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A boy aged 8 years 3 months developed flecainide toxicity following reduced milk intake.
The boy, whose history included innocent murmurs, a postulated benign form of acrocyanosis or Raynaud's phenomenon and supraventricular tachycardias (SVTs), was started flecainide therapy around 5 years of age. Flecainide was started at 45mg (2 mg/kg/dose) twice daily [route not stated] as a maintenance antiarrhythmic. At that time, he weighed 21.5kg. He received routine therapeutic drug monitoring, and his flecainide concentrations were persistently subtherapeutic. At 7 years of age, he experienced three episodes of SVT and was treated with adenosine. His family confirmed good medication adherence...