Another topic recently spinned off onto this topic. healthunlocked.com/afassoci... The question merits a wider discussion. By bisoprolol I include beta-blockers or alternative calcium channel blockers.
Now, if you are comfortable with taking advice from doctors, then go with that. But some of us feel more comfortable when we directly interact with doctors, and come to a joint decision.
It has been said that Flecainide MUST be taken with bisoprolol. drugs.com/ppa/flecainide.html and this article talks about initiation and continuance. Right now I will leave aside the initiation question. For the question of continuance, the point seems to be that maybe the ventricular rate will be increased, which blockers counteract.
There is also the assertion on safety that Flecainide can double the repeat rate of a heart attack. I am routinely suspicious of this argument, since, it is not the percentage increase that counts, it is the absolute figures. When absolute figures are missing, then someone is hiding something. When the absolute rate is less than 0.1% then it can probably be ignored since other factors swamp the estimation.
Looking for recent review articles on this subject.
there is no mention of blockers.
2. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. I quote concerning the possible effect of Flec on the ventricular rate: "Control of the ventricular rate using a beta blocker or nondihydropyridine calcium channel
antagonist is recommended for patients with paroxysmal, persistent, or permanent AF (260-262). (Level of Evidence: B)". Note the level of evidence. This is B, which looks impressive but it is not. It is "Data derived from a single randomized trial or nonrandomized studies". At this point, the vaguely possible benefits may well be exceeded by the negatives. Remembering that is it well known in medicine, that half such research papers are probably wrong, and you get a question to think about, no where near strong evidence.
3. Review Article. 2012. Safety of Flecainide. Tamargo, Capucci and Mabo. Drug Safety 35(4):273-289. This does not mention betablockers as a useful extra. On the contrary, section 4.3.2 says, and I quote for those who do not have access to this article: "When used to prevent the recurrence of PAF flecainide has been shown to have a good safety profile". The only significant warning is to watch the Potassium levels in your blood. + the usual list of contraindications.
Section 5.2 warns AGAINST the use of betablockers with Flecainide. "The co-administration of flecainide and pro-
pranolol increased the plasma levels of both drugs by 25% compared with control values, which may exert an additive negative inotropic effect and prolong the PR interval".
So, there you are. I hope this is interesting to some people. At least, for me, it renders highly questionable the assertion that both MUST be taken together, while leaving open that there are, sometimes, in a minority of cases, some good reasons.