Flecainide monitoring (HP438)

Flecainide monitoring (HP438)

Overview/Purpose

The Flecainide Handy Protocol for Medicines Safety is designed to ensure consistency and minimise risks during the prescribing and monitoring of this high-risk antiarrhythmic drug in primary care. 

What does it do?

When a positive helicobacter result is recorded the protocol will offer to prescribe eradication therapy for the patient.  The record is checked for allergy to penicillin and the user offered appropriate options based on this information.

Why is it important?

HP438 standardises high-risk prescribing of flecainide according to accepted guidelines, clinical evidence, and national safety warnings, reducing medication errors and improving patient safety 

Drug Monitoring

This protocol ensures that essential monitoring checks are not missed, which is critical for flecainide due to its narrow therapeutic index and pro-arrhythmic potential. 
  1. Cardiac Function: Prompts for recent ECG checks (QRS widening) and confirmation that there is no structural heart disease (eg: prior MI or heart failure), which is an absolute contraindication.
  2. Electrolytes: Monitoring of U&Es (especially Potassium, as hypokalaemia significantly increases toxicity and the risk of fatal pro-arrhythmias) is not mandated but PCIT has handy protocols which produce alerts for results outside normal ranges.
  3. Frequency: Specifies the required frequency for follow-up ECGs and blood tests. 

Drug Risks

The protocol highlights the most severe and specific risks associated with flecainide, requiring documented patient counselling and clinician vigilance. 
  1. Pro-Arrhythmia: Clearly identifies the potential for flecainide to worsen pre-existing arrhythmias or induce new, potentially fatal, ventricular tachyarrhythmias (VT/VF). 
  2. Mortality: Underlines the significant increase in all-cause mortality when flecainide is used in patients with structural heart disease. 
  3. Non-Cardiac Effects: Reminds clinicians to ask about and document common side effects such as dizziness and visual disturbances. 

Drug Interactions

These are notified by other Handy Protocols and provide quick reference to clinically significant drug interactions, helping prescribers check for co-prescribed medications that could alter flecainide levels or exacerbate cardiac risk. 
  1. Increased Levels: Warns about drugs that inhibit CYP2D6 or compete for metabolism, such as amiodarone or quinidine, which can dangerously elevate flecainide plasma concentrations. 
  2. Additive Effects: Highlights concurrent use of Beta-blockers or Calcium-channel blockers, which carries an increased risk of bradycardia and AV block. 

What does it look like?

When triggered the following popup will show. Items below the top line will display based on dates of events in the record.


  1. Angiography in last 5 years (only for patients aged 50+ or with QRISK >20%)
  2. ECG in last 12 months
  3. Echo in last 12 months
  4. Cholesterol in last 12 months
  5. BP in last 12 months
  6. Potassium in last 6 months

Hints and Tips

HP438 will prompt whenever a consultation is started.
Flecainide is typically for use only after specialist initiation (cardiologist) or for "pill-in-the-pocket" strategies reviewed by a specialist. 
Patient Education: Advise carrying an Arrhythmia Drug Safety Card and emphasise that patients must report new symptoms (eg: breathlessness, fainting) immediately. 

How to get it

Optional Handy Protocols will need to be 'activated' within your clinical system. See our support article for instructions: How to locate Optional Handy Protocols and Activate these


System Triggers

System trigger: Add a consultation
Run mode: Always run
Drug: Patient has a current medication course of flecainide, or has had an issue of flecainide in the last 3 months.

Change management considerations

Your team need to be aware that this protocol will prompt the need for assessment.