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AF Association
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How soon do you take PIP Flecainide once AF starts.

Just wondering what interval you leave between AF starting and taking your PIP Flecainide for those of you on that regime.

My cardiologist (I've now been discharged ) having been prompted by me as I stood by the door to leave

said about 10 minutes.

I'm probably tempting fate to say I haven't had an 'episode' since February.

When I do, it takes about 7hrs or so to revert back to NSR.

The combination of the drug and AF leaves me feeling totally washed out for a day or even two.

I've often wondered if I left it for a while would it revert back ok.

What advice did your cardiologist/EP give you.

Any feedback gratefully received.

Jo

36 Replies
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I've only been on PIP many years ago and I took pills (not Flecainide though) as soon as it started or even before if I could feel something stirring! I wasn't taking many though, just very occasionally.

Koll

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Yes I know that makes sense...I'm overthinking things.

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I tend to agree with Koll. As soon as you think you may be having or about to have an event take it. Why wait?

Bob

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Agree, just wishful thinking on my part.

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Hi Jo - I take Flecainide as a PIP and my tachycardia can last for months if not checked by this pill. I try a few breathing exercises first and if that doesn't work I take 1 x 50mg it usually starts at a rate of 180bpm. If after say 1.5hrs it isn't back to normal I take another and around 3hrs after it started my heart rate will usually have reverted to normal.

Flecainide has been my wonder pill, before going on this my heart would keep racing until I had a cardioversion and during that waiting time I would be stuck with a heart rate of a continuous 130bpm which was quite disabling.

Like you I feel a little drained for a few days afterwards.

Jean

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Hi Jean

I've been prescribed 150mgs straight off for an AF attack with the proviso to repeat 12 hrs later if required (haven't had to ) suppose will have to accept the consequences of the medication......sometimes just sometimes this pill popping becomes tiresome.

Jo

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I hate taking any pills! Which is why I've gone for PIP.

Talking to my EP on phone tomorrow. I bet he'll try and get me to take Flecainide all the time. He doesn't like it taken as PIP.

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Will be interesting to hear what EP says, wonder what his objection is to PIP ?

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Just to let you know, my EP got his new AF nurse to ring me the other day (not him). I was so disappointed as she didn't appear to be very well informed. Was a complete waste of time really. She didn't know why my E P doesn't like Flec as a PIP.

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When I was told to stop flecainide, it was suggested that if I had AF I should wait an hour and then take 50mgs and a further 50mgs an hour later if needed.

I have taken 50mgs three times since last July with a cessation of AF within an hour. I have had AF a few other times and have not bothered with flecainide as it really wasn't much of a bother and I've returned to NSR spontaneously. I don't feel washed out by AF.

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Thanks for replying, seems there is a variation on what people are instructed to do.

Jo

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I think that's across the board.

When I took 100mgsx 2 of flecainide on a daily basis I used to add 100mgs to my usual morning dose if I woke with AF. This wasn't really the best when my daily dose went up to 150mgs and I wish I had stayed on 200mgs a day and used extra only when needed.

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I am very impressed with flecainide as a 'pill in the pocket' which I have while awaiting an ablation (quite soon I'm told following postponement last Friday because of complications with the fellow ahead of me).

Using the drug as a 'pill in the pocket' I was told to wait 2 hours after an episode starts but I confess I didn't ask why. Perhaps the idea of at least a short wait is to allow for the episode to end itself - I don't know. But I have found the drug incredibly effective, halting episodes in 40 to 60 minutes every time with no adverse side effects at all. It makes me wonder why this is not the first call to arms instead of an electro-cardioversion. I had one of those some months back and while it worked fine it was all a bit of a palaver (appointment, wait, admission, anaesthetic, recovery, discharge etc) when 200 mgs of flec would have done the job at home quicker than it takes me to get to the hospital.

I'm sure there's a reason....there usually is!

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How frustrating for you AN - all prepared and then no joy. Hope you don't have long to wait.

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Thanks Relim. Disappointing certainly but these things happen - there's always folk worse off......like the chap ahead of me. Interestingly, they've suggested that sedation rather than general anaesthetic will get me slotted in sooner so I've gone for that. I hope that wasn't a mistake!

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I've no complaints about sedation .... and nothing unpleasant afterwards. I found it as good as oblivion, although it all looked fascinating and then, a bit annoyingly, I woke up hours later. But they use an amnesic and one wonders - well I do - if one has babbled liberally and inappropriately.

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Thanks for replying.

I was beginning to question whether I should be taking PIP straight away or wait...but ? how long.

Now I'm wondering if my initial dose is high enough as it takes 7hrs plus to revert to NSR,

Lots to ponder on ,

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Anticoagulate - Do you take your 200mg of flec in one dose?

Jean

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Yes Jean. 2 x 100 mg tablets a couple of hours after the AF starts. The instructions are then to take a second dose of 1 x 100mg if not back in sinus rhythm after two hours. That's it then for the day.

But, I've never needed to take the second dose as I'm usually back in sinus within the hour.

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That sounds good.

Have spoken to my GP this morning and he says ok for me to up my initial flec dose from 50mg to 100mg. I usually take 50mg, which never stops the AF + tachycardia, but it usually stops after I take the second dose 50mg an hour or so later. So I'm hoping that one dose of 100mg will work quicker.

Thank goodness for this site or we would never get the ideas to help stop our attacks.

Thank you.

Jean

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Let me know if 100mg works for you and I may well try reducing mine to 100mg next time. Hopefully though, with my ablation next Monday, I've had my last episode.........wishful thinking!

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been on flecainide for 3 weeks - from 50mg to 100mg now 150 twice a day. Help!!!!!! how long does it take to work??? side effectd going down

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I'm just on the 'pill in the pocket' - ie not taken regularly, only take it once when AF starts. Works well for me (at the moment) but, clearly.... it's not the same for everyone.

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Will do and good luck for Monday.

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I take flecainide x 50 mg x 2 daily. Alongwith beta blockers it has been wonderful i have been advised if my heart beat increased to take an extra 50 mg. I think you must be advised by your cardioligist or ask the cardiac nurses who are fantastic or bhf good luck.

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Thanks for replying, yes i'll have to sort this one out.

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Pity but I think it's all individual decisions based on individual circumstances circumstances......for instance I have had PAF over a number of years peaking in 9 episodes a month even on 100mg/day Flecainide, which now works well at 200mg/day for me.

Therefore in my case I would take my half daily dose early without delay if an episode starts (I've only had one) but would wait if it was less than 6 hours since my last dose.

With PIP and no major AF history I would be tempted to first try breathing/other suggestions appearing here to see if the body can do it itself. The caution is that if left too long too often the heart can develop a bad habit, which could repeat AF more often.....why can't life be simpler!!

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Thanks for replying.

I've managed on occasions to do the breathing 'thing' or coughed several times, even jumped up and down lol and had success.

Oh well back to the drawing board aka GP/ Cardiologist to get some clarification.

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Hello Tyson,

I've been on Flecainide used as Pill in Pocket since 2012.

Having Paroxysmal A F I was prescribed this by my Cardiologist,taking

300mg all at once only when an episode comes on,and to take it after

10mins.

This really is a wonder Drug,within 10mins to 2hrs my heart is back in rhythm,have not had an episode for 3 months,touch wood.

Good luck and keep well.

Eleanor.

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Thank you for that information, it's sounds very much like the advice I was given. Maybe if my initial dose was higher then my episodes would resolve sooner,?? something to consider.

At the moment I'm trying to decide whether the Rivaroxaban I'm taking or the statin Atrovastatin is causing me to feel jaded.

I too haven't had an episode for three months, long may it continue eh !

Jo

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I am also on Rivaroxaban since last August no problem at all,

knowing these help prevent AF devastating strokes is enough

for me,I feel more confident than Aspirin for 16yrs,which we now know is of no use preventing AF strokes.

Atorvastatan!!!!!!!terrible time with those,I watched for a few years for Rosuvastatin which I had read about,this came on the

market 2002,been on this since then,more expensive than others,I take dose of 10mg daily and my cholesterol sits at 4-5,

excellent drug ,I have no side effects.

Hope this is of some help to you Tyson,also I would ask your

Cardiologist,if you could try a higher dose of Flecainide,as PIPnot your doctor,they don't seem to know as much about AF.

Good luck.

Eleanor.

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Thank you i'll look into Rosuvastatin.

What sort of problems did you have on Atrovastatin? apart from feeling jaded I've started to get indigestion (which I've never suffered from)

Jo

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Within a week of starting Atorvastatin,developed blisters between fingers,

Very painful,had to have cream prescribed for this,it went on for weeks then settled,indigestion so bad felt like I was having a heart attack,with pain around my gums,this happened after I had a meal,then after about a month,very bloated stomach then swelling.

As I had been through every Statin on the market this was the last one,

By this time I'd been on Statins since 1997,and told by doctor I would have to put up with it,until Rosuvastastin was on the market 2002,as I said before this is a much better drug,but they won't tell you about it,as I said before,much more expensive,you will have to ask for it.

Now for the Flecainide,I give it 10 mins when an episode comes on,I know by then the AF is going to last,as I said 40mins to 2hrs usually back in rhythm.(Remember 300mg was described by Cardiologist for me)

I keep a diary of episodes going back to 1999 when it started,this is handy

when I see Cardiologist at AF clinic or if I ever have to go to A&E.

Hope this is of some help joe,keep in touch and let me know how you go.

Eleanor.

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Thanks for that Eleanor, I'm not taking The Atrovastatin tonight, really uncomfortable gastric wise, will try and get appt with GP tomorrow.

I think I need to stay off statins for a while just to confirm it's not anything to do with the Rivaorxaban (sure it's not) but need to make sure. I've also tried Pravastatin.....equally tired with that one so stopped after three weeks.

Sadly my cholesterol is 7.2 so I need something.

Really appreciate all your input.

Will let you know once I'm sorted.

Jo

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Good luck Jo,look forward to hearing how you get on.

Eleanor.

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Really interested to read the replies on here, I use flecainide as a PIP, initially I was told to take 50mg twice a day, i have subsequently upped this to 100mg twice a day. Flecainide has never stopped the AF it just slows it down,. It can take from 6-32 hours before I revert to normal sinus rhythm. Having seen some people have take 150/300mg I might up mine again when I get an attack!

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