Flecainide and Ritonavir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ritonavir
Flecainide
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased flecainide exposure and an increased risk of cardiac arrhythmias
Interaction Deep Dive
Concurrent use of ritonavir and flecainide is contraindicated as it may increase flecainide exposure which has the potential for cardiac arrhythmias12.
Why it happens (mechanism)
Inhibition of CYP2D6-mediated metabolism of flecainide
Common questions
Can I take Flecainide and Ritonavir together?
Increased flecainide exposure and an increased risk of cardiac arrhythmias Always confirm with your pharmacist or prescriber before making any change.
How serious is the Flecainide and Ritonavir interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Flecainide or Ritonavir need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: PAXLOVID(TM) oral tablets, nirmatrelvir oral tablets, ritonavir oral tablets. Pfizer Labs (per FDA), New York, NY, 2025. DailyMed
- Product Information: NORVIR(R) oral tablets, oral solution, oral powder, ritonavir oral tablets, oral solution, oral powder. AbbVie Inc (per FDA), North Chicago, IL, 2019. DailyMed
Keep reading about Ritonavir
Keep reading about Flecainide
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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