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Test ID: FLEC    
Flecainide, Serum

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Useful For Suggests clinical disorders or settings where the test may be helpful

Optimizing dosage

 

Assessing toxicity

 

Monitoring compliance

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Flecainide (Tambocor) is a Class I cardiac antiarrhythmic agent indicated for treatment of paroxysmal supraventricular dysrhythmia, paroxysmal atrial fibrillation/flutter, and life-threatening ventricular dysrhythmias. After oral administration, flecainide is nearly completely absorbed and peak concentrations are attained in approximately 3 hours. The half-life averages approximately 20 hours, but is widely variable (12 to 27 hours) and steady-state concentrations are typically achieved in approximately 5 days. Flecainide is eliminated from blood by hepatic metabolism, as well as renal clearance; significant changes in either organ system will cause impaired clearance. Common adverse effects include dizziness, visual disturbances, and dyspnea. Mild-to-moderate toxicity is associated with dizziness, visual disturbances, headache, nausea, fatigue, palpitations, and chest pain. Visual hallucinations and dysarthria may occur at toxic serum concentrations. Death can occur from hypotension, respiratory failure, and asystole.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Trough Value

0.2-1.0 mcg/mL: Therapeutic concentration

>1.0 mcg/mL: Toxic concentration

Interpretation Provides information to assist in interpretation of the test results

Flecainide is most effective in premature ventricular contractions suppression at serum concentrations in the range of 0.2 to 1.0 mcg/mL.

 

Serum concentrations above 1.0 mcg/mL are associated with a high rate of cardiac adverse experiences such as conduction defects or bradycardia.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Specimens that are obtained from gel tubes or anticoagulate collections can cause assay interference.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Nader R, Horwath AR, Wittwer CT: In Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Sixth edition. St. Louis: Elsevier 2018

2. Burtis CA, Ashwood ER, Bruns DE, et al: In Tietz Textbook of Clinical Chemistry and Molecular Diagnosis. Fifth edition. St Louis: Elsevier. USA 2012

3. Josephson ME, Buxton AE, Marchlinski FE: The tachyarrhythmias: tachycardias. In Harrison's Principles of Internal Medicine. 12th edition. Edited by JD Wilson, E Braunwald, KJ Isselbacher, et al. New York, McGraw-Hill Book Company, 1991, p 915

4. Valdes R Jr, Jortani SA, Gheorghiade M, et al: Standards of Laboratory Practice: Cardiac Drug Monitoring. Clin Chem 1998;44(5):1096-1099

5. Joseph SP, Holt DW: Electrophysiological properties of mexiletine assessed with respect to plasma concentrations. Eur J Cardiol 1980 Feb;11(2):115-121