Question for those on flecainide who also use asthma pumps

Is anyone who is taking flecainide to control a-fib also using an asthma pump?

Specifically I am looking for people using a beta agonist (salbutomol)? Have you experienced any difference in your asthma pre flecainide compared to post flecainide?

I am Ipratropium Bromide (brand is ipvent) and find it is not quite strong enough - especially in the cold - but am loathe to switch to a beta agonist due to their potential to trigger a-fib.

10 Replies

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  • I see that no one has answered, so I will have a go, though I have extremely limited experience of this.

    I use Salbutamol occasionally. I use it when in some buildings, or, when mucus is thick and I am finding coughing difficult. There have been seasons when I was on flecainide ([pre and post AF) and I was never told to stop. Have you checked the drug interactions sites?

  • Thanks for the reply!

    I have searched for interactions, but don't find any. I have found one website that says Ipratropium Bromide can act as an anti-arrhythmia (but only found this once). If that its the case it would explain some of the tightness I experience when running, but not what I experience as lower thresholds/triggers for asthma (and I am only referring to exercise induced asthma).

    I first went into a-fib about 6 weeks after first taking salbutumol. I saw a pulmonologist at that time and he said salbutumol is a known trigger for a-fib. He thought it was unlikely it triggered my a-fib as the a-fib only started after using it for a few weeks, whereas if it is the trigger it would trigger a-fib straight away.

    So because of that he recommended I switch to Ipratropium Bromide, which my cardiologist thinks its safer to use but was not really that phased about it. When I asked about the salbutumol-a-fib link he said in my case it was very unlikely.

    I have been in a-fib 3 times since April 2015 so not particularly keen on experimenting!

  • Not sure what to think. Let me try to think as if it were me trying to cope. I appreciate that you do not want to experiment on yourself.

    1. Salbutamol has been known for decades. That makes me want to trust it.

    2. There is a whole range of asthma drugs available, so you might want to see if another one does not give the problem.

    3. ipratropium does seem to sometimes interact with the heart, causing tachycardia or palpitations. At this point you begin to get suspicious, because flecainide is an anti-arrhythmic, which even used on its own can sometimes cause more problems than it cures. Sometimes with Flec, less is better -- there is an optimal dose. On drugs/com I did not find any interactions. But, drugs.com had nothing.

    4. Salbutamol can cause faster heart rate, especially in the minutes after inhalation. But, if you have been used to taking it for a long time, I would be surprised if you suddenly developed this. It can cause an irregular heart beat, so, fast + irregular is close to Afib. Surely then, Flecainide would help! On drugs.com I found some interesting comments. "Using albuterol together with flecainide can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. The risk may exist even when albuterol or similar medications are given by oral inhalation directly into the lungs.". Note, comments refer to the tablet and the implication is that they are even rarer with the spray.

    I find I need to use several interactions sites. Also, take courage. Most of the nasty interactions are rare. It is easy when you read the list to think you have that interaction, even for people used to reading them. So make sure you discuss it with someone.

    5. Are you sure you went into Afib after taking Salbutemol? Was there some other trigger?

  • Thanks again for this.

    I didn't explain myself properly.

    First - I started using salbutemol in about February last year and I picked up the A-fib mid April. Those are the facts.

    Second - My pulmonoligist said there are cases of salbutemol triggering a-fib. He did not think that it triggered my a-fib because I only went into a-fib at least six weeks after I started using it - and I only use it when I exercise.

    Then.

    When I started on flecainide I took 200mg a day - and i really struggled when exercising. But I have heard plenty of other people struggling to exercise (at a vigorous level) on 200mg too. So after a bit i asked the pulmonologist about a flec-ipratropium interaction and he didn't find any. His suggestion was the same as yours - now that the flec is controlling the a-fib, why not go back to salbutemol?

    So I called my cardiologist and put that to him - his response was to rather lower the flec dosage, which I have done - to 100mg. That has made a major difference.

    I haven't considered asking about other asthma sprays and will follow that advice.

    Its all still sort of new - I went on to flec in October last year after going into a-fib so soon after the first time I was happy to take 200mg as it gave me peace of mind about the a-fib, the rest was secondary. I changed from 200mg to 100mg in about February, which was when I stopped running and started training for a mountain bike race. I really have to push myself hard to trigger the asthma when riding, so it wasn't an issue when I was riding.

    Now I am getting back into running and the asthma is being triggered almost every run...but it could be either/and the cold weather (its winter where I am); that I am not as running fit as I think.

    But i think you have a point - I may ask the cardiologist again about the salbutemol. ...and so be it it triggers the a-fib and I need to be cardioverted again .... I hope the pretty nurse that looked after me last time, looks after me again!

  • Thanks for the clarifications.

    The doctor did well to lower the dose of Flecainide. This medicine is quite tricky, and individual tolerance varies widely. There are many threads here on that subject. Also, beware, that in a few years time your own tolerance may change. Flec is a marvelous medicine for some, and no good for others. Often the simple change of a lower dosage makes all the difference. You can safely break the tablets. I use it on demand -- when I need it -- and I actually crunch mine up with my teeth and swallow with water to provide speedy action.

    Look for other, non medical reasons if you can. The other thing is that AF is very common in athletes. So, the old approach, you have to push your way through the pain barrier, stay fit, etc, you probably need to pull back on. There are gentle ways of staying fit that you probably will need to learn.

    Everyone is different. Know yourself. For me, it is now quite clear that the background strain of a move + pushing through the pain barrier one time too much was what provoked, in my case, a tachycardia that would not stop and developed into AF.

    Since Cardioversion I have been prescribed Pill In the Pocket, and I take either Flecainide, or Bisoprolol, or both, depending on the circumstances. So far so good. And, yes, I have had to cut back on exercise, especially any kind that requires a sudden push.

  • Thanks. I am still learning, like most other people with a-fib. A year ago i thought i could get fit enough to do a half marathon. I am now only aiming for 12km (or maybe 15...). So i am not doing hectic training....well compared to my sister who does ultra marathons...

    a few weeks back my cardiologist suggested i ween myself off flecainide - i started skipping every second day - the first day i skipped was tuesday, by that sunday i was back in a-fib! So unfortunately pill in the pocket doesn't work for me!

  • Sorry for you that Afib easily returns. There are two other things you can try to wean yourself off flecainide. It has quite a short half life, so, skipping a day means you probably had too little.

    1. You can get special capsules, which are slow release. See if 50mg slow release works better than 100mg daily, or something similar.

    2. I find the tablets easily break. Therefore, you could try a lower dosage, knowing you could easily add to it quickly at the first sign of trouble.

    3. There is a variant of pill in pocket, which means you take a low dosage, and supplement when you feel something is starting.

    4. Everyone is different. But some people find they can manage the night without much problem: the pressure is the daytime. Others find the pressure is the evening. Therefore, you could experiment with the timing of the small dose.

    5. The textbooks may say that 50mg is not enough. Well, Flec is not like an antibiotic where you must maintain high levels to be effective. For some, 50mg do actually work.

    6. Yes, it is quite a restriction to have to pull back on exercise. View it this way. Pull back now, with a view to slowly creeping back later. The usual advice is to avoid pushing yourself, and if you can talk or sing then you have the right level.

  • As you put so much time into your responses I wanted you to know that I think my challenges lay in the asthma and dealing with that properly.

  • Thanks again. I am using slow release tambocor. The most recent time I went into a-fib I took 400mg of tambocor in one day (apparently over the limit) and stayed in a-fib. The only way out was a cardioversion.

    I have mitral stenosis, which may be the underlying cause of the a-fib (good chance, but not a certainty), so i think its here to stay. At the moment I am happy being in rhythm and being able to exercise...i am not going win any races, but then I get to enjoy to the view!

  • Hi

    I only only just seen this post, i am on Salbutomal spray for Asthma, i was n it befor e. I. got AF. My Asthma has not changed, i am also on Felcainide 100mg. Twice a day. Also Verapamil 40 mg twice a day, but i was told Beta Blockers. Can affect if you have. Asthma, that is why can only use Certain ones and why they put me on Varapamil, so i would go back to. Doctor. And ask if tablets ok with you having Asthma,

    Suzy

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