Flecainide Dosage

Hi, I would like to gauge a response from people out there who take Flecainide, either pill in the pocket or daily dosage. I have recently had my dosage increased to 2 x 100mg daily and I don't think it is working. I'm still getting an episode once a week like clockwork. When you guys have an episode and take Flec as "A pill in the pocket", how long would you expect it to curb an episode? I appreciate everybody is different and we all react differently, but would you expect it to be a matter of hours opposed to say 36 hours? Also, if you are on a daily dosage and you have an episode and take additional Flec, would you again expect it to cease the episode swiftly?



23 Replies

  • Maximum dose I was told you can take is 400mgs but Flecanide only has a short life so I would expect it to kick in around an hour or so of taking it however I'm not recommending you take this. When I took Flek 300 mgs a day (via my GP) it gave me awful visual disturbances. My EP reduced this to 200mgs but I got by on 100mgs but only because I had a structurally normal heart. Now I've been ablated I had only two veins firing.

    When I first got my pill in the pocket I ended up escalating my dose too 100 mgs at night myself. Now Im taking it 100mgs bd but only on the advice of a medical professional.

    It takes a while for it to settle into your system. If I did have a funny episode I found taking an extra 100mgs knocked it back into NSR.

  • Thanks Loo. My dosage was upped to 100mg twice daily and when I have an attack I can take an extra 100. The reason I ask is because I don't think Flec is working for me. When I increase the dosage as per my Doctor's recommendation my episode still goes on for up to 40 hours. I would have thought the increased dosage should have pulled me out.

  • Time to try a different drug ---Propafanone maybe.?


  • If you still have AF an hour or so after taking a top up dose then either you haven't taken enough or it's not working.

    Jason, I would discuss with your GP taking more than an extra 100mgs as a top up (as you are currently only going up to 300mgs in a day) rather than increasing your regular dose. It is my view that the less flecainide you take, the better and I regret taking 150 mgs twice every day. I think I would have done better on a lower dose with scope to get rid of any AF with a good clout when needed.

  • I have an appointment with the Cardiologist in a months time and have everything written down. Time of episodes, length of episodes, what I was doing prior to the episodes, etc. These are all points for discussion. In the meanwhile if I have another attack this weekend I will be on the phone Monday morning to give them an update. On the plus side over the past 4 weeks I have never eaten as healthy, not touched a drop of beer and I'm down to Cruiserweight, which is something I haven't reached for several years.

  • AF is a great thing for making us toe the healthy drinking and eating line!

  • I used to take 150 mg Flec pill in pocket and found it worked after and hour or so. However most of the time I did not take flec at all preferring to stop the episodes by exercising, but this only worked in the morning.

  • Thanks Bob & Ben. When I take my increase of Flec it certainly doesn't go within the hour. It takes anything from 6 - 40 hours. Could well be a time for a change.

  • Agree Bob Flek is not for everyone :-!

  • Flecainide doesn't work on me and in fact gives me mild palpitations unless a very low dose. EP changed me over to another drug. I'd ask for something else, it clearly isn't working.

  • I think that' s what I'm going to have to do Koll. I suspect the frequency of the episodes would indicate the Flec has no effect and am increased dosage doesn't appear to improve things. Initially I had no issues with the lower dosage and had two months AF free, however I don't know how much of that could have been down to the Amiodarone still being present in my system.

  • I was put on 300mg a day as like you I was getting breakthroughs about once a week on 200 a day. This completely dealt with the A.F. but gave me the same visual disturbances as Loo. I reduced the dose to 100 a.m. and 150 pm and the A.F. is still at bay and the visual disturbances are less but not gone. Because of this my E.P. has put me on the waiting list for an ablation. The trouble does seem to be that in order for the dose to be effective the chances of bad side effects are greater, for me at least. X

  • I started with 100mg flecanide as pill in the pocket and my episodes went on for up to 24 hours so didn't work very quickly. I am now on 150mgs daily and take one at 7am, 5pm and 7pm and feel I get fewer breakthroughs as they are spaced out and cover me better. If I do go into AF I take a 150mg stat dose which settles it now within about 5 hours. I am also now on the waiting list for ablation as feel so bad when in AF.

  • When I was PiP I was taking 150mg flec each time an episode occurred. The longest episode as a result was then around 10 hours. But as this didn't stop them happening, I changed to 150mg twice a day. This stopped AF completely.

    I've had an ablation now so will stop flec in two week's time. As Bob has said, maybe you need to try something else. Or maybe up your dose?

    After reading some of the other replies, I realised that the visual disturbances I get when I'm tired may be as a result of flec. Happy days.

  • I had 9 episodes in a month on 100mg per day with an otherwise normal heart etc, upped it to 200mg and episode free for 4 months and counting with very careful management of known lifestyle triggers- EP still recommends ablation.

  • I was fine on 200mgs a day for a couple of years and then AF crept in and my dose was 300mgs a day and it still didn't control it. I now don't take any flecainide - the dose was dropped to 200 immediately after my ablation four months ago, then reduced again to 100 after 6 weeks and I've had no flecainide at all for the last 3 weeks.

  • One thing I never really had prior to taking Flec was triggers, not really anyway. Coffee, alcohol and bad food weren't that much of an issue. Dehydration did however cause me issues, but I was on Amiodarone at the time. Cold drinks are definitely a trigger. Three times drinking a cold drink (Non alcohol) have set me off, which can be a pain in the rear with the nice weather we have been having.

  • My experience of flecainide started 18 months ago, when I persuaded my gp to let me take it continually for a month so that I could hopefully stay well for my son's wedding. I had 50mg x 2 daily. It worked, and I was actually af free for 10 weeks. My gp wouldn't let me stay on it, and it was a year later that I sort of insisted that I would like to take it permanently, and she got me a consultant appt. That was ok, and I have been on 50mg x 2 daily since April.

    Sadly, it hasn't worked so well this time. I am still getting af about twice a month, but the nature of the episodes has changed a lot. They last a bit longer, up to 4 hours, and they are so mild that I can hardly notice when they start and stop! What's more, I can work through them. I had af during a wedding tea recently, but managed to eat everything, and join in the dancing afterwards! (The episode had passed off by that time - I doubt I could dance whilst in af!) That would have been impossible at one time. When I get an episode now, I will take 50mg flec straight away, and then maybe miss the next regular dose as I probably don't need it. I have never had an episode end quickly after a pill, it usually goes on for a couple of hours, and it has been like that when I was taking it as 'pill in pocket'.


  • Hi Jason,

    You will find many who are perfectly happy - and for several years. My first positive experience was when they injected me with Flecainide IV , 100 mgs. I cardioconverted within 15 minutes.

    I then went to daily, and didn't like the feelings and asked within days to go to PIP. All ok, used that method for the last year until the 1st ablation. Post ablation I was in much worse AF and more often, hence and put on Fleca 2x100mg per day. I weaned myself lower to 50mg 1xday and things improved in terms of breathlessness and energy. The Afib did not, so 2nd Ablation. I am now back on PIP, though it doesn't seem to work for me anymore. I used to convert within 2hours at the most. Now it takes 6-7 hours and I don't actually think it is the flecainide that does it...

    In my case I believe the Flecainide made my Afib worse over time. Such is particular to me in any case.

    By the way since I have rapid AF (150-210+) so I need to combine it with 25mg of Metoprolol.

    Just one more experience for your notebook! Hoping you find the right combination soon,

  • Hi Iris, I like you don't think it works for me. My last episode was 39 hours, so any additional Flec I was taking couldn't have worked. I think I was going back into NSR myself. I've not increased my dosage, but I have been experimenting with the times I take it. Cold drinks are a trigger for me, so I'm avoiding them. Here's to an AF free weekend.

  • Well as expected my weekly episode arrived yesterday. I took 200mg as PiP, but it didn't put me back in NSR. It did however lower my pulse rate to around 78, but it was very erratic. I took another 150mg this morning and about 50 minutes later I was in NSR.

    I contacted my Cardio's secretary to inform them of the developments and about an hour later I got a call from him. We had a good chat for about 10 minutes and without any prompt from me he decided to refer me to an EP with a view to an ablation. I'm happy to take this route knowing full well it's not forced to work first time and it's not without risks, but if it does and I can start to plan things on a weekend again it will be worth it. I was due to take part in the Tough Mudder yesterday, but there was no way I could run through fields, submerged pipes and swim in lakes whilst in AF.

    I'm not sure how long the process from referral to procedure takes, not that swift I guess, but at least I'm heading in the right direction.

  • I think you're right to go for the ablation given that it is ruling your life/weekends especially.

    I wonder why it only comes at the weekends for you?

    Do you have a hectic week and then relax at the weekend or vice versa? Or is it to do with sleep, having more or less at weekends?

    Or a beer/glass of wine?

    As for flecainide, I've been prescribed it PIP. Not had to take it yet but my EP said to take 1x50, then another after half an hour if it hasn't worked! Reading all the above doses, it seems like a tiny dose which probably wouldn't work anyway.

    I'm also scared to take a first dose outside of a medical environment.

    Good luck to you with your referral Jason.

  • Thank you for the good wishes. I really can't put a finger on why it comes at a weekend. It's been 8 weekends on the trot now and I honestly couldn't say why, although once a Friday comes I now start to feel a little anxious which probably doesn't help. Certainly for the past 5 weeks my diet has been excellent, I've steered clear of the booze and carried on with my exercise. I could kind of understand if the episodes happened on a Sunday, as that is the day I do relax, however they don't, 3 on a Sunday, 3 on a Saturday and 2 on a Friday evening.

    I haven't had any issues taking the Flecainide daily (100mg twice a day), however when I have taken an increased dosage during an episode I have felt pretty "Spaced Out" on a couple of occasions. I don't have any problems taking medication and reading about other peoples experiences with Flecainide the majority are very good. It just doesn't look like the one for me. I used to be on Amiodarone which is a very potent drug and it kept me in NSR with no side effects, however it's not really one to be taken in the long run.

    Hopefully you won't have need to take PIP, fingers crossed :)

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