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Loperamide red flags — GPhC CRA MCQ

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HardGastrointestinal TherapeuticsLoperamide red flagsGPhC CRA

A specialist asks which initial oral flecainide regimen complies with the SmPC for a 70-year-old whose creatinine clearance is 30 mL/min/1.73 m2. Which regimen should be selected?

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

Reveal the answer and explanation

Correct answer: E — Flecainide 50 mg twice daily with frequent plasma levels during initial treatment

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as E

A supplies 200 mg/day, twice the maximum initial daily dose for this degree of renal impairment. B supplies 150 mg/day and omits the recommended frequent plasma monitoring. C is correct: at creatinine clearance 35 mL/min/1.73 m2 or less, the maximum initial dose is 100 mg daily or 50 mg twice daily, with frequent plasma-concentration monitoring. D averages 100 mg/day across two days but gives excessive individual doses and is not the recommended regimen. E uses an unsupported loading dose followed by 200 mg/day.

Reference: Flecainide acetate 100 mg tablets SmPC. https://www.medicines.org.uk/emc/product/11891/smpc