Flecainide Acetate and Selegiline Hydrochloride

• Generic Name: flecainide
• Dosage Forms: n.a.
• Other Brand Names: Tambocor

Suppression and prevention of recurrent ventricular arrhythmias (e.g., sustained VT) that, in the clinician’s judgment, are considered life-threatening. (See Boxed Warning.)

Because of arrhythmogenic potential and associated risk of death, use of flecainide for less severe arrhythmias (e.g., PVCs) not recommended.

No evidence that use is associated with beneficial effect on mortality or sudden death.

Prevention of paroxysmal supraventricular tachycardia (PSVT), including AV nodal reentrant tachycardia and AV reentrant tachycardia (e.g., Wolff-Parkinson-White syndrome); other symptomatic, disabling, supraventricular tachycardias of unspecified mechanisms; and symptomatic, disabling paroxysmal atrial fibrillation/flutter (PAF) in patients without structural heart disease.

One of several drugs that may be used for ongoing management of PSVT in patients without structural or ischemic heart disease; however, because of adverse effects, use generally reserved for patients in whom other therapies (e.g., catheter ablation, β-adrenergic blocking agents, diltiazem, verapamil) are ineffective or contraindicated.

Considered a drug of choice for pharmacologic cardioversion of atrial fibrillation or flutter.

May be used for ongoing management of other supraventricular tachycardias (e.g., focal atrial tachycardia, junctional tachycardia).

Because of risk of proarrhythmia, do not use in patients with structural heart disease or ischemic heart disease.

• Generic Name: selegiline
• Dosage Forms: n.a.
• Other Brand Names: Eldepryl, Zelapar, Emsam

Used as adjunctive therapy for symptomatic treatment of parkinsonian syndrome (e.g., parkinsonism, Parkinson disease [paralysis agitans]) in patients who exhibit a deteriorating response to levodopa/carbidopa; designated an orphan drug by FDA for this condition. Appears to be most beneficial when used during the early stages of the “wearing off” effect. Especially useful in improving “end-of-dose” motor fluctuations.

Has been used as monotherapy in patients with newly diagnosed parkinsonian syndrome. Because selegiline is well tolerated and possibly neuroprotective (i.e., reduces the rate of progression of parkinsonian syndrome ), some clinicians initiate therapy with selegiline in such patients, reserving levodopa or another agent (i.e., dopamine agonist) until manifestations become severe enough to warrant more aggressive therapy. However, the manufacturers state that there is no evidence from controlled studies indicating that selegiline provides benefit in the absence of concurrent levodopa therapy.

Has been used with equivocal results for the palliative treatment of mild to moderate dementia of the Alzheimer’s type (Alzheimer’s disease, presenile or senile dementia).