Dose:    Initial: 1 mg/kg/dose Q 12 hours times 2
                Maintenance: 1 to 8 mg/kg/day            

Frequency:     Q 8 to 12 hours

Comments: Flecainide is an anti-arrhythmic agent used for the suppression or prevention of life-threatening ventricular arrythmias (sustained ventricular tachycardia) and the prevention of symptomatic, disabling supraventricular tachycardia in patients without structural heart disease. Its use should be reserved for life-threatening ventricular arrythmias unresponsive to conventional therapy. Monitor drug levels with the target being 200 to 500 ng/ml (steady state levels obtained 3-5 days after starting the drug or changing the dose). The half-life in a newborn is 29 hours.  The drug should be administered with water on an empty stomach. Administration with milk will interfere with the absorption of the drug. Decrease dose with the presence of liver or renal injury.

The following drug interactions have been noted. When used with Adenosine, patients on flecainide may have a marked prolongation in QTc. Digoxin toxicity can occur due to higher digoxin levels. The beta blockade effects on the heart due to propranolol may be potentiated.

Toxicity:  Flecainide can worsen or cause arrhythmias that may lead to death.  Bradycardia, heart block, worsening ventricular arrythmias, congestive heart failure, chest pain, increased P-R interval, and increased QRS duration. Common side effects are nausea, vomiting, and diarrhea. Other side effects includ blood dyscrasias, hepatic dysfunction, tremors, blurred vision, corneal depositions, and dyspnea. Dizziness and headaches have also been reported.

Preparation: Available from pharmacy in a 5 mg/ml oral suspension. Formulation from Pediatric Dosage Handbook.  Give with tiny amounts of water, not formula or milk. Store under refrigeration. Stable for 45 days. Shake well before use.