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  6. Flecainide Pill in the Pocket (PITP) (1185)
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Flecainide Pill in the Pocket (PITP) (1185)

To be used only on specialist cardiology advice 

Some patients may present with episodes of recurrent atrial fibrillation (AF) infrequently and are haemodynamically stable but remain symptomatic enough to require attendance to Emergency Department or hospitalisation.

After their initial presentation to secondary care, Pill in the Pocket (PITP) strategy for flecainide can be prescribed on discharge as a strategy for prompt restoration of acute onset AF back to sinus rhythm without the need for emergency room intervention. PITP is based on single self-administered dose of flecainide in patients with infrequent symptoms.

Flecainide PITP should ONLY be initiated by Cardiology specialists in secondary care. It may be started in selected patients who have not had flecainide an as inpatient if deemed suitable by the Cardiology specialist. Flecainide PITP should NOT be used in patients with significant coronary heart disease or structural heart disease.

PITP strategy has only been studied in specific class 1c antiarrhythmic drugs in AF. It should not be used for other drugs for other arrhythmias.

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Editorial Information

Last reviewed: 20/12/2024

Next review date: 31/12/2026

Author(s): Bik Yun Chai, Katarzyna Nowak.

Version: 1

Author email(s): katarzyna.nowak3@nhs.scot.

Approved By: Safer Use of Medicines Subcommittee of ADTC

Document Id: 1185

References
  1. European Society of Cardiology. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal (2024) 45, 3314–3414.
  2. American College of Cardiology. Markman TM, Jarrah AA, Tian Y, et al. Safety of Pill-in-the-Pocket Class 1C Antiarrhythmic Drugs for Atrial Fibrillation. JACC Clinical Electrophysiology 2022;8:1515-1520.
  3. Alboni P, Botto G, Baldi M, Luzi M, Russo V, Gianfranchi L et al. Outpatient Treatment of Recent-Onset Atrial Fibrillation with the “Pill-in-the-Pocket” Approach. The New England Journal of Medicine 2004;351:2384-2391.
  4. Electronic Medicines Compendium. Summary of Product Characteristics - Flecainide 100mg tablets. https://www.medicines.org.uk/emc/product/3086/smpc.