The drug agency warns of the global shortage of a drug prescribed for heart problems. France is concerned, many pharmacies no longer have it. Possible alternatives.
A drug flecainide sustained releaseused to improve symptoms of heart rhythm disordersis currently under supply tension around the world, including in France, and may be unavailable for many patients, alerts theMedicines Agency (ANSM) in a press release dated August 31, 2023. This medicine – only available on prescription – is a antiarrhythmic, it is Flécaïne® LP. He is able to change the speed of transmission of nerve impulses within the heart muscle and fight against its anarchic contractions. In the presence of an arrhythmia, the heart tends to beat too slowly (known as bradycardia), too fast (this is called a tachycardia) or irregularly.
What to take instead of Flécaine?
So that patients with arrhythmia can continue to be treated, the ANSM and the French Society of Cardiology have issued recommendations. In the event of immediate unavailability of the treatment initially prescribed, the medications listed below can be dispensed replacing by the pharmacist without prior medical advice. The pharmacist must, however, inform the patient of this replacement and advise him to see his doctor in the event of an adverse effect or symptom that he considers unusual.
► First-line solution: if supplies are sufficient, replacement with another proprietary flecainide with sustained release (LP), or immediate release, should be preferred.
→ If an LP shape is availablethe different dosages of LP capsules can be replaced by the pharmacist to obtain the prescribed dosage: for example: a 150 mg LP capsule can be replaced by a 50 mg LP capsule and a 100 mg LP capsule, to be taken once a day (exemption for one month only).
→ In case of unavailability of LP formsthe LP form can be replaced by the immediate release form by the pharmacist, respecting the same prescribed daily dose, and indicating to the patient that the dose must be divided into 2 doses per day (morning and evening): for example: 1 100 mg tablet to take morning and evening, instead of 1 200 mg LP capsule once a day (dispensed for one month only).
► Second-line solution: If the prolonged release (LP) or immediate replacement specialties are out of stock, immediate release form magistral preparations of flecainide can be prepared with a raw material for pharmaceutical use. As with immediate release tablets, compounded preparations can be replaced by the pharmacist, respecting the prescribed daily dose and indicating to the patient that the dose must be divided into 2 doses per day (morning and evening): for example: Flécaine LP 150 mg 1 capsule per day = master preparation of Flécainide acetate 75 mg 1 capsule in the morning and 1 capsule in the evening (dispensation for one month only)
► As a last resort: flecainide can be replaced by a drug containing propafenone, after consulting a cardiologist and upon presentation of a prescription. In this case, a medical consultation is necessary before initiating treatment, in particular to control the patient’s heart rate, due to the bradycardic properties of propafenone (slowing down the heart rate). Furthermore, this substitution requires close monitoring, in particular by electrocardiogram after the 8th/10th day, to check the patient’s heart rate. The dosage must be defined by the doctor on a case-by-case basis.
I am a patient taking Flecaine, what should I do?
- Go to a pharmacy and check with your pharmacist for another equivalent medication (according to the recommendations above)
- Consult your doctor if the pharmacist has not been able to provide equivalent treatment and for the doctor to adapt the treatment.
- Consult your doctor if unusual symptoms appear when changing treatment.