelli GV "Provocation of atrioventricular reentry tachycardia: a paradoxical effect of adenosine." Pacing Clin Electrophysiol 16 (1993): 8-12
  30. "Product Information. Tonocard (tocainide)." Merck & Company Inc (2002):
  31. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals (2002):
  32. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
  33. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals (2002):
  34. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
  35. "Product Information. Procan SR (procainamide)." Parke-Davis (2001):
  36. "Product Information. Pronestyl (procainamide)." Apothecon Inc (2001):
  37. Raehl CL, Patel AK, LeRoy M "Drug-induced torsade de pointes." Clin Pharm 4 (1985): 675-90
  38. Buss J, Neuss H, Bilgin Y, Schlepper M "Malignant ventricular tachyarrhythmias in association with propafenone treatment." Eur Heart J 6 (1985): 424-8
  39. Sulke AN, Holt P, Sowton GE "Acceleration of conduction within an accessory pathway with propafenone." Int J Cardiol 28 (1990): 105-7
  40. "Product Information. Adenocard (adenosine)." Fujisawa (2001):
  41. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
  42. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
  43. "Product Information. Rythmol (propafenone)." Knoll Pharmaceutical Company
  44. Ben-Sorek ES, Wiesel J "Ventricular fibrillation following adenosine administration. A case report." Arch Intern Med 153 (1993): 2701-2
  45. Said SAM, Somer ST, Luttikhuis HAO "Flecainide-induced JT prolongation, t wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation." Int J Cardiol 44 (1994): 285-7
  46. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH "Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs." JAMA 270 (1993): 2590-7
  47. "Product Information. Norpace (disopyramide)." Searle (2001):
  48. Oberg KC, Otoole MF, Gallastegui JL, Bauman JL "''late'' proarrhythmia due to quinidine." Am J Cardiol 74 (1994): 192-4
  49. Romer M, Candinas R "Adenosine-induced non-sustained polymorphic ventricular tachycardia." Eur Heart J 15 (1994): 281-2
  50. Hohnloser SH, Klingenheben T, Singh BN "Amiodarone-associated proarrhythmic effects - a review with special reference to torsade de pointes tachycardia." Ann Intern Med 121 (1994): 529-35
  51. Celiker A, Tokel K, Cil E, Ozkutlu S, Ozme S "Adenosine induced torsades de pointes in a child with congenital long QT syndrome." Pacing Clin Electrophysiol 17 (1994): 1814-7
  52. Exner DV, Muzyka T, Gillis AM "Proarrhythmia in patients with the Wolff-Parkinson-White Syndrome after standard doses of intravenous adenosine." Ann Intern Med 122 (1995): 351-2
  53. Williamson BD, Hummel J, Niebauer M, Man C, Strickberger SA, Daoud E, Morady F "Bradycardia-facilitated polymorphic ventricular tachycardia caused by amiodarone after radiofrequency modification of atrioventricular conduction." Am Heart J 130 (1995): 399-401
  54. Dhein S, Schott M, Gottwald E, Klaus W "Electrocardiological profile and proarrhythmic effects of quinidine, verapamil and their combination: a mapping study." Naunyn Schmiedebergs Arch Pharmacol 352 (1995): 94-101
  55. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
  56. Hohnloser SH, Vandeloo A, Baedeker F "Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine." J Am Coll Cardiol 26 (1995): 852-8
  57. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):
  58. Silverman AJ, Machado C, Baga JJ, Meissner MD, Lehmann MH, Steinman RT "Adenosine-induced atrial fibrillation." Am J Emerg Med 14 (1996): 300-1
  59. Boriani G, Biffi M, Frabetti L, Azzolini U, Sabbatani P, Bronzetti G, Capucci A, Magnani B "Ventricular fibrillation after intravenous amiodarone in wolff-parkinson-white syndrome with atrial fibrillation." Am Heart J 131 (1996): 1214-6
  60. Faggiano P, Gardini A, Daloia A, Benedini G, Giordano A "Torsade de pointes occurring early during oral amiodarone treatment." Int J Cardiol 55 (1996): 205-8
  61. Heisler BE, Ferrier GR "Proarrhythmic actions of flecainide in an isolated tissue model of ischemia and reperfusion." J Pharmacol Exp Ther 279 (1996): 317-24
  62. Strickberger SA, Man KC, Daoud EG, et al. "Adenosine-induced atrial arrhythmia: a prospective analysis." Ann Intern Med 127 (1997): 417-22
View all 62 references
Major

Flecainide (applies to flecainide) sinus-AV node dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Heart Block

The use of flecainide is contraindicated in patients with cardiogenic shock, second- or third-degree AV block or right bundle-branch block when associated with a left hemiblock(bifascicular block) in the absence of a functional artificial pacemaker, or congenital QT prolongation. Therapy with flecainide should be administered with extreme caution in patients with sick sinus syndrome or bradycardia-tachycardia syndrome due to the risk of sinus bradycardia, pause or arrest.

References

  1. Forbes WP, Hee TT, Mohiuddin SM, Hillman DE "Flecainide-induced cardiogenic shock." Chest 94 (1988): 1121
  2. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
Moderate

Antiarrhythmics (applies to flecainide) electrolyte imbalance

Moderate Potential Hazard, High plausibility. Applicable conditions: Hyperkalemia, Hypokalemia, Magnesium Imbalance

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

References

  1. "Product Information. Tonocard (tocainide)." Merck & Company Inc (2002):
  2. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals (2002):
  3. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Xylocaine (lidocaine)." Astra-Zeneca Pharmaceuticals (2002):
  5. "Product Information. Procan SR (procainamide)." Parke-Davis (2001):
  6. "Product Information. Pronestyl (procainamide)." Apothecon Inc (2001):
  7. "Product Information. Quinidex Extentabs (quiNIDine)." Wyeth-Ayerst Laboratories
  8. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
  9. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim (2001):
  10. "Product Information. Rythmol (propafenone)." Knoll Pharmaceutical Company
  11. "Product Information. Norpace (disopyramide)." Searle (2001):
  12. "Product Information. Cordarone (amiodarone)." Apothecon Inc (2022):
  13. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn (2001):
View all 13 references
Moderate

Flecainide (applies to flecainide) hepatic dysfunction

Moderate Potential Hazard, High plausibility. Applicable conditions: Liver Disease

Since flecainide elimination from plasma can be markedly slower in patients with significant hepatic impairment, flecainide should not be used in such patients unless the potential benefits clearly outweigh the risks. If used, frequent and early plasma level monitoring is required to guide dosage. Additionally, dosage increases should be made very cautiously when plasma levels have plateaued (after more than four days).

References

  1. McQuinn RL, Pentikainen PJ, Chang SF, Conrad GJ "Pharmacokinetics of flecainide in patients with cirrhosis of the liver." Clin Pharmacol Ther 44 (1988): 566-72
  2. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
Moderate

Flecainide (applies to flecainide) renal dysfunction

Moderate Potential Hazard, High plausibility.

Flecainide is primarily eliminated by the kidney. Approximately 30% (10% to 50%) of flecainide is excreted in the urine unchanged. The serum concentration of flecainide is increased and the half-life prolonged in patients with renal impairment. Rare conditions such as a strict vegetarian diet or renal tubular acidosis that significantly increase the urinary pH slow the urinary elimination of flecainide. Adjustment of dosage is necessary and modification should be based on the degree of renal impairment. Clinical monitoring of cardiac function (ECG) and renal function is recommended.

References

  1. Williams AJ, McQuinn RL, Walls J "Pharmacokinetics of flecainide acetate in patients with severe renal impairment." Clin Pharmacol Ther 43 (1988): 449-55
  2. Hertrampf R, Gundert-Remy U, Beckmann J, et al. "Elimination of flecainide as a function of urinary flow rate and pH." Eur J Clin Pharmacol 41 (1991): 61-3
  3. Forland SC, Burgess E, Blair AD, et al. "Oral flecainide pharmacokinetics in patients with impaired renal function." J Clin Pharmacol 28 (1988): 259-67
  4. Braun J, Kollert JR, Becker JU "Pharmacokinetics of flecainide in patients with mild and moderate renal failure compared with patients with normal renal function." Eur J Clin Pharmacol 31 (1987): 711-4
  5. Borgeat A, Biollaz J, Freymond B, Bayer-Berger M, Chiolero R "Hemofiltration clearance of flecainide in a patient with acute renal failure." Intensive Care Med 14 (1988): 236-7
  6. Bailie GR, Waldek S "Pharmacokinetics of flecainide in a patient undergoing continuous ambulatory peritoneal dialysis." J Clin Pharm Ther 13 (1988): 121-4
  7. Forland SC, Cutler RE, McQuinn RL, Kvam DC, Miller AM, Conard GJ, Parish S "Flecainide pharmacokinetics after multiple dosing in patients with impaired renal function." J Clin Pharmacol 28 (1988): 727-35
  8. Ziegelbaum M, Lever H "Acute urinary retention associated with flecainide." Cleve Clin J Med 57 (1990): 86-7
  9. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals (2001):
View all 9 references

Flecainide drug interactions

There are 338 drug interactions with flecainide.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.