Drugs
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Flecainide is a Class I antiarrhythmic drug of the local anaesthetic type. It can be given either intravenously or orally and its pharmacokinetic properties allow relatively long (12 hours) dosing intervals with oral administration. In several open and a few controlled therapeutic trials, orally administered flecainide has brought about a greater than 90% suppression of ventricular ectopic beats in about 80% of patients. ⋯ The moderate negative inotropic effects of flecainide can become clinically significant in patients with impaired ventricular function. Thus flecainide, with its convenient dose schedule and apparently low incidence of serious side effects, would appear to be a useful addition to the antiarrhythmic agents available. Further studies are needed though, to confirm its long term tolerability when used prophylactically.
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The acute effects of intravenous flecainide on electrically-induced paroxysmal supraventricular tachycardia and the safety and efficacy of long term prophylaxis with orally administered flecainide were assessed in 37 patients with paroxysmal supraventricular tachycardia refractory to treatment with 'conventional' antiarrhythmic drugs. Over a mean treatment period of 14.2 months, flecainide 200 to 400mg daily completely suppressed paroxysmal supraventricular tachycardia in 9 of 20 patients with paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome, while 3 patients reported only transient episodes of paroxysmal supraventricular tachycardia, and 1 patient had a decreased ventricular response to chronic atrial fibrillation. Of 17 patients with paroxysmal supraventricular tachycardia due to atrioventricular nodal re-entry, flecainide 200 to 500mg daily for a mean period approaching 26 months totally prevented episodes of paroxysmal supraventricular tachycardia in 8, and reduced the frequency and duration of episodes of paroxysmal supraventricular tachycardia in 3 others. ⋯ Side effects usually involved the central nervous system and were most commonly manifested by disturbances in vision, balance, and taste and increased nervousness. These side effects generally subsided following 1 to 2 months' treatment with flecainide. No abnormal trends were observed in laboratory analysis of blood samples taken from patients during long term treatment with flecainide.(ABSTRACT TRUNCATED AT 250 WORDS)