Global Flecainide Shortage: Exploring Reliable Therapeutic Alternatives

The global shortage of flecainide, an antiarrhythmic drug, is putting patients’ health at risk. The drug regulatory agency has issued recommendations for affected individuals. Flecainide is prescribed for rhythm disorders when the heart rate is abnormal. Extended-release flecainide medications have been experiencing supply constraints since 2022, but the shortage has recently worsened, affecting all manufacturers of the molecule. This shortage is attributed to difficulties in sourcing raw materials and packaging supplies. In a press release dated August 31, 2023, the drug regulatory agency provides guidance on what actions individuals should take if they are affected by the shortage.

Alternative Therapies for Extended-Release Flecainide: What are the Options?

To facilitate patient management, the French National Agency for Medicines and Health Products Safety (ANSM) has developed recommendations in consultation with the French Society of Cardiology, the College of General Medicine, and patient associations.

As a first-line option, if there are sufficient stocks, another flecainide-based medication, whether it is extended-release or immediate-release, should be used. The equivalencies can be found on the ANSM website.

As a second-line option, pharmacists can dispense compounded preparations that they themselves formulate. In both cases, pharmacists can provide the substitute medication without prior medical advice.

Finally, as a last resort, propafenone can be used after consultation with a cardiologist and upon presentation of a prescription. If any side effects or unusual symptoms occur, it is advised to consult a healthcare professional.

What is the purpose of flécaïnide?

This molecule is an antiarrhythmic drug commonly prescribed for certain heart rhythm disorders. It is used when the heart beats at an incorrect frequency, which should be between 60 and 80 beats per minute. Flécaïnide is prescribed for the treatment and prevention of rhythm disorders originating in the ventricle, one of the heart’s chambers. It is also prescribed for the prevention of certain tachycardias or when an implantable defibrillator is worn. In extended-release form, it is taken once a day.

Why it is important not to stop your treatment

The global shortage of flecainide can lead to a sudden discontinuation of treatment, resulting in the reoccurrence of symptoms for which it is prescribed. This is particularly distressing for patients as rhythm disorders can be extremely uncomfortable and anxiety-inducing to experience. Additionally, intense tachycardia can progress to ventricular fibrillation, the most serious rhythm disorder where heart contractions become completely chaotic. In rare cases, sudden death may also occur.

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