Life-Threatening Errors With Fiecainide Suspension in Children

摘要

Fiecainide is an oral class IC anti-arrhythmic drug that may be used to treat atrial fibrillation or supraventricular tachycardia, particularly when conventional treatment agents fail. Because it is available commercially only as 50-mg, 100-mg, and 150-mg tablets, it must be compounded into a suspension when needed for infants and small children. Unfortunately, errors during preparation and dosing of the suspension have occasionally led to serious overdoses that resulted in cardiac emergencies and required immediate therapeutic intervention. Overdoses can lead to seizures and cardiotoxicity, including ventricular tachycardia and fibrillation due to sodium-channel blockade. Treatment includes sodium bicarbonate boluses or sodium chloride boluses and extracorporeal circulatory support.