Paranoid Psychosis and Myoclonus: Flecainide Toxicity in Renal Failure

Flecainide is a sodium channel blocker used mainly in the treatment of supraventricular arrhythmias. Central nervous system side effects such as dizziness, visual disturbances, headache and nausea are commonly associated with flecainide, but severe central nervous system toxicity is rare. We report the first case of flecainide toxicity in a patient with end-stage renal failure. Cessation of flecainide therapy resulted in a fall in serum flecainide levels, with associated resolution of adverse central nervous system effects. We also review the pharmacokinetics of flecainide in patients with chronic kidney disease.

[1]  N. Powe,et al.  International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. , 2006, Journal of the American Society of Nephrology : JASN.

[2]  Charles E McCulloch,et al.  Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. , 2004, The New England journal of medicine.

[3]  Deeb N Salem,et al.  Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. , 2004, Journal of the American Society of Nephrology : JASN.

[4]  Karen J. Ferguson,et al.  Willis on narcolepsy , 2003, Journal of neurology, neurosurgery, and psychiatry.

[5]  M. Bennett.  Paranoid psychosis due to flecainide toxicity in malignant neuropathic pain , 1997, Pain.

[6]  L. Bertilsson,et al.  Pronounced differences between native Chinese and Swedish populations in the polymorphic hydroxylations of debrisoquin and S‐mephenytoin , 1992, Clinical pharmacology and therapeutics.

[7]  M. Relling,et al.  Lower prevalence of the debrisoquin oxidative poor metabolizer phenotype in American black versus white subjects , 1991, Clinical pharmacology and therapeutics.

[8]  D. Sheridan,et al.  Generalized seizures as the presentation of flecainide toxicity. , 1989, European heart journal.

[9]  P. Ibáñez,et al.  CLINICAL PHARMACOKINETICS OF INTRAVENOUS FLECAINIDE IN CRITICALLY ILL PATIENTS , 1989, Journal of clinical pharmacy and therapeutics.

[10]  L. Bertilsson,et al.  Polymorphic debrisoquin hydroxylation in 757 Swedish subjects , 1988, Clinical pharmacology and therapeutics.

[11]  S. Parish,et al.  Flecainide Pharmacokinetics After Multiple Dosing in Patients with Impaired Renal Function , 1988, Journal of clinical pharmacology.

[12]  R. Mcquinn,et al.  Pharmacokinetics of flecainide acetate in patients with severe renal impairment , 1988, Clinical pharmacology and therapeutics.

[13]  D. Ramsdale,et al.  Dysarthria and visual hallucinations due to flecainide toxicity. , 1986, Postgraduate medical journal.

[14]  J. Braun,et al.  Pharmacokinetics of flecainide in patients with mild and moderate renal failure compared with patients with normal renal function , 2004, European Journal of Clinical Pharmacology.

[15]  J. Ghika,et al.  Acute reversible ataxo-myoclonic encephalopathy with flecainide therapy. , 1994, Schweizer Archiv fur Neurologie und Psychiatrie.

[16]  M. Weir,et al.  The Cardiac Arrhythmia Suppression Trial Investigators: Preliminary Report: Effect of Encainide and Flecainide on Mortality in a Randomized Trial of Arrhythmia Suppression After Myocardial Infarction. , 1990 .

[17]  W. Rogers,et al.  Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. , 1989, The New England journal of medicine.