Comprehensive medication guide to Flecainide including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$20 copay for generic on most commercial and Medicare Part D plans (Tier 1–2); quantity limits may apply at some plans.
Estimated Cash Pricing
$22–$94 retail per month for generic; as low as $11–$15 with GoodRx or SingleCare coupons for a 30-day supply of any strength.
Medfinder Findability Score
80/100
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Flecainide acetate (brand name: Tambocor) is a Class IC antiarrhythmic agent used to prevent and treat dangerous heart rhythm disorders. FDA-approved since 1984, it works by blocking fast sodium channels in cardiac cells to slow and stabilize abnormal electrical conduction. The generic has been widely available since 2004.
In 2023, flecainide was the 223rd most prescribed medication in the United States with over 1 million prescriptions. It is approved for paroxysmal atrial fibrillation/flutter (PAF), paroxysmal supraventricular tachycardia (PSVT), and life-threatening sustained ventricular tachycardia in patients without structural heart disease.
Flecainide is available as oral tablets in three strengths: 50 mg, 100 mg, and 150 mg. It is typically taken twice daily (every 12 hours), with dosing starting low and increased gradually as needed. It is not a controlled substance and does not require special prescribing restrictions beyond standard cardiac monitoring.
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Flecainide belongs to the Class IC group of antiarrhythmics — drugs that block fast sodium (Na+) channels in heart muscle cells. Each heartbeat begins with an electrical impulse traveling through the heart via specialized conduction pathways. This impulse is powered by the rapid flow of sodium ions into cardiac cells through these channels.
By partially blocking these sodium channels, flecainide reduces the speed of the electrical impulse traveling through the heart — particularly through the His-Purkinje system. This slowing disrupts the reentrant circuits that sustain arrhythmias like AFib and PSVT, allowing the heart to return to and maintain normal sinus rhythm.
Unlike Class III antiarrhythmics (amiodarone, sotalol), flecainide has minimal effect on the QT interval, meaning it carries a lower risk of torsade de pointes in patients with structurally normal hearts. However, its strong conduction-slowing effect makes it dangerous in patients with structural heart disease or prior myocardial infarction, where it can paradoxically worsen arrhythmias.
50 mg — tablet
Starting dose for PAF/PSVT; taken twice daily. Maximum 300 mg/day.
100 mg — tablet
Standard dose for VT initiation (100 mg q12h) and escalated PAF/PSVT. Maximum 300-400 mg/day depending on indication.
150 mg — tablet
Higher maintenance dose; typically used when 100 mg BID is insufficient. Requires ECG monitoring.
Flecainide is not currently on the FDA's official drug shortage list. As a generic available from multiple manufacturers since 2004, nationwide supply is generally stable. However, patients regularly encounter localized pharmacy-level stock gaps, particularly for the 50 mg tablet strength.
These gaps occur because flecainide is a specialized cardiac medication stocked in smaller quantities than high-volume generics. Pharmacies using just-in-time inventory systems and shared distributors can all run low simultaneously when a regional demand spike or backorder hits. Independent pharmacies, hospital-affiliated pharmacies, and grocery store chains often maintain separate supply chains and may have stock when big retail chains do not.
If you're having trouble finding flecainide, medfinder calls pharmacies near you to locate which ones have your specific strength in stock and texts you the results — saving hours of frustrating phone calls.
Flecainide is not a controlled substance, so it can be prescribed by any licensed prescriber with prescribing authority. However, because of the required cardiac evaluation (ECG, echocardiogram) and the FDA Black Box Warning requiring hospital initiation for ventricular arrhythmias, it is most commonly prescribed by cardiac specialists.
Common prescribers of flecainide include:
Telehealth is appropriate for ongoing management and follow-up of stable flecainide patients, but initial prescribing typically requires in-person evaluation including ECG and echocardiogram to screen for contraindications.
No. Flecainide is not a controlled substance and is not scheduled by the Drug Enforcement Administration (DEA). This means it can be prescribed by any licensed prescriber without special DEA registration, refilled without restriction, and transferred between pharmacies freely.
However, flecainide does carry an FDA Black Box Warning — the most serious warning category — restricting its use to life-threatening ventricular arrhythmias based on the CAST trial findings. It also carries monitoring requirements (ECG, drug levels, labs) due to its proarrhythmic potential. These clinical requirements are enforced by medical standards, not by DEA scheduling.
Most common side effects are dose-related and often improve at lower doses or over time:
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Propafenone (Rythmol)
Class IC antiarrhythmic with similar mechanism plus mild beta-blocking effect. Available in immediate-release and extended-release (Rythmol SR). Best for structurally normal hearts; outpatient initiation possible.
Sotalol (Betapace)
Class III antiarrhythmic with beta-blocking properties. Can be used with some structural heart disease. Requires in-hospital initiation with QTc monitoring. Available as generic.
Dronedarone (Multaq)
Class III antiarrhythmic for paroxysmal/persistent AFib. Outpatient initiation possible. Contraindicated in permanent AFib, severe HF, and concurrent with flecainide (major interaction).
Amiodarone (Pacerone)
Most effective antiarrhythmic; can be used with structural heart disease. Requires long-term monitoring for thyroid, pulmonary, hepatic, and ocular toxicity. Generic available.
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Dronedarone (Multaq)
majorMajor interaction: dronedarone inhibits CYP2D6 and can significantly raise flecainide blood levels, increasing risk of serious cardiac toxicity. Concurrent use should be avoided.
Ritonavir
majorMajor interaction: potent CYP2D6 inhibitor that dramatically increases flecainide levels. Can be life-threatening. Avoid concurrent use.
Quinidine
majorMajor interaction: additive sodium channel blocking effects plus CYP2D6 inhibition raises flecainide levels. Combination can be dangerous.
Amiodarone
moderateModerate interaction: inhibits CYP2D6, increasing flecainide levels by up to 50%. If both drugs required, reduce flecainide dose and monitor ECG and drug levels carefully.
Propranolol
moderateModerate interaction: additive negative inotropic effects and AV nodal slowing. Monitor for bradycardia and heart failure. Sometimes intentional to prevent 1:1 AF conduction.
Digoxin
moderateModerate interaction: flecainide increases digoxin plasma levels approximately 15-25%. Monitor digoxin levels and adjust dose when starting or changing flecainide.
Cimetidine (Tagamet)
moderateModerate interaction: cimetidine slows flecainide metabolism and can raise blood levels. Use alternative heartburn medication if possible.
Flecainide is a well-established, effective antiarrhythmic medication that has been helping patients control dangerous heart rhythm disorders for over 40 years. When used in appropriately selected patients — those with structurally normal hearts and paroxysmal AFib, PSVT, or life-threatening VT — it has an excellent track record of efficacy and tolerability.
The most important considerations for flecainide patients in 2026 are patient selection (ensuring no structural heart disease), medication adherence (never stopping abruptly), drug interaction awareness (390+ documented interactions), and proactive pharmacy management (starting to search for refills 5–7 days early, since stock gaps at individual pharmacies are common).
Generic flecainide is affordable ($11–$15/month with discount programs) and widely available at a national level, but localized pharmacy stock gaps are real. When you can't find it at your usual pharmacy, medfinder can help you locate it quickly — so you never have to miss a dose.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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