Hi,

After administration of one XL capsule, plasma flecainide concentrations gradually increase after a lag time of 2 to 3 hours to reach a peak between the 21st and 25th hour and remain at plateau levels until after the 30th hour.

After reaching the steady state concentration (3-5days), it exerts maximum action. However in some publications, it is reported that maximum effect was at week 24 and the improvement was maintained up to week 48. You can find 2 references below.

1. https://www.ecrjournal.com/articles/atrial-fibrillation-and-flecainide-safety-effectiveness-and-quality-life-outcomes,

2.https://academic.oup.com/europace/article/13/2/161/519048

So Dr.Sercan, how much time does the patient need before switching to another class of medication? 3-5 days, or 24 weeks?

In our practice, we usually increase the dosage up to 2x100mg or 2x150mg and combine with metoprolol 25-50mg or bisoprolol 2.5-5mg. We usually wait at least 4 weeks.

Dr.Sercan is there any evidence for this line of treatment ( increase the dosage up to 2x100mg or 3x100mg and combine with metoprolol 25-50mg or bisoprolol 2.5-5mg. We usually wait at least 4 weeks. )?

This data is coming mainly from short term follow up of FLEC-SL trial.

Lancet. 2012 Jul 21;380(9838):238-46.

Europace. 2016 Nov;18(11):1698-1704. Epub 2016 Feb 17.

According to the Physician treatment for peak effect.

Thanks a lot Dr.Sercan!

Thank you all!

Thanks a lot.

You are welcome :)