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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" /><meta name="citation_title" content="Flecainide" /><meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="citation_date" content="2018/01/24" /><meta name="citation_pmid" content="31643355" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548023/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Flecainide" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="DC.Date" content="2018/01/24" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548023/" /><meta name="description" content="Flecainide is an oral antiarrhythmic agent that has been in use for several decades. Long term flecainide therapy is associated with a low rate of serum enzyme elevations and is a very rare cause of clinically apparent acute liver injury." /><meta name="og:title" content="Flecainide" /><meta name="og:type" content="book" /><meta name="og:description" content="Flecainide is an oral antiarrhythmic agent that has been in use for several decades. Long term flecainide therapy is associated with a low rate of serum enzyme elevations and is a very rare cause of clinically apparent acute liver injury." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548023/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/livertox/Flecainide/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548023/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK548023_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK548023_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Flavoxate/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/Flibanserin/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK548023_"><span class="title" itemprop="name">Flecainide</span></h1><p class="small">Last Update: <span itemprop="dateModified">January 24, 2018</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="Flecainide.OVERVIEW"><h2 id="_Flecainide_OVERVIEW_">OVERVIEW</h2><div id="Flecainide.Introduction"><h3>Introduction</h3><p>Flecainide is an oral antiarrhythmic agent that has been in use for several decades. Long term flecainide therapy is associated with a low rate of serum enzyme elevations and is a very rare cause of clinically apparent acute liver injury.</p></div><div id="Flecainide.Background"><h3>Background</h3><p>Flecainide (fle kay' nide) is a benzamide derivative analogue of the local anesthetic procaine and has electrophysiological effects that resemble quinidine (antiarrhythmic Class IC). Flecainide appears to act by blocking open sodium channels and outward potassium channels. As a consequence, it decreases cardiac automaticity, increases refractory periods and slows conduction. Flecainide was approved for use in the United States in 1985. Its current indications include prevention and suppression of life threatening ventricular arrhythmias and conversion of supraventricular tachyarrhythmias and subsequent maintenance of normal sinus rhythm in patients without structural heart disease, in whom other agents were unsuccessful. Flecainide is available in tablets of 50, 100 and 150 mg generically and under the brand name Tambocor. The usual maintenance dose in adults is 50 to 200 mg twice daily. The most common side effects include dizziness, visual blurring, headache, fatigue, anxiety, gastrointestinal upset and nausea.</p></div><div id="Flecainide.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>In clinical trials, flecainide was associated with a low rate of serum aminotransferase and alkaline phosphatase elevations. Despite wide scale use, flecainide has only rarely been linked to cases of clinically apparent liver injury. The typical presentation is with a cholestatic hepatitis arising within 1 to 6 weeks of starting flecainide. In addition, instances of acute hepatic injury arising within 1 to 3 days of starting flecainide with marked, but short lived elevations in serum aminotransferase levels and minimal increases in alkaline phosphatase have been published, but may actually represent acute worsening of congestive heart failure and ischemic hepatitis due to the proarrhythmic effects of flecainide. In all instances, the liver injury was self limited. Immunoallergic and autoimmune features were not present.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: C (probable rare cause of clinically apparent liver injury).</p></div><div id="Flecainide.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The mechanism by which flecainide might cause liver injury is unknown. Flecainide is metabolized in the liver predominantly by CYP 2D6. In some instances, symptoms and liver test abnormalities may be due to worsening of congestive heart failure and hepatic congestion.</p></div><div id="Flecainide.Outcome_and_Management"><h3>Outcome and Management</h3><p>Liver injury due to flecainide is rare and usually mild. Cases of prolonged jaundice, but no reports of acute liver failure, chronic hepatitis or vanishing bile duct syndrome attributed to flecainide, have been published. There is little information about cross sensitivity to liver injury between flecainide and other oral antiarrhythmics, but such shared sensitivity is unlikely.</p><p>Drug Class: <a href="/books/n/livertox/AntiarrhythmicAgents/">Antiarrhythmic Agents</a></p></div></div><div id="Flecainide.CASE_REPORT"><h2 id="_Flecainide_CASE_REPORT_">CASE REPORT</h2><div id="Flecainide.Case_1._Cholestatic_hepatitis"><h3>Case 1. Cholestatic hepatitis due to flecainide.</h3><p>[Modified from: Mikloweit P, Bienmüller H. [Drug-induced intrahepatic cholestasis caused by flecainide acetate and enalapril]. Internist (Berl) 1987; 28: 193-5. German. <a href="https://www.ncbi.nlm.nih.gov/pubmed/3034817" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PubMed Citation</a>]</p><p>A 64 year old man developed abnormal liver tests five weeks after starting flecainide for cardiac tachyarrhythmias. He had a history of coronary artery disease and had been hospitalized for acute myocardial infarction, during which he had several episodes of ventricular tachycardia treated with lidocaine and then with oral flecainide (200 mg daily). His other medications included furosemide, spironolactone, metoprolol, glibecamide, and coumadin. Five weeks after starting flecainide therapy, laboratory testing demonstrated a total serum bilirubin of 3.0 mg/dL and alkaline phosphatase 310 U/L (Table). Flecainide was stopped the following day, but serum alkaline phosphatase levels continued to rise. He was started on propafenone. Tests for hepatitis B were negative and ultrasonography showed no evidence of biliary obstruction. A liver biopsy showed a cholestatic hepatitis with portal inflammation. Thereafter, serum bilirubin levels and alkaline phosphatase levels began to improve. Limited follow up was provided. [A second case of cholestatic hepatitis in this publication was attributed to enalapril]</p><div id="Flecainide.Key_Points"><h4>Key Points</h4><div id="Flecainide.T1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548023/table/Flecainide.T1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Flecainide.T1_lrgtbl__"><table><thead><tr><th id="hd_h_Flecainide.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Medication:</th><td rowspan="1" colspan="1" style="vertical-align:top;">Flecainide (200 mg daily)</td></tr></thead><tbody><tr><th headers="hd_h_Flecainide.T1_1_1_1_1" id="hd_b_Flecainide.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Pattern:</th><td headers="hd_b_Flecainide.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Cholestatic (R=0.7)</td></tr><tr><th headers="hd_h_Flecainide.T1_1_1_1_1" id="hd_b_Flecainide.T1_1_1_2_1" rowspan="1" colspan="1" style="vertical-align:top;">Severity:</th><td headers="hd_b_Flecainide.T1_1_1_2_1" rowspan="1" colspan="1" style="vertical-align:top;">3+ (jaundice, hospitalization)</td></tr><tr><th headers="hd_h_Flecainide.T1_1_1_1_1" id="hd_b_Flecainide.T1_1_1_3_1" rowspan="1" colspan="1" style="vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.latency/">Latency</a>:</th><td headers="hd_b_Flecainide.T1_1_1_3_1" rowspan="1" colspan="1" style="vertical-align:top;">5 weeks</td></tr><tr><th headers="hd_h_Flecainide.T1_1_1_1_1" id="hd_b_Flecainide.T1_1_1_4_1" rowspan="1" colspan="1" style="vertical-align:top;">Recovery:</th><td headers="hd_b_Flecainide.T1_1_1_4_1" rowspan="1" colspan="1" style="vertical-align:top;">Unclear</td></tr><tr><th headers="hd_h_Flecainide.T1_1_1_1_1" id="hd_b_Flecainide.T1_1_1_5_1" rowspan="1" colspan="1" style="vertical-align:top;">Other medications:</th><td headers="hd_b_Flecainide.T1_1_1_5_1" rowspan="1" colspan="1" style="vertical-align:top;">Glyburide, metoprolol, furosemide, spironolactone, warfarin, and lidocaine</td></tr></tbody></table></div></div></div><div id="Flecainide.Laboratory_Values"><h4>Laboratory Values</h4><div id="Flecainide.T2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548023/table/Flecainide.T2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Flecainide.T2_lrgtbl__"><table><thead><tr><th id="hd_h_Flecainide.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Time After Starting</th><th id="hd_h_Flecainide.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">Time After Stopping</th><th id="hd_h_Flecainide.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a> (U/L)</th><th id="hd_h_Flecainide.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">Alk P (U/L)</th><th id="hd_h_Flecainide.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.bilirubin/">Bilirubin</a> (mg/dL)</th><th id="hd_h_Flecainide.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Other</th></tr></thead><tbody><tr><td headers="hd_h_Flecainide.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Pre</td><td headers="hd_h_Flecainide.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Flecainide.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">15</td><td headers="hd_h_Flecainide.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">145</td><td headers="hd_h_Flecainide.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">0.9</td><td headers="hd_h_Flecainide.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Hospital admission</td></tr><tr><td headers="hd_h_Flecainide.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">2 weeks</td><td headers="hd_h_Flecainide.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Flecainide.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">25</td><td headers="hd_h_Flecainide.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">115</td><td headers="hd_h_Flecainide.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">0.8</td><td headers="hd_h_Flecainide.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td headers="hd_h_Flecainide.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">5 weeks</td><td headers="hd_h_Flecainide.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">0</td><td headers="hd_h_Flecainide.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">45</td><td headers="hd_h_Flecainide.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">310</td><td headers="hd_h_Flecainide.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">3.0</td><td headers="hd_h_Flecainide.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.jaundice/">Jaundice</a></td></tr><tr><td headers="hd_h_Flecainide.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Flecainide.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">2 days</td><td headers="hd_h_Flecainide.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">50</td><td headers="hd_h_Flecainide.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">420</td><td headers="hd_h_Flecainide.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">7.6</td><td headers="hd_h_Flecainide.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td headers="hd_h_Flecainide.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">6 weeks</td><td headers="hd_h_Flecainide.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">8 days</td><td headers="hd_h_Flecainide.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">40</td><td headers="hd_h_Flecainide.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">479</td><td headers="hd_h_Flecainide.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">4.2</td><td headers="hd_h_Flecainide.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Liver biopsy</td></tr><tr><td headers="hd_h_Flecainide.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">7 weeks</td><td headers="hd_h_Flecainide.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">12 days</td><td headers="hd_h_Flecainide.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">40</td><td headers="hd_h_Flecainide.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">340</td><td headers="hd_h_Flecainide.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">2.5</td><td headers="hd_h_Flecainide.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td headers="hd_h_Flecainide.T2_1_1_1_1 hd_h_Flecainide.T2_1_1_1_2" colspan="2" rowspan="1" style="vertical-align:top;">
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<b>Normal Values</b>
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</td><td headers="hd_h_Flecainide.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><31</b>
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</td><td headers="hd_h_Flecainide.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><130</b>
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</td><td headers="hd_h_Flecainide.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><1.2</b>
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</td><td headers="hd_h_Flecainide.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr></tbody></table></div></div></div><div id="Flecainide.Comment"><h4>Comment</h4><p>This patient developed cholestatic hepatitis 5 weeks after starting flecainide with improvements starting within a few days of stopping therapy. The cholestatic picture, timing of onset and lack of other known hepatotoxic exposures make flecainide a likely cause.</p></div></div></div><div id="Flecainide.PRODUCT_INFORMATION"><h2 id="_Flecainide_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><div id="Flecainide.BPI" class="box"><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Flecainide – Generic, Tambocor®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Antiarrhythmic Agents</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Flecainide" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div></div><div id="Flecainide.CHEMICAL_FORMULA_AND_STRUCTUR"><h2 id="_Flecainide_CHEMICAL_FORMULA_AND_STRUCTUR_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="Flecainide.T3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548023/table/Flecainide.T3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Flecainide.T3_lrgtbl__"><table><thead><tr><th id="hd_h_Flecainide.T3_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">DRUG</th><th id="hd_h_Flecainide.T3_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_Flecainide.T3_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Flecainide.T3_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Flecainide.T3_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Flecainide</td><td headers="hd_h_Flecainide.T3_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135004577" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">54143-56-5</a>
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</td><td headers="hd_h_Flecainide.T3_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">C17-H20-F6-N2-O3.C2-H4-O2</td><td headers="hd_h_Flecainide.T3_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
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<div class="graphic"><img src="/books/NBK548023/bin/Flecainide_Structure.jpg" alt="Chemical Structure for Flecainide" /></div>
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</td></tr></tbody></table></div></div></div><div id="Flecainide.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Flecainide_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 24 Janurary 2018</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Flecainide.R1">Zimmerman HJ. Antiarrhythmics. Drugs used in cardiovascular disease. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 642-4.<div><i>(Expert review of hepatotoxicity of antiarrhythmics and procainamide published in 1999; mentions that flecainide has been linked to rare cases of cholestatic jaundice).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R2">De Marzio DH, Navarro VJ. Hepatotoxicity of cardiovascular and antidiabetic drugs. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 519-40. (Review of hepatotoxicity of cardiovascular agents, mentions that.<div><i>flecainide has been linked to rare cases of hepatocellular injury that is rapidly reversible).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R3">Sampson KJ, Kass RS. Antiarrhythmic drugs. In, Brunton LL, Chabner BA, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill, 2011, pp. 815-48.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R4">Hopmann G, Surmann T. [Cholestatic jaundice during flecainide therapy]. Dtsch Med Wochenschr 1984; 109: 1863. German. [<a href="https://pubmed.ncbi.nlm.nih.gov/6499688" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6499688</span></a>]<div><i>(61 year old man developed nausea followed by jaundice 30 days after starting flecainide for ventricular arrhythmias [peak bilirubin 15.8 mg/dL, ALT 71 U/L, Alk P 585 U/L] with slow recovery, symptoms resolving after 2, jaundice 3.5 and liver enzymes 5 months after stopping).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R5">Mikloweit P, Bienmüller H. [Drug-induced intrahepatic cholestasis caused by flecainide acetate and enalapril]. Internist (Berl) 1987; 28: 193-5. German. [<a href="https://pubmed.ncbi.nlm.nih.gov/3034817" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3034817</span></a>]<div><i>(64 year old man developed jaundice 5 weeks after starting flecainide [peak bilirubin 7.6 mg/dL, ALT 152 U/L, Alk P 479 U/L, eosinophils 6%], resolving upon switching to propafenone: Case 1).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R6">Kühlkamp V, Haasis R, Seipel L. [Flecainide-induced hepatitis]. Z Kardiol 1988; 77: 678-80. German. [<a href="https://pubmed.ncbi.nlm.nih.gov/3149084" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3149084</span></a>]<div><i>(51 year old man developed nausea and abdominal pain 2 days after starting flecainide [ALT 993 U/L, bilirubin 3.0 mg/dL, Alk P normal], resolving within 2 weeks of stopping).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R7">Flecainide for supraventricular tachyarrhythmias. Med Lett Drugs Ther 1992; 34: 71-2. [<a href="https://pubmed.ncbi.nlm.nih.gov/1630411" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1630411</span></a>]<div><i>(Short summary of efficacy and safety of flecainide published soon after its approval in the US; adverse effects include dizziness and blurred vision, but recommended restricted use because of its proarrhythmic effects).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R8">Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, Arensberg D, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991; 324: 781-8. [<a href="https://pubmed.ncbi.nlm.nih.gov/1900101" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1900101</span></a>]<div><i>(Among 1498 patients with myocardial infarction and ventricular ectopy, 323 were treated with flecainide and 318 with placebo and followed for a mean of 10 months; there was an excess mortality from cardiac arrest in antiarrhythmic treated patients; no mention of hepatotoxicity or ALT elevations).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R9">Roden DM. Antiarrhythmic drugs: from mechanisms to clinical practice. Heart 2000; 84: 339-46. [<a href="/pmc/articles/PMC1760959/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1760959</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10956304" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10956304</span></a>]<div><i>(Overview of antiarrhythmic drugs which are separated into four classes based upon molecular target: I being sodium channel blockers; II beta blockers; III potassium channel blockers; and, IV calcium channel blockers; some agents having multiple targets).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R10">McNamara RL, Tamariz LJ, Segal JB, Bass EB. Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. Ann Intern Med 2003; 139: 1018-33. [<a href="https://pubmed.ncbi.nlm.nih.gov/14678922" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14678922</span></a>]<div><i>(Systematic review of literature on efficacy and safety of drugs for atrial fibrillation; flecainide has been shown to be effective in conversion of atrial fibrillation to normal sinus rhythm; hepatic side effects are not discussed).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R11">Drugs for cardiac arrhythmias. Treat Guidel Med Lett 2007; 5: 51-8. [<a href="https://pubmed.ncbi.nlm.nih.gov/17505408" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17505408</span></a>]<div><i>(Concise review of drugs for arrhythmias; flecainide is effective in preventing supraventricular tachycardia and atrial fibrillation in “otherwise healthy hearts” and in suppressing ventricular arrhythmias, but has been associated with an increase in mortality after myocardial infarction; no mention of hepatotoxicity as an adverse event).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R12">Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J; Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008; 135: 1924-34 . [<a href="/pmc/articles/PMC3654244/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3654244</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18955056" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18955056</span></a>]<div><i>(Among 300 cases of drug induced liver disease in the US collected from 2004 to 2008, none were attributed to flecainide).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R13">Tamargo J, Capucci A, Mabo P. Safety of flecainide. Drug Saf 2012; 35: 273-89. [<a href="https://pubmed.ncbi.nlm.nih.gov/22435343" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22435343</span></a>]<div><i>(Review of the use and safety of flecainide mentions rare reports of serum aminotransferase elevations and hepatic dysfunction, including cholestasis and hepatic failure: "However, no causal relationship has been established"). </i></div></div></li><li><div class="bk_ref" id="Flecainide.R14">Gao S, Dai W, Zhang L, Juhaeri J, Wang Y, Caubel P. Risk of Cardiovascular Events, Stroke, Congestive Heart Failure, Interstitial Lung Disease, and Acute Liver Injury: Dronedarone versus Amiodarone and Other Antiarrhythmics. J Atr Fibrillation 2013; 6: 890. [<a href="/pmc/articles/PMC5153130/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5153130</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28496906" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28496906</span></a>]<div><i>(Analysis of health care database of 10,455 adults with atrial fibrillation or flutter seen between 2009 and 2010 treated with antiarrhythmics for serious outcomes found no difference in incidence [per 1000 person years] of acute liver injury for flecainide [5], dronedarone [7.6], propafenone [14] or even amiodarone [18.9]).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R15">Hernández N, Bessone F, Sánchez A, di Pace M, Brahm J, Zapata R, A Chirino R, et al. Profile of idiosyncratic drug induced liver injury in Latin America: an analysis of published reports. Ann Hepatol 2014; 13: 231-9. <a href="https://www.ncbi.nlm.nih.gov/pubmed/24552865" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">PubMed Citation</a>. [<a href="https://pubmed.ncbi.nlm.nih.gov/24552865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24552865</span></a>]<div><i>(Among 176 reports of drug induced liver injury from Latin America published between 1996 and 2012, none were attributed to flecainide).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R16">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al.; United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. Gastroenterology 2015; 148: 1340-52.e7. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25754159" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">PubMed Citation</a>. [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div><i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, none were due to flecainide).</i></div></div></li><li><div class="bk_ref" id="Flecainide.R17">Jenkins DJA, Freeman M, Mangat I, Srichaikul K, Jayalath VH, Faulkner D, Sievenpiper JL, et al. Flecainide and elevated liver enzymes in α1-antitrypsin deficiency. HeartRhythm Case Rep 2016; 2: 237-240. [<a href="/pmc/articles/PMC5419749/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5419749</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28491677" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28491677</span></a>]<div><i>(72 year old man with atrial fibrillation developed abdominal discomfort and liver test abnormalities within days of starting metoprolol and flecainide [ALT ~200 U/L], which resolved within 10 days of stopping and recurred [ALT 60 U/L] with restarting flecainide).</i></div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK548023/?report=reader">PubReader</a></li><li><a href="/books/NBK548023/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK548023" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK548023" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Flecainide. [Updated 2018 Jan 24].<span class="bk_cite_avail"></span></div></div></li><li><a href="/books/NBK548023/pdf/Bookshelf_NBK548023.pdf">PDF version of this page</a> (116K)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>New and Updated</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22LiverTox%22+AND+pmcbook&sort=date&size=200" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">In PubMed</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Bulk Download</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://ftp.ncbi.nlm.nih.gov/pub/litarch/29/31/" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">Bulk download LiverTox data from FTP</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Overviews</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/intro/">Introduction</a></li><li><a href="/books/n/livertox/ClinicalCourse/">Clinical Course</a></li><li><a href="/books/n/livertox/ClinicalOutcome/">Clinical Outcomes</a></li><li><a href="/books/n/livertox/ImmuneFeatures/">Immune Features</a></li><li><a href="/books/n/livertox/Phenotypes_intro/">Phenotypes</a></li><li><a href="/books/n/livertox/Causality/">Causality</a></li><li><a href="/books/n/livertox/DrugCategory/">Likelihood Scale</a></li><li><a href="/books/n/livertox/Severity/">Severity Grading</a></li><li><a href="/books/n/livertox/CaseReport/">Writing a Case Report</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Support Links</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/livertox/">LiverTox Homepage</a></li><li><a href="/books/n/livertox/masterlistintro/">Master List of LiverTox Drugs [with Metadata]</a></li><li><a href="/books/n/livertox/drugliverinjury/">LiverTox Drugs by Drug Class</a></li><li><a href="/books/n/livertox/aboutus/">About LiverTox</a></li><li><a href="/books/n/livertox/editorsandreviewers/">Editors and Review Committee</a></li><li><a href="/books/n/livertox/alert/">Meetings and News</a></li><li><a href="/books/n/livertox/abbreviation/">Abbreviations Used</a></li><li><a href="/books/n/livertox/glossary/">Glossary</a></li><li><a href="/books/n/livertox/resource/">Information Resources</a></li><li><a href="/books/n/livertox/disclaimer/">User/Medical Advice Disclaimer</a></li><li><a href="/books/n/livertox/Contactus/">Contact Us</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>OTHER REFERENCE LINKS</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li>
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<a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&pubmedfilters=true&term=(Flecainide/AE)+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D%3A%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Recent References on Flecainide: from PubMed.gov</a>
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<a href="https://clinicaltrials.gov/ct2/results?term=Flecainide" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Trials on Flecainide: from ClinicalTrials.gov</a>
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23(3):733-40. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31643962" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Mexiletine.</a><span class="source">[LiverTox: Clinical and Researc...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Mexiletine.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/6418100" ref="ordinalpos=1&linkpos=4&log$=relatedarticles&logdbfrom=pubmed">[Flecainide: a new antiarrhythmic agent].</a><span class="source">[Arch Mal Coeur Vaiss. 1983]</span><div class="brieflinkpop offscreen_noflow">[Flecainide: a new antiarrhythmic agent].<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Leclercq JF, Coumel P. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Arch Mal Coeur Vaiss. 1983 Oct; 76(10):1218-30. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/6852073" ref="ordinalpos=1&linkpos=5&log$=relatedarticles&logdbfrom=pubmed">A comparison of the antiarrhythmic effects on AV junctional re-entrant tachycardia of oral and intravenous flecainide acetate.</a><span class="source">[Eur Heart J. 1983]</span><div class="brieflinkpop offscreen_noflow">A comparison of the antiarrhythmic effects on AV junctional re-entrant tachycardia of oral and intravenous flecainide acetate.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Bexton RS, Hellestrand KJ, Nathan AW, Spurrell RA, Camm AJ. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Eur Heart J. 1983 Feb; 4(2):92-102. </em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=31643355" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=31643355" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c8df6ea68b6b5afc6eb451">Flecainide - LiverTox</a><div class="ralinkpop offscreen_noflow">Flecainide - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c8df6dab82281a803664db">Flavoxate - LiverTox</a><div class="ralinkpop offscreen_noflow">Flavoxate - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c8df6ca68b6b5afc6ea810">Flavocoxid - LiverTox</a><div class="ralinkpop offscreen_noflow">Flavocoxid - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c8df6bb15b832ebc09907f">Fingolimod - LiverTox</a><div class="ralinkpop offscreen_noflow">Fingolimod - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c8df6af4a390645e2b756a">Finerenone - LiverTox</a><div class="ralinkpop offscreen_noflow">Finerenone - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
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