Drug interactions
Flecainide + Rolapitant
Severity: Major
Flecainide and Rolapitant: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Flecainide depends considerably on CYP2D6 for clearance and has a narrow therapeutic index. Inhibition by rolapitant can raise flecainide concentrations for weeks and increase the risk of conduction block and proarrhythmia.
What this interaction means in plain words
Flecainide and Rolapitant can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Flecainide belongs to Cardiovascular; Rolapitant belongs to Gastrointestinal Tract.
Why it happens
Rolapitant inhibits CYP2D6, decreasing the metabolic clearance of flecainide.
What to do
Avoid the combination if possible, or monitor ECG (PR and QRS intervals) and flecainide plasma levels. Lower the flecainide dose as needed, and remember the effect persists for weeks.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Rolapitant
- Pimozide + Rolapitant Contraindicated
- Rolapitant + Thioridazine Contraindicated
- Atomoxetine + Rolapitant Major
- Deutetrabenazine + Rolapitant Major
- Eliglustat + Rolapitant Major
- Fosphenytoin + Rolapitant Major
Other interactions of Flecainide
- Flecainide + Nirmatrelvir Contraindicated
- Flecainide + Nirmatrelvir / ritonavir Contraindicated
- Flecainide + Pimozide Contraindicated
- Flecainide + Ritonavir Contraindicated
- Flecainide + Thioridazine Contraindicated
- Flecainide + Tipranavir Contraindicated
Frequently asked questions
Can I take Flecainide with Rolapitant?
MediHelp rates the interaction as major. Flecainide and Rolapitant can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Flecainide depends considerably on CYP2D6 for clearance and has a narrow therapeutic index. Inhibition by rolapitant can raise flecainide concentrations for weeks and increase the risk of conduction block and proarrhythmia.
How serious is the interaction between Flecainide and Rolapitant?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination if possible, or monitor ECG (PR and QRS intervals) and flecainide plasma levels. Lower the flecainide dose as needed, and remember the effect persists for weeks.
What other medicines interact with Rolapitant?
MediHelp also lists interactions of Rolapitant with, for example, Pimozide, Thioridazine, Atomoxetine. The full list is on the Rolapitant page.
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