Key result
Flecainide response in children depends on ontogeny and genetics, demanding precision dosing strategies.
Why the study?
Knowledge gaps remain regarding how genetic variation impacts flecainide disposition and response, particularly in developing children with potentially immature pathways.
This review highlights the critical need for pediatric-specific pharmacogenomic and ontogenic data to optimize flecainide dosing and improve safety in children with tachyarrhythmias.
Should not yet change flecainide dosing in children; leaves open prospective validation of ontogeny- and genotype-guided strategies.
Flecainide acetate is a Class 1c anti-arrhythmic with a potent sodium voltage gated channel blockade which is utilized for the second-line treatment of tachyarrhythmias in children and adults. Given its narrow therapeutic index, the individualization of drug therapy is of utmost importance for clinicians. Despite efforts to improve anti-arrhythmic drug therapy, there remain knowledge gaps regarding the impact of variation in the genes relevant to flecainide's disposition and response. This variability is compounded in developing children whose drug disposition and response pathways may remain immature. The purpose of this comprehensive review is to outline flecainide's disposition and response pathways while simultaneously highlighting opportunities for prospective investigation in the pediatric population.
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Palmen et al. (2024) conducted a review in Pediatric arrhythmias. Flecainide was evaluated. Flecainide disposition and response in pediatric patients are significantly influenced by ontogeny and genetic variation, highlighting the need for precision-based dosing strategies in children.
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