Reducing Flecainide dose

Has anyone had their dosage of Flecainide reduced successfully in the absence of episodes?

I have taken 2 x 100mg daily for 7 months and have been arrythmia free. I am following a strict health diet and exercise regime and would love to suggest to my EP at follow up (in about 6 months) that perhaps it could be reduced. But ....... does the heart get 'used' to the higher dose?

Any experiences, good or bad, would be most welcome.

18 Replies

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  • there are no receptors for Flecainide so the body can't get used to it. Addictive drugs have receptors which multiply when you take them so that you need more etc but Flec is not like that. People often say that flecainide stopped working for them but this is not what happens. AF gets worse so the flec isn't able to control it.

  • Thanks Bob - my thinking is that if and when it gets worse, I don't have much wriggle room on 200mg per day.

  • Exactly what my cardiologist said last week. He was happy for me to reduce the dose to 150mg/day taken in three doses of 50mg in his words to give us more capability to increase the dose if it came back. Not sure whether that's good news or not!

    Incidentally, my pulse seems to be reducing on 200mg, it went down 4 points to 56 at the start 12 months ago and recently it has dropped another 4 points?!

  • Hi Finvola, about Mid-December my episodes started to subside after weekly runs of AF. I believe that was down to a thyroid issue I had being treated successfully. About Mid January I decided to self medicate, now I do not and would not advise this, the only reason I did was because I had my ablation coming up and I thought I had nothing to lose. I dropped from 2 x 100MG a day to cutting a 100MG in half and taking one half in the morning and one in the evening. I did this for about 4 weeks and things went OK, then one week I had three episodes in a week all be it for an hour or so. I went back to my original does and didn't have an episode on the run up to my ablation.

    I had a friend who after months of having no AF reduced his Flec, but within a short period he was having plenty of episodes.

  • Interesting Jason - although I wouldn't fiddle with the dose myself, I can understand why you tried it. Hope the ablation gets rid of the need for it at all for you.

  • The cardiologist speaker at B'rum last year who had had AF when young through over exertion and got himself off them said to me afterwards he would advise staying on Flec for 2 years. Of course there are your individual circumstances but it can be done, maybe just if you are young.

  • I would suggest you do just that - ask your EP, I’m sure they’ll have an informed opinion and be able to advise. It's what I did when wanting to reduce/stop Propafenone 3 months after ablation and he has given me that option, with a proviso of monitoring.

    I have been on 150mg twice a day (with a flex option up to 4x150mg a day if that doesn't control it) since last summer. I have been on 2x mostly with occasional periods of 3x a day to date.

    I have tried twice in the last month to cut out the evening dose for a couple of days (as I suspected it might also be reducing heart rate slightly and this is obviously lower overnight). However I have been symptomatic on those days and have reverted back to the 2x150mg a day for now.

    Propafenone and Flecainide are both the same class of anti-arrhythmic drug.

    Good luck.

    Jo

  • Thank you Jo. I am thinking of suggesting to the EP that, as my episodes only ever happened during waking hours, to try and cut to 1 x 100 morning and 1 x 50 evening and see what happens.

    I hope you can manage to reduce your dose too.

  • I suggested to my cardio that as my episodes were always late pm/evening/night I go onto 50mg morning and 100mg late afternoon; he said better to smooth it out with 50mg three times a day.

  • Many thanks, orchardworker, you have raised several interesting points - all noted for my EP follow up. Regarding HR, mine used to be around 72-ish resting, even on Bisoprolol and now is in the mid sixties.

  • Hi Finvola I take 2x100mg daily and have been symptom free dor 6 months. This morning I woke at 5.30am with flutters and feeling unwell. Went to GP who sais bp and pulse were ok. Pulse was rather low though. Now stomach upset and coated tongue along with constant trips to the loo from 5.30am til 11,00am. Don't know what was wrong? Does anyone?

  • Hello joholl - I would suspect either a bug or something you've eaten disagreeing with you - certainly any stomach upset always goes straight for my heart, too. Hope you are feeling better.

  • My pulse is lower and I have a coated soarish, swollenish coated tongue. At present I tested for poor gut bacteria so taking probiotics but maybe Flec has some influence on this issue.

  • I had my flecainide reduced from 100mgs x 2 per day to 50mgs x 2 as I was AF free and within 4 days I had AF again! I ended up taking 150mgs x 2 per day for 8 months and regret taking such a large dose for so long.

  • Oh dear - only 4 days. That was disappointing. I remember your warning about the larger dose of Flecainide and how it made you feel.

  • Yes, with hindsight I would have preferred not have been on 300mgs a day. I'm really pleased not to be taking flecainide any more. Apart from anything else, it's nice to be able to eat at any time of the day!

  • Pre-ablation I was taking 2x100 Flecainide daily. Now I am on 2.5 Bisoprolol just to help my damaged heart. I have to take 1x100 Flecainide on two occasions as a pill-in-the-pocket. I am amazed at how quickly it works - within half an hour. On both occasions I waited 2 hours to check how established the arrhythmia had become and also to ensure that my stomach was empty. I never go anywhere without these amazing tablets!

  • That sounds positive, jennydog and I'm happy for you that things have improved so much. Flecainide has really changed my life for the better - fingers crossed. Your post has given me food for thought too. Perhaps a slight dose reduction plus PIP just in case might work. :)

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