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Flecainide Contraindication CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseFlecainide Contraindication CKDESENeph

A 65-year-old man with CKD G4 develops atrial flutter with rapid ventricular response. His cardiologist wants to start Flecainide. Is this appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — No – Flecainide is renally cleared and accumulates in CKD G4-5, increasing the risk of proarrhythmic effects (ventricular arrhythmias); it should be avoided or used with extreme caution with dose reduction and monitoring

Flecainide is a Class 1C anti-arrhythmic that is partially renally excreted (30%). In CKD G4-5, accumulation occurs, increasing the risk of proarrhythmic effects (particularly dangerous – can cause ventricular tachycardia/fibrillation). BNF recommends dose reduction in renal impairment and avoidance in severe CKD. Alternative rate-control agents for atrial flutter in CKD include Bisoprolol (hepatically cleared), Diltiazem (hepatically cleared), or Digoxin (with renal dose adjustment and level monitoring). Amiodarone is also hepatically cleared but has significant long-term toxicity.

Reference: BNF 2024 – Flecainide; NICE NG196 – AF