About Flecainide

I'm awaiting ablation and have been prescribed Flecainide as a 'pill in the pocket' should I have any AF episodes. I used it for the first time yesterday and it was certainly effective? Around 40 minutes after taking 200mg I was back in NSR. My question to those with experience of 'pill in the pocket' use of Flec: I understand that it doesn't work for everyone but for those it does work for - has your experience shown it to be consistent or is it pot luck or perhaps its effectiveness tails off in time. I'm only talking about 'pill in the pocket' use - those on regular daily dosages will inevitably have different experiences.

I have a long-distance walk coming up at the end of April and a badly timed AF episode could scupper my ability to be involved. I'd like to be at least fairly confident - now that it's been shown to work for me - that should sod's law comes into play, I could pop a Flec and end the AF episode as quickly next time.

9 Replies

  • I have used it twice as a pip. My AF stopped it about 30 mins.

    I had had different accounts of how to use it. I was once told that 2.5 Bisoprolol plus 100 Flecainide was the best and my EP seemed 0K with that when I asked recently.

    I read on this site that you should wait for 2 hours before taking a pip to ensure that the AF was established. This ties in with it being best to take Flecainide on an empty stomach.

    My rule is to always, always, have the Flecainide with me. I have some in my wallet, some upstairs, some in the kitchen.

  • Regardless of how long it may take to revert you the point regarding effectiveness really depends on the AF. As we know, AF always progresses and it was explained to me that when people find that Flecainide no longer works, it is not the drug failing but the AF getting worse. There are no receptors in the body for flec in the way that there are for a narcotic drug so the body doesn't get used to it and need more. It either works or it doesn't depending on the severity of the AF.


  • Hi PIP flecanide user, like you I used to dose with flecanide as PIP for about 2 years, in my case I would find that at some time the episodes would be regular enough to make the PIP dose greater than a low regular use.

    However, as most of the episodes were during relaxed or sleeping time I found that walking / cycling or general activity were not affected.

    Strenuous work periods would often be the most likely time to have ectopic beats follow if not a full blown episode to use PIP.

    I have now had the ablation treatment and been medication free for 2 months with no episodes and much reduced ectopic beats / missed beats.

    Good luck with the walk.


  • I like the sound of what you're saying, anticoagulatenow, and taking 200mgs is what I would like to do. However, it isn't in accord with what I was told to do now that I'm no longer taking flecainide routinely - i.e if I go into AF, wait an hour and if there is no cessation, take 50mg of flecainide and if no joy, take another 50mg an hour after the first. Presumably I fit in eating around this. I don't know if I'd need to continue in that fashion as I have reverted to NSR both times I have taken the 50mg - so perhaps it's enough. But I have also reverted to NSR without the aid of flecainide and I now feel much less dependant on it. But I do feel, perhaps wrongly, that a good slug of the stuff should sort things out better than taking a bit and then a bit more later.

    I think you have to test the water and learn what works for you. Before ablation, I sometimes found extra flecainide worked well on top of my usual dose and sometimes it didn't and I got peeved an hour's AF later and took more and then AF would stop within minutes. Had I not waited long enough or had the second dose done the trick?

    When I was taking 150mgs twice a day routinely, I felt I had little scope to hit any AF with extra flecainide and feel with hindsight that I would have done better to have stuck with 100mgs x 2 and an extra 100mgs or more when needed to surprise my heart into NSR.

    The benefits of taking a low routine dose topped up in a way that zaps AF instead of taking a higher dose in the hope of controlling AF is something I'd raise at Patients' Day. I regret taking so much flecainide and wish my ablation had been a year earlier than it was.

    I'm really pleased to have been able to give flecainide up. I frequently go out without taking any with me, unless I'm going far from home. I still get a bit of AF very occasionally.

  • I used Flec as a PIP for about 5 years very successfully 300mg stopped AF within 60 mins usually. And then my AF progressed so that wasn't possible as I was getting several episodes a week and I went onto daily dose until my ablation.

  • Hi, i was on 150 flecanide daily and then would take a 200mg stat dose if in AF. It would take 90-120 minutes to go back into sinus rhythm and it did always work. If i didn"t take it in one hit the AF would take over 24 hours to stop. Have now had an ablation and hopefully AF free :)

  • Thanks to you all for your comments.

  • I was PIP in the pocket for a few years and I think retrospectively that I often had it feeling odd but did't take anything as don't know/monitor things like I do now.

    However things were taken out of my hands 12 months ago when I had 9 episodes in a month and the cardio said better to go on a regular dose now as important to stop it all together as the more you have the more you are likely to get, even if PIP puts you back in NSR.

    Started on 100mg/day of Flec - no good, upped the dose to 200mg/day and coupled with a lot of lifestyle changes I haven't had an episode for 12 months. No side effects apart from I feel I am only operating at 70% capacity.

    Hope that helps your decision.

  • I am on Flecainide as Pill in Pocket,carry the dose 300,with me at all times.

    Was told by Cardiologist to give the AF 10 mins,then take them.

    If I wake up from sleep and don't know how long AF has been going,I take

    dose right away,it can take about 40mins to 2hrs to go back to rhythm.

    It works for me every time,coming 3yrs now,have AF 16yrs,must say I

    Feel very confident on this medication.

    Hope it helps you too.


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