Flecainide as Pill in Pocket

I've just started taking Flecainide as a pill in the pocket and am amazed at how quickly I revert to sinus rhythm. Could other members who do the same please let me know the dose they take and how long they take it for to make sure that it's really stopped their heart racing. Also do you take other control drugs at the same time? I was advised to take a very small dose of Metoprolol or Bisoprolol alongside the Flecainide.

Many thanks


29 Replies

  • Jean it is nearly ten years ago that I took flec as PIP but then I was on atenalol as well and took 300mg at start of event. NO MORE for 24 hours after that. Sometimes worked for me .--often didn't and EP switched me to propafanone full time. Neither did that very well hence the start of my ablation journey.

    What did the doctor tell you to take? We shouldn't be telling you!


  • Hi Bob - Thanks for your response. I was prescribed Flecainide after my last Ablation 18 months ago and took it for a brief period. Then when I last saw my EP a few months ago he suggested it may help me. As I was feeling so well at that time I said I would give it some thought. Then I read on this site of people taking it as a PIP.

    When my tachycardia kicked off a while back I spoke to my GP and also my AF nurse about taking it as a PIP and they ok'd this, but I didn't think to ask how it should be taken or what dose. I've been taking it, when I have an attack, as originally prescribed 2 x 100mg a day and it works amazingly well. I'm not asking what dose other people are taking to do the same, just out of interest as to what works for other people.

    So please everyone let me know what works for you.


  • I was instructed to wait an hour if I have AF and then take 50mgs of flecainide and see what happens. If there's no joy after a further hour, I can consider another 50mgs.

    When I'm back in normal rhythm, then end of story. I don't take more flecainide. I feel the less I have the better and, three cheers, I don't currently need any on a daily basis. I used to take 150mgs x 2 per day and with hindsight I'd have preferred to stick to a lower dose and take more only if needed.

  • Hi Rellim, that's just how I hope flecainide will work for me. I've only taken it twice so far and it's worked each time. Like you I want to take as little as possible. It's interesting all the different instructions people are given re taking it. How long have you been on this medication and do you take any other tablet alongside it?

  • Short answer - I've taken flecainide for 3.5 years and I take atenolol and losartan. And warfarin.

    Long answer - I started on flecainide after my first ablation four years ago, 100mgs x 2 and it worked wonderfully - but when it was cut down to 50mgs x 2, I had AF again, so I went back to 100mgs x 2 and was AF free for almost a year. Then I had the odd moment and a year or so on I had a 16 hour bout of AF. When I went later to see my GP to ask the question you've just posed, I saw a locum and he said go to A & E if you have AF (!). He set in motion a string of appointments (echocardiogram, 7 day ECG and cardiologist who put me on warfarin (much to my dismay), upped the flecainide to 150mgs x 2 and sent me to an EP. Eight months later I had a second ablation which has been almost completely successful. Flecainde was cut down to 100mgs x 2, then 50 x2 and I haven't taken it routinely since last July. I've had a few trivial bits of AF - it has never been very troublesome - and have taken 50mgs of flecainide on two occasions. The atenolol (have been on it for 11 years) and losartan are for high blood pressure.

  • Hi Jean,

    Until a few months ago I was on 150 mg Flecainide as PIP and could almost set my watch to being back to normal in 2 hours. I took the 150g in one dose and then just waited - it wasn't a case of continue taking them until back to normal. I was on Bisoprolol for a while and then changed to Tildiem Retard, a calcium channel blocker with the same sort of role.

    Unfortunately my AF got worse so I'm now on daily medication but at the time it was nice to know that the Flecainide would get me back to normal.

    NB I also learned the hard way not to go and do a 7 mile walk as soon as I had returned to normal after taking Flecainide as PIP - that landed me straight back in AF! The AF nurse advised that having had an episode and taken the Flecainide, moving around as part of normal living was fine but I shouldn't actively exercise.


  • Hi Caroline - Thanks for your response. After taking my dose of Flecainide I'm normally back in sinus rhythm within two hours too.

    Does the Tildiem Retard keep you in rhythm all the time now? I must say I've not heard of that medication before.

    It's interesting what you say about not doing a long walk after an attack. I will bear that in mind, though I'm usually pretty tired for a few days once my pulse is back to normal anyway.


  • Hi Jean,

    The Flecainide is supposed to prevent or reduce the breakthrough AF episodes, the Tildiem just keeps the heart rate from rocketing when I go into AF. I still get episodes, but instead of every few days, it's now weeks between them (best is 8 weeks so far).

  • Forgot to say that the other guidance the AF nurse gave me was not to take the Flecainide immediately the AF started, but that if I was still in AF after about 30 mins, I should take it at that point (because after 30 mins it is definitely AF).

    As with Bob, once I had taken my 150mg, I was not allowed to take any more in 24 hours.


  • Interesting, thank you for letting me know.


  • As I've said above, I used to take 300mgs of flecainide a day routinely, and would add in another 50mgs if I had AF which was not very often. It annoyed me that on 300 a day, there was not much scope to take extra and I would have liked to have taken less by the day and had more to top up with. And the side effects might have diminished. I was told 400 mgs was my max dose in 24 hours. I once took 350mgs in 6 hours (150 mgs at 11pm and 200 in a slight daze at 5 am when I woke in AF and had forgotten I was taking flecainide at 11 am and 11 pm instead of first thing and 6pm. Sorted me out in no time but I was left with only 50mgs to have at 11 pm. Had a good night, no AF, somewhat to my surprise. I wonder how I would have got on if I had been on a lower dose and PIPed when needed.

  • Hi Jean

    Pleased to hear you have a new medication/treatment regime and I trust it will give you the relief you need and is well deserved. I have not taken Flecainide as PIP as was the original plan but after my last episode I was put on Flec 2 x 100mg per day ongoing.

    l am having my ablation two weeks today (yelp) and will have to be off the meds in advance and the EP hopes if he can blitz my SVT he is going to take me off meds and see what happens. I suspect if it works I will be given Flec as a PIP so as with you I am very interested in the best way to take it.

    When it was first discussed with me my Cardiologist (not EP as I wasn't with one then) said I would really have to be sure it was an AF attack before I took it so not to take it immediately and wait a while to see if it progressed.

    Good luck with your PIP regime.



  • Hi Dee - Yes I'm delighted that Flecainide is working for me - it's like a miracle drug! I take it and then a few hours later my heart is back in sinus rhythm. Quite unbelievable considering my tachycardia used to go on for months. Just wish I'd known about it before.

    Which hospital are you going to for your ablation and are you having a general anaesthetic or sedation? Although my two were sedation, I was very out of it and not overly aware of what was going on. Bob says having a tooth out is worse and I agree with that statement, just wish the process was that quick.

    I think you will find you will feel so much better after your ablation as your attacks have been so severe. I will certainly be thinking of you on that day and awaiting your news.

    Jean x

  • I find that Flecainide does bring you back in NSR, however when I was taking it, my epsiodes of AF actually increased and became more aggressive

    For example had my first AF last Saturday morning for nearly three weeks, was due to play golf so took 100mg of Flec, within an hour back in NSR and went off to golf, same occurred Sunday, same process, but by yesterday evening, as has happended in the past, AF was pretty much full on all day and night, took no more Flec, only my 2.5 Bisopropol and today so far so good.

    Also there have been times back last year when in AF I automatically returned to NSR in under 2hrs without the aid of any meds.

    As mentioned many times over, we are all individuals and its not a one fits all unfortunately.

    Bring on Ablation.

  • Hi Mick and thank you for your response. I have had two ablations which haven't been successful and I've now been told that because of the extensive scarring these procedures have caused in my heart I am not suitable for any more.

    I have only taken flecainide on two occasions over the last month and it worked in stopping my AF and tachycardia. However, when I took it last Saturday evening, it went but then came back far worse the next day. It was one of those sessions when you feel that your heart is trying to get out of your body and flopping around in your chest. I hadn't had such a bad attack for 18 months. So I can agree with you saying it can possibly make attacks more aggressive.

    I rang the heart nurse yesterday at the hospital, where I had my procedures carried out, to talk about flecainide and she went and had a word with my EP. He sent back the message that he is not happy for me to take flecainide as a pill in the pocket (hope my GP doesn't get told off). Apparently some EP's are against it being taken this way, chatting to the nurse she said that the other EP who works there is o.k. with it being taken as a pill in the pocket.

    I've now been put on the list for my EP to call me - wonder how many months I'll have to wait for that to happen!!

  • So pleased for you Jean. Best wishes Dee

  • Hi Jean. I have been taking Flecanaide as a PIP since 2008. Usually after 100 mg AF will be gone in 2 to. 6 hours, if still in AF after 6 hours I will take another 100 mg, usually AF gone after 2-3 hours. Last year had 34 hours of AF after taking 200 mg of Flecanaide, no effect , then to A&E , on the trolley to theatre for cardioversion I spontaneously reverted to SR. I am not on any other medications, except Magnesium tab. and probiotic. I have no problems with weight, Blood pressure or any other health problems. Have allergies to MSG and other preservatives. Now I am on the list for ablation in Melbourne , Cabrini Hospital, not 100 percent sure if I Am ready for it. I fell that more Flecanaide , more AF. All the best Jean.


  • !!!!!!!!!!!

  • Sorry MS444, but I'm afraid I think the procedure you have suggested is extremely unwise and dangerous.

  • Hi Ewcia - Thank you for your response. I have had AF for around 9 years and like you I avoid all artificial preservatives and sweeteners. I try to eat only natural foods and discovered many years ago that artificial sweeteners triggered my AF.

    I have only ever taken Flecainide as a pill in the pocket on two separate occasions recently. However, I did notice that my second attack of tachycardia was far worse than any other in the last 18 months. It was one of those ones where it feels like your heart is trying to get out of your body, if you understand that feeling. I now have a little voice in my head saying was this triggered by taking Flecainide the day before.

    I can be in AF with tachycardia for up to 2 months at a time and usually have to have a cardioversion to bring it back to normal sinus rhythm. I have had two ablations and they haven't worked for me. I've been told now that, because of the extensive scarring these procedures have caused in my heart, I'm not suitable for further ablations.

    Do you find that taking magnesium helps with your AF? I took it for several years, but it made my stomach very sore (took me a long time to find out magnesium was the cause).

    It's such a big step to agree to an ablation, so I understand your concern. I can only say that on the whole for me they didn't work, but have helped a little with regards to the fact that my heart no longer hammers away when I climb hills and I find them easier to get up.

    Best wishes.


  • Thanks a lot Jean for sharing your story with me. I take 2 tabl of magnesium a day, have no pain in my stomach just a lots of belching (which could be just mine digestive system problem).

    Keep well.

  • Hi Jean, I take flecanide 100mg daily and then a 200g dose in one go to revert back to sinus if I go into AF. I will revert back within 2 hours. I used to take it daily and then take extra 50mg flecanide at intervals which then took up to 24 hours or longer to work. I also take bisoprolol. I had my ablation in January so hoping to come all these drugs :)

  • Thank you for your response Kiwi2. It's always good to hear how others get on with a drug. I do hope you make a full recovery from your ablation.


  • Hi Jean, I take 100mg pill when I need to. This isn't very often since my ablation 7 years ago. It is just a back up option and gives me confidence just knowing I have it.


  • Hi Jackie - Thank you for your response. I'm glad flecainide helps you and yes I think sometimes just the reassurance of having a pill that works can keep us well. I always feel extremely well leading up to my EP appointment, but once that day goes it's all down hill!!


  • Hi Jean I posted to you yesterday but it didn't stick??

    I took 300 mg and it usually worked within 3 hours, I tried waiting an hour before taking it but it never reverted to NSR so I found the sooner I took it the better and quicker it worked, but as someone else said, not within an hour of having food, before or after. I found the efficacy starts to reduce over time (years).

  • Hi CDreamer and thank you for your response.

    I managed to get a message to my EP yesterday via my AF nurse and he has said he doesn't like me using this method of taking Flecainide and I'm on his list for a telephone consultation. It seems that the other EP at the hospital is ok with flec as PIP but not mine. Hope my GP doesn't get into trouble.


  • Hi Jean, I take 2 x 100MG a day, so technically not PiP. I did cut back to 1 x 50MG a day and that worked for a good few weeks, but the episodes started to creep back, however 2 x 100MG in one go at the start of an episode sorts me out in about 90 minutes, which is better than it used to do. Up until just before Christmas, I would have episodes lasting anything up to 4 days. Flec is all I take (Other than Warfarin), as my heart rate only goes to about mid 70's during an episode with a normal resting HR of about 52.

    Glad to hear this works for you. Even though we still have the episodes when the Flec is working it's not that much of an inconvenience, well in my opinion any way.

    Take care,


  • Hi Jason and thank you for your response. I managed to get a message to my EP yesterday via my AF nurse and he has said he doesn't like me using this method of taking Flecainide and I'm on his list for a telephone consultation. It seems that the other EP at the hospital is ok with flec as PIP but not mine. Hope my GP doesn't get into trouble.

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