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Flecainide and amiodarone interaction.

P Shea, R Lal, S S Kim

Journal of the American College of Cardiology

|May 1, 1986

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Concomitant oral amiodarone and flecainide therapy increases flecainide plasma levels. This drug interaction necessitates a dose reduction of flecainide (FLE) when co-administered with amiodarone (AMIO) to maintain therapeutic efficacy.

Area of Science:

Pharmacology
Clinical Pharmacy
Cardiology

Background:

Flecainide is an antiarrhythmic medication used to treat various heart rhythm disorders.
Amiodarone is a potent antiarrhythmic drug with a complex pharmacokinetic profile.
Potential drug interactions between amiodarone and other antiarrhythmic agents require careful consideration.

Purpose of the Study:

To investigate the pharmacokinetic interaction between oral amiodarone and oral flecainide.
To determine the effect of amiodarone on flecainide plasma levels and required dosage.

Main Methods:

Observational study involving patients receiving concurrent oral amiodarone and flecainide therapy.
Measurement of flecainide plasma levels (trough plasma level at steady state/daily dose).

Related Experiment Videos

Comparison of flecainide dosage required to maintain similar plasma levels during monotherapy versus combination therapy.

Main Results:

Amiodarone significantly increased the mean dose-adjusted flecainide plasma level (from 2.3 +/- 0.8 to 3.4 +/- 0.9 ng/ml per mg/day, p < 0.01).
The mean daily dose of flecainide was reduced by approximately one-third when co-administered with amiodarone to achieve comparable plasma concentrations.
This indicates a significant pharmacokinetic interaction where amiodarone inhibits flecainide clearance.

Conclusions:

Concurrent administration of oral amiodarone and flecainide results in elevated flecainide plasma levels.
A significant reduction in flecainide dosage is necessary when used concomitantly with amiodarone to avoid potential toxicity.
Clinicians must be aware of this drug interaction to ensure safe and effective antiarrhythmic therapy.