Flecainide overdose

Fatal flecainide overdose has been reported in a 65-year-old man who probably took 20 tablets of 100 mg each (68). However, no chnical details were available, because he was found dead. Flecainide was detected in his blood, gastric contents, and hver. O-dealkylated flecainide was found in his urine. 

Corkeron MA, van Heerden PV, Netvman SM, Dusci L. Extracorporeal circulatory support in near-fatal flecainide overdose. Anaesth Intensive Care 1999 27(4) 405-8. 

Drug overdose Life-threatening flecainide intoxication in a 2-year-old toddler occurred when syringes used for oral administration were accidentally reversed, producing a fivefold flecainide overdose 3 hours after drug administration he developed a bradycardia of 50/minute and had a cardiopulmonary arrest, requiring resuscitation and adrenaline, after which the bradycardia recurred, followed by a wide-complex tachycardia that converted rapidly to a narrow-complex tachycardia after bolus intravenous adrninistration of sodium bicarbonate [60 ]. He then remained hemo-dynamicaUy stable and in sinus rhjflhm. The serum flecainide concentration was 0.7 mg/1. 

Williamson DG, Sinha A, Frost I, Singh VK Management of persistent wide QRS in flecainide overdose with magnesium sulphate. Emerg Med J 2010 27(6) 487-8. 

Soni S, Gandhi S. Flecainide overdose causing Brugada-type pattern on electrocardiogram in a previously well patient. Am J Emerg Med 2009 27(3) 373-5.e3. 

Drug overdose A flecainide overdose is associated with a high mortality. This is due to its combination of negative inotropic and prodysrhythmic effect, in addition to its potent ability to slow cardiac conduction. The long-term effects of flecainide overdose may include irreversible third-degree heart block requiring the placement of a pacemaker [25]. 

A 72-year-old woman, treated with flecainide and haloperidol, presented with breathlessness due to regular tachycardia with wide QRS complex. The ECG showed a regular monomorphic tachycardia at ISObpm, no apparent P wave, QRS duration of 240 ms with a left bxmdle branch block. An intravenous bolus of 10 mg ATP was administered. However, it turned out to be ineffective. The diagnosis of tachycardia induced by flecainide overdose was considered and treatment with 8.4% sodium bicarbonate was initiated. The sodium bicarbonate infusion caused immediate narrowing of the patienPs QRS and the ECG showed sinus rhythm. Blood samples confirmed flecainide overdose [27]. 

Jang DH, Hoffinan RS, Nelson LS. A case of near-fatal flecainide overdose in a neonate successfully treated with sodium bicarbonate. J Emerg Med 2013 44(4) 781. ... 

The use of techniques of circulatory support (extracorporeal oxygenation and intra-aortic balloon pump) in seven cases of overdose with antidysrhythmic drugs (disopyramide, flecainide, prajmaline, and quinidine) has been reviewed (62). 

Other case reports and studies describe heart failure, dyspnoea, - sinus arrest, heart block, "" hypotension, " and bradycar-(jj 4,5,8,io,ii,i4-i8 jjj patients taking verapamil with alprenolol, atenolol, metoprolol, " propranolof " or pindolol. In two further cases, bradycardia occurred in patients taking verapamil and using timolol eye drops. Another case has been reported, but this was complicated by the presence of flecainide , (p.844). A number of reports noted that patients experiencing this interaction had reasonable left ventricular function. Heart block and hypotension or cardiogenic shock has also been reported after verapamil was given with atenolol or propranolol in overdose. 

Drug overdose Deliberate overdose with flecainide has been described [66 ]. 

Cardiovascular An overdose of flecainide may manifest as prolongation of the PR, QRS, and QTc intervals on ECG and the development of bradycardia, premature ventricular complex (PVC), ventricular tachycardia, and fibrillation. The ECG changes observed in flecainide toxicity may resemble Brugada syndrome [24]. 

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