Flecainide PIP

Hello everyone, I've just been reading some of your posts about how much Flecainide to take as pip but they are all dated a year ago. I was just wondering how you are all getting along and if you are still using Flec as PIP.

I was on Flec 150mg slow release but I didn't like the heavy tired feeling I felt all the time so my EP said I could take it as pip 100mg but he said to take it if palpitations got too bothersome as I normally get them before Afib starts.

Thanks Trish

48 Replies

  • I took Flec as a PIP for about 6 years and it worked for me until episodes got too frequent which is when I started down the Ablation route.

  • thanks, CDreamer. How long did it take to work after an episode started? I haven't had many episodes of Afib and I can't take blood thinners. I'm 62 and for now my EP says I'm at low risk of stroke so he doesn't recommend I take one but even so I'm worried so try to avoid going into tachy or Afib. How did your ablation work for you? If I do go down that road eventually, I believe I'll still need a blood thinner so I don't know what they'll do knowing I can't take one.

  • It usually took between 1-2 hours - I took maximum dose 300mg and on an empty stomach - once made the mistake of taking it after food, nothing dire happened but I felt very nauseous for the 24 hours it took to clear my system.

    Ablation worked very well the second time around. There are many different drugs used for anticoagulants and there is also a procedure which eliminates the risk of stroke for people who cannot have anti-coagulants and who are high risk. You would need to speak to your EP if ablation was offered for you. Not everyone is suitable.

    Best wishes CD.

  • Thanks CD. My doctor tells me I am at low risk at the moment but I'm 62 now so I'll have to sort something out for later if I don't want to take Flec all the time. Glad your ablation worked well for you the second time. My EP talked to me about ablation for tachycardia and said it might also stop AFib. I understand there are 3 or 4 types of ablation if you choose to go down that road but I understand I'd have to be anti-coagulated for the ablation, anyway. Trish

  • I take 100 flecainide as a pip. It usually works within 2 hours.

    I understand that flecainide works best on an empty stomach. If I suspect that AF is starting I wait until it is definitely established before taking the flecainide and that means that my stomach will be empty.

  • Thanks, Jenny. The doc's given me 100mg to take as soon as I get too many palpitations hoping that will stop the Afib from starting.

  • I come to this question with a past history of taking Flecainide. I know that my normal dosage is 50/50 and recent observation has show that, even though it has a short half life, there is a certain amount of building up, therefore after a week or so re-starting, I was better on 25/25. I noticed I needed to reduce, because irregularities built up again, so I strongly suspected I was going over the limit.

    The Cardiologist, knowing my background, prescribed 100mg as PIP, with 50mg 2 hours later if little effect. I try to take mine ASAP, and I crunch the tablet and drink it with a glass of water. If water is not available, I manage without. I would go for the quick acting version for PIP, not the slow acting version.

    Once having taken PIP I am experimenting with staying on it for a week or so, especially if there are known stress factors to manage better.

  • I never thought of crunching the tablet to make it work more quickly. My EP said 130mg slow release was no good to stop it quickly, it would be better to take 100mg of the fast acting tablet, it would work better. When you say 50/50 does that mean 50mg in the morning then 50mg at night?

  • Yes

  • Hi I used to have it as pip, now I take 100mg twice a day. This has settled my AF.

  • Glad to hear it's settled it. I was very short of breath on the 150mg slow release and woke up several times a night. Hope the pip works so I don't have to take it all the time but like you, it did control my AF.

  • Hi Trish, my cardiologist has always favoured the lowest effective regular dose rather than the potentially 'rocky road' of PIP. I started with PIP, then because episodes increased went onto 50/50 Flecainide and then 100/100 to stop it.

    Flec may be upsetting my stomach though, can I ask why you went on 'slow release' Flec as I haven't heard of that before, is it the same principal as enteric aspirin, if so it may suit me better?

  • Hi Orchard, My EP said the slow release was better if you are taking it all the time because the amount is released slowly over 24 hours so the effect is more even. When I use it as PIP, the 100 mg is released all at once so it goes into your system straight away and luckily will be potent enough to stop the AFib episode in its tracks. It didn't upset my stomach but I'm short of breath and have a kind of nipping pain now and then in the chest. I've read that symptoms go away with time once your body has gotten used to the Flec. If you are taking a Beta Blocker with the F, maybe it's that that's upsetting your stomach.

  • Thanks Trish, so many choices, the bain of our life!

  • Hi Trish

    I take 2x 50 mg pop basis . I can't recall having any noticeable negative effects taking Fleccanide and it's proved effective for the majority if my episodes. If it wasn't for a dilated LA, I probably would have carried on with this method. I'm opting for ablation.

    Best of luck

  • Good Luck to you Tricky for the ablation. From what I've heard they work really well, being Afib free without drugs would be great. Trish

  • Hi Trish

    What does the abbreviation pip stand for?


  • Pill in pocket

  • Thank you - Just never heard of it

  • Hi Mags, Yes, that's it Pill in the Pocket instead of all the time. A lot of people prefer that route instead of taking the drug daily but if my episodes become too often, I'll go back to the daily dose.

  • Works well for me taking 50 or 100 mg. usually effective within 2 hours. Been doing this for 4 years.

  • That's a long time. Can I ask how often you get an episode? My EP said if I only need PIP once a month or even better once every three months, it's ok, but if I need to take a PIP, say, every week, then it's not worth it and I should revert to the daily dose. Trish

  • I've been taking Flecainide ( 100 twice a day ) for near enough twenty years. I get an average of two episodes of AF a month. If I have recently taken one of the regular 100s, I take another. It it's a while since I took the regular dose, I take 250 at once. In all cases, I return to sinus rhythm within four hours and then usually skip the next routine pill.

  • Thanks, pilgarlick, so you are taking it daily. Are you still paroxysmal after all this time? Trish

  • Dear Trish

    When I was first diagnosed in 1994, I was getting episodes of AF as often as three times a week, some lasting as long as 24 hours and I was re-admitted to hospital a couple of times. On both occasions I reverted to NSR without needing any other treatment. Over the years, I have settled to the two or three or four times a month I mentioned before. I went in for an ablation, but the procedure was stopped because of a technical failure of one of their bits of kit, and I haven't been back. Very strangely, I acquired giant cell arteritis (GCA) last year and have been taking steroids ever since. In the first year after the steroids, the episodes of AF disappeared altogether, but have now reverted to the frequency mentioned above. I think I am lucky as I am not really affected by the episodes as much as so many obviously are, and they rarely prevent my doing whatever it is I am doing or planning to do.

    best wishes Mike

  • Hi Mike, that's a good attitude to take, I wish I could be the same but it's this not being able to take a blood thinner that gets to me as I know I'm not covered for a stroke although my EP says to me ... 'Not everyone who has Afib has a stroke'! but there's always the first time I think. I have a cerebral cavernoma that hasn't bothered me, it was discovered by chance in 2007 and the doctor doesn't want to treat it because it's so small and best left alone. But of course it would be dangerous to take anti coagulants with a cavernoma. I don't get many episodes, (see my reply to Jay below) and I'm 62 and at low risk for now.

    I've just googled GCA, I hadn't heard about it before. Do you know what caused it, it wouldn't be the side effects of your AFib treatment, would it? I'm glad to hear your episodes have gotten less frequent and don't stop you getting on with life. Trish

  • Thanks, Trish. I hadn't heard of GCA before either, although it's quite common among the elderly. MIne started with bad headaches and double vision. Nobody seems to know what causes it, so I don't think there's any link with AF, or its treatment or drugs. It's a auto-immune disease and seems to be self-limiting and generally goes away after a year or two on steroids.

  • Mags60

    Pop is 'pill in pocket' to take when episode starts

    I take 100mg BD maintenYabd have 300mg as PIP for episodes; they have decreased in frequency since taking Flecainide (for 3 years) and episode usually resolves within 30 mins if PIP required.

    If within 1 hour of maintenance dose I will adjust PIP dose to just 100 or 200mg depending on severity.

    Interesting so many different regimes and a slow release version. That's new to me.

  • What is maintenYabd?

  • Hello Clara, I'm in France but I think the slow release would be available all over.

    Sorry, I didn't understand , are you on Flecainide daily then take extra when you have an episode? I don't know what BD maintenYabd is. Trish

  • hi there,

    I'm 62 and last year was diagnosed with breast cancer. I have PAF and have been taking Flecainide 150 morning and the same in the evening and thankfully my AF is under control. I have no problems with it and hope it stays that way.

    stay well

    Blue :-)

  • Hello Blue, I'm 62 also and I'm sorry to hear about your cancer, it's bad enough having PAF without any more worries, it's hard to keep the stress down, isn't it. I'm glad your AF is under control now and you've had no bad side effects on the drug, hope also that your treatment for the cancer is working and your getting positive results. You, too. Stay well. Trish

  • PiP didn't work for me. I've been taking 150mg x 2 a day for about 10 years. I rarely get an episode. The last was due to dehydration about 2 months ago. As soon as I rehydrated it stopped.

  • That's great Thomas, I mean that you rarely get an episode, not that the PIP didn't work !! I just find it hard to believe that I have to take a tablet for life that has so many side effects, that's why I asked to try PIP, I haven't needed to try it yet but hope it works if I do need to take it. Some people prefer ablation to be free of drugs if they can but I'm 62 so I wonder if it's not best to stop worrying and just take the drug. Trish

  • I don't have any side effects from Flecainide. I did from Amiodorone, so was switched to Flecainide, but tablets affect different people in different ways. I'm 71 and try not to worry about anything.

  • That's the way to go .... stress makes it much harder so you're right to try and not worry, glad you have no side effects from Flec and I've heard really bad things about Amiodorone.

  • I take 100mg as a pip when it's needed. If necessary I can add an extra 50mg. I have found it best to take it before things get too bad,ie when I feel my heart is going off on one!

  • Hi Jay, Do you get palpitations as a warning? My EP says take a 100 mg Flec when I get too many palps so that it might stop Afib starting. Trish

  • Hi Trish, I just feel that my heart is out of sync and not quite settled so to stop it actually going into palpitations in a big way I take the Flec. I had an ablation in 2008 and things are very much quieter now!! Before my ablation I had PAF episodes every 2 weeks which were very limiting as we couldnt plan anything like days out without worrying if it was going to go off.

  • Hi Jay, I just wish that having an ablation would completely stop the bouts of Afib so that people could stop taking drugs, it's a shame to go through the ablation and still have to take them. I'm lucky that my afib isn't a lot YET. One tachycardia in 1995. One AFib in 2009 then a bout in April this year then a second tachycardia in October. Now the Flec PIP is just in case I get another attack. The EP spoke about ablation but I don't think I've had enough Afib to think about an ablation yet and ALSO because I can't take anti-coagulants, an ablation would be difficult. Glad things have quietened down for you now. Trish

  • Hi Trish

    I have paroxysmal AF - fortunately only about 7-10 episodes a year, always brought on by indigestion stimulating the old vagus nerve. I'm on dabigatran (Pradaxa) anti-coagulation daily but a PIP of Flecainide and bisoprolol will bring me back to SR within 1-3 hours.

    The dose I take is 2x100mg Flecainide and 1x2.5mg bisoprolol. If I'm not back in SR within 3 hours, I will take 1x100mg Flecainide extra.

    Hope this helps and good luck.

  • Hi Timince, Thanks for replying ... I've just looked up bisoprolol and see it's for high blood pressure but in your case it might be for slowing the heart rate down, is that right? The doc has only given me Flecainide to take but I'm worried about not being able to take an anti coagulant At the moment I'm at a very low risk he says but later when I'm 65 I should take one but I've been advised against it.

    The doctor told me to take 100 mg of Flec but I've seen a lot of people like yourself are taking up to 300 mg so I hope my 100 mg is enough. Will wait and see how it goes. Trish

  • Yes Trish, as a PIP, the Flecainide is for rhythm control and the bisoprolol is for heart rate control.

    Re need for anticoagulant : look up (or better still, discuss with your doc) what's known as your "chads2 score" This is used by your clinician to determine your risk of stroke from arrhythmia such as AF. You are probably at low risk for now but as you get older you will become at greater risk. Hope this helps.


  • Interesting reading all the above. I also have paroxysmal AF. Sotalol has not been working for me, and I keep getting more and more AF episodes - once a week once, once every two days! It is scary as I never know why! Sometimes I end up in A&E and everything else about me is fine, and they can't do anything, so now I'm trying to sit things out (hard, sometimes). Today, I just started Bisoprolol (1 x 2.5 mg) and after a week will go on Flecainide 2 x 50 mg a day. I cannot believe that even taking these pills, your SR doesn't return for 2-3 hours! Why can't 'they' find out the cause and treat that and not the symptoms?! It is so frustrating - it is like living on a knife edge!

  • I know the attacks are really horrible , aren't they? And yes, 2-3 hours seems a long time for it to stop. Good Luck for starting your Flecainide next week. I'm sure you'll be ok, my EP said 50 mg twice a day isn't a lot so with a bit of luck you won't experience bad side effects on that amount. Trish

  • Radyeatlantic

    MAINTENANCE is the regular dose you take of a medication to maintain your symptoms

  • Hello Trish,

    I have been using PIP Flecainide prescribed by Cardiologist over two years now.

    I have Proxysmal AF,when an episode comes on I have to take 300mg all at once.This works a treat for me,my heart is back to normal 40mins to 2hrs.

    Hope you find something that suits you soon,keep well.

    Best Wishes,


  • Hello Eleanor,

    Thanks for replying to my post. Up until now I've been lucky enough not to need it .... I've had a few palpitations but not bad enough to take a pill. The EP says to take just 100 mg in case of troublesome palps that could start a bout of afib, If it was Afib itself, I don't know if 100 would be enough to get me out of it. I don't like the idea of taking 300 all in one go because of the proarythmia side effect it's supposed to have. How often do you get your episodes? I like to 'prevent' rather than 'stop' because I'm not able to take anti coagulants like most people.


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