Details
Stereochemistry | RACEMIC |
Molecular Formula | C17H20F6N2O3 |
Molecular Weight | 414.3427 |
Optical Activity | ( + / - ) |
Defined Stereocenters | 0 / 1 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
FC(F)(F)COC1=CC(C(=O)NCC2CCCCN2)=C(OCC(F)(F)F)C=C1
InChI
InChIKey=DJBNUMBKLMJRSA-UHFFFAOYSA-N
InChI=1S/C17H20F6N2O3/c18-16(19,20)9-27-12-4-5-14(28-10-17(21,22)23)13(7-12)15(26)25-8-11-3-1-2-6-24-11/h4-5,7,11,24H,1-3,6,8-10H2,(H,25,26)
DescriptionSources: http://www.drugbank.ca/drugs/DB01195Curator's Comment: Description was created based on several sources, including
https://www.drugs.com/pro/flecainide.html
Sources: http://www.drugbank.ca/drugs/DB01195
Curator's Comment: Description was created based on several sources, including
https://www.drugs.com/pro/flecainide.html
Flecainide is a potent anti-arrhythmia agent, effective in a wide range of ventricular and atrial arrhythmias and tachycardias. Flecainide has local anesthetic activity and belongs to the membrane stabilizing (Class 1) group of antiarrhythmic agents; it has electrophysiologic effects characteristic of the IC class of antiarrhythmics. Flecainide acts on sodium channels on the neuronal cell membrane, limiting the spread of seizure activity and reducing seizure propagation. The antiarrhythmic actions are mediated through effects on sodium channels in Purkinje fibers. Flecainide is a sodium channel blocker, binding to voltage gated sodium channels. It stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses. Ventricular excitability is depressed and the stimulation threshold of the ventricle is increased during diastole. Flecainide is sold under the trade name Tambocor (manufactured by 3M pharmaceuticals). Flecainide went off-patent on February 10, 2004. In addition to being marketed as Tambocor, it is also available in generic version and under the trade names Almarytm, Apocard, Ecrinal, and Flécaine.
Originator
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
Target ID: CHEMBL1980 Sources: https://www.ncbi.nlm.nih.gov/pubmed/21194571 |
67.2 µM [IC50] | ||
Target ID: CHEMBL2072 Sources: https://www.ncbi.nlm.nih.gov/pubmed/20590641 |
18.0 µM [Ki] | ||
Target ID: CHEMBL240 Sources: https://www.ncbi.nlm.nih.gov/pubmed/26159617 |
1.49 µM [IC50] | ||
Target ID: CHEMBL1964 Sources: https://www.ncbi.nlm.nih.gov/pubmed/12875427 |
7.8 µM [IC50] |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
---|---|---|---|---|
Preventing | Flecainide Approved UseIn patients without structural heart disease, Flecainide is indicated for the prevention of
- paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms
- paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms
Flecainide is also indicated for the prevention of
- documented ventricular arrhythmias, such as sustained ventricular tachycardia (sustained VT), that in the judgment of the physician, are lifethreatening. Launch Date2001 |
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Preventing | Flecainide Approved UseIn patients without structural heart disease, Flecainide is indicated for the prevention of
- paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms
- paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms
Flecainide is also indicated for the prevention of
- documented ventricular arrhythmias, such as sustained ventricular tachycardia (sustained VT), that in the judgment of the physician, are lifethreatening. Launch Date2001 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
355 ng/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/3094570 |
200 mg single, oral dose: 200 mg route of administration: Oral experiment type: SINGLE co-administered: |
FLECAINIDE plasma | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED |
|
1710 ng/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/3094570 |
2 mg/kg single, intravenous dose: 2 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
FLECAINIDE plasma | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
5979 ng × h/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/3094570 |
200 mg single, oral dose: 200 mg route of administration: Oral experiment type: SINGLE co-administered: |
FLECAINIDE plasma | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED |
|
6238 ng × h/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/3094570 |
2 mg/kg single, intravenous dose: 2 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
FLECAINIDE plasma | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: FASTED |
|
5.9 μg × h/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/1782978 |
200 mg single, oral dose: 200 mg route of administration: Oral experiment type: SINGLE co-administered: |
FLECAINIDE plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
11.5 h EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/1782978 |
200 mg single, oral dose: 200 mg route of administration: Oral experiment type: SINGLE co-administered: |
FLECAINIDE plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
60% EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/6364769 |
FLECAINIDE plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
Doses
Dose | Population | Adverse events |
---|---|---|
1200 mg single, oral Overdose Dose: 1200 mg Route: oral Route: single Dose: 1200 mg Sources: Page: p.487 |
healthy, 18 n = 1 Health Status: healthy Age Group: 18 Sex: F Population Size: 1 Sources: Page: p.487 |
Disc. AE: Unconsciousness, Cyanosis... AEs leading to discontinuation/dose reduction: Unconsciousness Sources: Page: p.487Cyanosis Bradycardia Arrhythmia |
3800 mg single, oral Overdose Dose: 3800 mg Route: oral Route: single Dose: 3800 mg Co-administed with:: diazepam, p.o(50 mg) Sources: loperamide, p.o(20 mg) |
healthy, 28 n = 1 Health Status: healthy Age Group: 28 Sex: F Population Size: 1 Sources: |
Disc. AE: Polymorphic ventricular tachycardia... AEs leading to discontinuation/dose reduction: Polymorphic ventricular tachycardia Sources: |
10 g single, oral Overdose Dose: 10 g Route: oral Route: single Dose: 10 g Sources: Page: p.423 |
healthy, 36 n = 1 Health Status: healthy Age Group: 36 Sex: M Population Size: 1 Sources: Page: p.423 |
Disc. AE: Ventricular tachycardia, Hypotension... AEs leading to discontinuation/dose reduction: Ventricular tachycardia Sources: Page: p.423Hypotension Cardiopulmonary arrest |
1 g single, oral Overdose Dose: 1 g Route: oral Route: single Dose: 1 g Co-administed with:: lamotrigine, p.o Sources: Page: p.1quetiapine, p.o |
unhealthy, 62 n = 1 Health Status: unhealthy Condition: Atrial fibrillation Age Group: 62 Sex: M Population Size: 1 Sources: Page: p.1 |
Disc. AE: Brugada syndrome, Mental status changes... AEs leading to discontinuation/dose reduction: Brugada syndrome Sources: Page: p.1Mental status changes Fatigue |
200 mg 2 times / day multiple, oral Recommended Dose: 200 mg, 2 times / day Route: oral Route: multiple Dose: 200 mg, 2 times / day Sources: |
unhealthy Health Status: unhealthy Condition: Paroxysmal supraventricular tachycardias|paroxysmal atrial fibrillation/flutter|Sustained ventricular tachycardia Sources: |
Disc. AE: Ventricular tachycardia, Cardiac arrest... AEs leading to discontinuation/dose reduction: Ventricular tachycardia Sources: Cardiac arrest |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Arrhythmia | Disc. AE | 1200 mg single, oral Overdose Dose: 1200 mg Route: oral Route: single Dose: 1200 mg Sources: Page: p.487 |
healthy, 18 n = 1 Health Status: healthy Age Group: 18 Sex: F Population Size: 1 Sources: Page: p.487 |
Bradycardia | Disc. AE | 1200 mg single, oral Overdose Dose: 1200 mg Route: oral Route: single Dose: 1200 mg Sources: Page: p.487 |
healthy, 18 n = 1 Health Status: healthy Age Group: 18 Sex: F Population Size: 1 Sources: Page: p.487 |
Cyanosis | Disc. AE | 1200 mg single, oral Overdose Dose: 1200 mg Route: oral Route: single Dose: 1200 mg Sources: Page: p.487 |
healthy, 18 n = 1 Health Status: healthy Age Group: 18 Sex: F Population Size: 1 Sources: Page: p.487 |
Unconsciousness | Disc. AE | 1200 mg single, oral Overdose Dose: 1200 mg Route: oral Route: single Dose: 1200 mg Sources: Page: p.487 |
healthy, 18 n = 1 Health Status: healthy Age Group: 18 Sex: F Population Size: 1 Sources: Page: p.487 |
Polymorphic ventricular tachycardia | Disc. AE | 3800 mg single, oral Overdose Dose: 3800 mg Route: oral Route: single Dose: 3800 mg Co-administed with:: diazepam, p.o(50 mg) Sources: loperamide, p.o(20 mg) |
healthy, 28 n = 1 Health Status: healthy Age Group: 28 Sex: F Population Size: 1 Sources: |
Cardiopulmonary arrest | Disc. AE | 10 g single, oral Overdose Dose: 10 g Route: oral Route: single Dose: 10 g Sources: Page: p.423 |
healthy, 36 n = 1 Health Status: healthy Age Group: 36 Sex: M Population Size: 1 Sources: Page: p.423 |
Hypotension | Disc. AE | 10 g single, oral Overdose Dose: 10 g Route: oral Route: single Dose: 10 g Sources: Page: p.423 |
healthy, 36 n = 1 Health Status: healthy Age Group: 36 Sex: M Population Size: 1 Sources: Page: p.423 |
Ventricular tachycardia | Disc. AE | 10 g single, oral Overdose Dose: 10 g Route: oral Route: single Dose: 10 g Sources: Page: p.423 |
healthy, 36 n = 1 Health Status: healthy Age Group: 36 Sex: M Population Size: 1 Sources: Page: p.423 |
Brugada syndrome | Disc. AE | 1 g single, oral Overdose Dose: 1 g Route: oral Route: single Dose: 1 g Co-administed with:: lamotrigine, p.o Sources: Page: p.1quetiapine, p.o |
unhealthy, 62 n = 1 Health Status: unhealthy Condition: Atrial fibrillation Age Group: 62 Sex: M Population Size: 1 Sources: Page: p.1 |
Fatigue | Disc. AE | 1 g single, oral Overdose Dose: 1 g Route: oral Route: single Dose: 1 g Co-administed with:: lamotrigine, p.o Sources: Page: p.1quetiapine, p.o |
unhealthy, 62 n = 1 Health Status: unhealthy Condition: Atrial fibrillation Age Group: 62 Sex: M Population Size: 1 Sources: Page: p.1 |
Mental status changes | Disc. AE | 1 g single, oral Overdose Dose: 1 g Route: oral Route: single Dose: 1 g Co-administed with:: lamotrigine, p.o Sources: Page: p.1quetiapine, p.o |
unhealthy, 62 n = 1 Health Status: unhealthy Condition: Atrial fibrillation Age Group: 62 Sex: M Population Size: 1 Sources: Page: p.1 |
Cardiac arrest | Disc. AE | 200 mg 2 times / day multiple, oral Recommended Dose: 200 mg, 2 times / day Route: oral Route: multiple Dose: 200 mg, 2 times / day Sources: |
unhealthy Health Status: unhealthy Condition: Paroxysmal supraventricular tachycardias|paroxysmal atrial fibrillation/flutter|Sustained ventricular tachycardia Sources: |
Ventricular tachycardia | Disc. AE | 200 mg 2 times / day multiple, oral Recommended Dose: 200 mg, 2 times / day Route: oral Route: multiple Dose: 200 mg, 2 times / day Sources: |
unhealthy Health Status: unhealthy Condition: Paroxysmal supraventricular tachycardias|paroxysmal atrial fibrillation/flutter|Sustained ventricular tachycardia Sources: |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
yes [IC50 0.44 uM] | ||||
yes [IC50 0.49 uM] | ||||
yes [IC50 191 uM] |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
yes | ||||
yes | yes (co-administration study) Comment: During the period in which the CYP2D6 inhibitor paroxetine was administered, the flecainide AUC in extensive and intermediate metabolizers was increased to 128.5% of basal values (90% CI, 122.2%– 135.2%) and 116.6% of basal values (90% CI, 107.3%–126.8%). However, poor metabolizers exhibited no alterations in AUC after administration of paroxetine (pharmacogenomic studies were also performed) |
Tox targets
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
PubMed
Title | Date | PubMed |
---|---|---|
Dysarthria and visual hallucinations due to flecainide toxicity. | 1986 Jan |
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Flecainide acetate in the treatment of tachycardias associated with Mahaim fibres. | 1987 Aug |
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[Hemodynamic effects of the anti-arrhythmia agent flecainide (Tambocor) in coronary surgery patients]. | 1987 Jun |
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Prevention of symptomatic recurrences of paroxysmal atrial fibrillation in patients initially tolerating antiarrhythmic therapy. A multicenter, double-blind, crossover study of flecainide and placebo with transtelephonic monitoring. Flecainide Supraventricular Tachycardia Study Group. | 1989 Dec |
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Flecainide-induced ventricular tachycardia and fibrillation in patients treated for atrial fibrillation. | 1989 Jul 15 |
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[Bidirectional tachycardia during therapy with lorajmine]. | 1989 Oct |
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Generalized seizures as the presentation of flecainide toxicity. | 1989 Oct |
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[Arrhythmogenic effect of flecainide--treatment with i.v. magnesium]. | 1989 Sep |
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Amiodarone toxicity: myopathy and neuropathy. | 1990 May |
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Combined application of class I antiarrhythmic drugs causes "additive", "reductive", or "synergistic" sodium channel block in cardiac muscles. | 1990 Nov |
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Safety and efficacy of oral flecainide therapy in patients with atrioventricular re-entrant tachycardia. | 1991 Feb 1 |
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Flecainide acetate prevents recurrence of symptomatic paroxysmal supraventricular tachycardia. The Flecainide Supraventricular Tachycardia Study Group. | 1991 Jan |
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Reversion of recent-onset atrial fibrillation to sinus rhythm by intravenous flecainide. | 1991 Jan 15 |
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Proarrhythmic and antiarrhythmic effects of flecainide on nonsustained reentry around the canine atrial tricuspid ring in vitro. | 1991 Nov |
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Flecainide in quinidine-resistant atrial fibrillation. | 1992 Aug 20 |
|
Long-term safety and efficacy of flecainide in the treatment of supraventricular tachyarrhythmias: the United States experience. The Flecainide Supraventricular Tachyarrhythmia Investigators. | 1992 Aug 20 |
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Asystole and cardiogenic shock due to combined treatment with verapamil and flecainide. | 1992 Aug 29 |
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Efficacy of flecainide, sotalol, and verapamil in the treatment of right ventricular tachycardia in patients without overt cardiac abnormality. | 1992 Oct |
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Flecainide induced peripheral neuropathy. | 1992 Oct 3 |
|
A randomized double-blind crossover study comparing the efficacy and tolerability of flecainide and quinidine in the control of patients with symptomatic paroxysmal atrial fibrillation. | 1992 Sep |
|
[Severe flecainide acetate poisoning. Apropos of a case]. | 1999 Feb |
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His-Purkinje system reentry as a proarrhythmic effect of flecainide. | 2000 Apr |
|
Implantable atrial defibrillator and detection of atrial flutter. | 2000 Apr |
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Successful extracorporeal life support in a case of severe flecainide intoxication. | 2001 Apr |
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Torsades de pointes ventricular tachycardia induced by mosapride and flecainide in the presence of hypokalemia. | 2001 Jan |
|
[Protocols for the treatment of supraventricular tachycardias in the fetus]. | 2001 Jun 23 |
|
Selection of drugs to test the specificity of the Tg.AC assay by screening for induction of the gadd153 promoter in vitro. | 2003 Aug |
|
Flecainide test in Brugada syndrome: a reproducible but risky tool. | 2003 Jan |
|
Safety and feasibility of a clinical pathway for the outpatient initiation of antiarrhythmic medications in patients with atrial fibrillation or atrial flutter. | 2003 Jun 15 |
|
Flecainide induced ventricular fibrillation in a neonate. | 2003 Oct |
|
Flecainide induced ventricular tachycardia (torsades de pointes). | 2003 Sep |
|
Use of ibutilide in cardioversion of patients with atrial fibrillation or atrial flutter treated with class IC agents. | 2004 Aug 18 |
|
Validation of a [3H]astemizole binding assay in HEK293 cells expressing HERG K+ channels. | 2004 Jul |
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Brugada pattern electrocardiographic changes associated with profound electrolyte disturbance. | 2004 Jul |
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Flecainide overdose--support using an intra-aortic balloon pump. | 2005 Dec 12 |
|
Long-term results of hybrid therapy in patients with atrial fibrillation who develop atrial flutter during flecainide infusion. | 2005 Jan |
|
Long-term protection of central axons with phenytoin in monophasic and chronic-relapsing EAE. | 2006 Dec |
|
[Intravenous flecainide administration for conversion of paroxysmal atrial fibrillation in the emergency room]. | 2006 May |
|
[Life-threatening ventricular tachycardia during flecainide treatment for symptomatic atrial fibrillation in a patient with a structural cardiac disorder]. | 2006 May 6 |
|
Management of atrial fibrillation. | 2007 |
|
Further evidence of inherited long QT syndrome gene mutations in antiarrhythmic drug-associated torsades de pointes. | 2007 May |
|
Flecainide cardiotoxicity precipitated by electrolyte imbalance. Caution with thiazide diuretics. | 2007 May |
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Paranoid psychosis and myoclonus: flecainide toxicity in renal failure. | 2008 |
|
Drug therapy considerations in arrhythmias in children. | 2008 Aug 1 |
|
Lidocaine-induced Brugada syndrome phenotype linked to a novel double mutation in the cardiac sodium channel. | 2008 Aug 15 |
|
Criteria for arrhythmogenicity in genetically-modified Langendorff-perfused murine hearts modelling the congenital long QT syndrome type 3 and the Brugada syndrome. | 2008 Jan |
|
Ventricular dysfunction: tachycardia induced cardiomyopathy. | 2008 May 1 |
|
Role of cytochrome P450 in drug interactions. | 2008 Oct 18 |
|
Selective regulation of cardiac organic cation transporter novel type 2 (OCTN2) in dilated cardiomyopathy. | 2011 Jun |
Patents
Sample Use Guides
In Vivo Use Guide
Sources: https://www.drugs.com/dosage/flecainide.html
Usual Adult Dose for Ventricular Tachycardia
Initial dose: 100 mg orally every 12 hours.
Maintenance dose: May be increased in increments of 50 mg bid every 4 days until efficacy is achieved. Most patients with SUSTAINED VT do not require more than 150 mg every 12 hours (300 mg/day), and the maximum dose recommended is 400 mg/day.
Usual Adult Dose for Atrial Fibrillation
Initial dose: 50 mg orally every 12 hours.
Maintenance dose: May be increased in increments of 50 mg bid every 4 days until efficacy is achieved.
Route of Administration:
Oral
In Vitro Use Guide
Sources: https://www.ncbi.nlm.nih.gov/pubmed/25219538
Flecainide produced a dose-dependent prolongation of the cardiac action potential at 1 and 3uM in human pluripotent stem cell-derived cardiomyocytes.
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Classification Tree | Code System | Code | ||
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NDF-RT |
N0000175426
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WHO-VATC |
QC01BC04
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LIVERTOX |
NBK548023
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FDA ORPHAN DRUG |
536716
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C01BC04
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NCI_THESAURUS |
C47793
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NCI_THESAURUS |
C93038
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m5400
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3356
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C62029
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K94FTS1806
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FLECAINIDE
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DB01195
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54143-55-4
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Flecainide
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100000080972
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CHEMBL652
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2560
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4096
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ACTIVE MOIETY
METABOLITE (PARENT)
SALT/SOLVATE (PARENT)