Class Ic antiarrhythmic
Flecainide acetate
Brand names: Tambocor
Adult dose
Dose: AF/SVT: 50–100mg BD (max 300mg/day). IV: 2mg/kg over 10–30 min (max 150mg). Pill-in-pocket: 200–300mg single dose
Route: PO/IV
Frequency: BD
Clinical pearls
- Use only after structural heart disease excluded (echo, ECG)
- Pair with rate-controlling drug in AF (1:1 conduction risk if flutter)
- CAST trial: avoid post-MI
Contraindications
- Heart failure
- Post-MI with asymptomatic ventricular ectopy/non-sustained VT
- Sinus node dysfunction/AV block without pacemaker
- Bundle branch block
- Structural heart disease
- Atrial flutter (without rate control)
Side effects
- Pro-arrhythmia (especially in structural heart disease)
- Visual disturbance
- Dizziness
- Conduction disturbances
- Negative inotropy
Interactions
- Amiodarone (raised levels — halve dose)
- Digoxin
- Verapamil
- Other negative inotropes
- β-blockers
Monitoring
- ECG (QRS widening, conduction)
- Plasma levels in renal/hepatic impairment
Reference: BNF; ESC AF guidelines; NICE NG196; https://bnf.nice.org.uk/drugs/flecainide-acetate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines