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Clinical pharmacokinetics of intravenous flecainide in critically ill patients
G Sangrador1, A Sánchez-Alcaraz, M Rodriguez
1Department of Pharmaceutical Services, Alcanyis Hospital, Xàtiva, Spain.
Abstract:
Plasma flecainide (FLC) levels versus time were measured in a group of 10 acute myocardial infarction (AMI) patients at our Intensive Care Unit. These patients were treated with single doses of 150 mg FLC as a 30-min intravenous infusion. Mean FLC plasma concentration values at 0, 1, 2, 4, and 8 h following administration were 562 +/- 271, 342 +/- 129, 270 +/- 90m, 240 +/- 80 and 210 +/- 60 ng/ml, respectively. Flecainide pharmacokinetics fitted an open two-compartment model, with a rapid distribution phase and a slow elimination phase. Mean values for the terminal plasma half-life (t1/2 beta) was 22.0 +/- 9.7 h and the volume of distribution (V beta) was 7.99 +/- 3.02 1/kg. FLC is different to other i.v. antiarrhythmics in having a prolonged plasma half-life which is a decided advantage. In contrast to lidocaine, FLC has a pharmacokinetic profile that enables it to be used for treating ventricular arrhythmia without constant-rate i.v. infusion and without the need for complicated loading dosages in order to avoid a 'pharmacokinetic dip' over the first hour of treatment.
Insights
Flecainide (FLC) shows a prolonged plasma half-life in acute myocardial infarction patients, simplifying ventricular arrhythmia treatment. Its pharmacokinetic profile avoids complex dosing, unlike other intravenous antiarrhythmics.
Area of Science:
- Pharmacology
- Cardiology
Background:
- Acute myocardial infarction (AMI) patients often require antiarrhythmic treatment.
- Intravenous antiarrhythmics present challenges in dosing and maintaining therapeutic levels.
Purpose of the Study:
- To evaluate the plasma flecainide (FLC) levels and pharmacokinetic profile in patients with AMI.
- To compare the pharmacokinetic advantages of FLC with other intravenous antiarrhythmics.
Main Methods:
- 10 AMI patients received a single 150 mg intravenous infusion of FLC over 30 minutes.
- Plasma FLC concentrations were measured at multiple time points (0, 1, 2, 4, and 8 hours).
- Pharmacokinetic analysis using an open two-compartment model.
Main Results:
- Mean terminal plasma half-life (t1/2 beta) was 22.0 +/- 9.7 hours.
- Mean volume of distribution (V beta) was 7.99 +/- 3.02 L/kg.
- FLC demonstrated a rapid distribution and slow elimination phase.
Conclusions:
- Flecainide possesses a prolonged plasma half-life, offering an advantage over other IV antiarrhythmics.
- FLC's pharmacokinetic profile allows for simplified treatment of ventricular arrhythmias without complex loading doses or continuous infusions.