Pill in the pocket

[Von19]

I have been prescribed Flecanide as PIP I am unsure how to take this Is it just when I get a rapid irregular pulse or any breakthrough symptom Thanks

[pottypete1]

Hello good morning

I have been taking Flecainide for many years and have also permission to take it as a pill in the pocket.

You should take the dose recommended by your EP but in no circumstances exceed it.

The issue for me has always been how soon before or after my regular dose I take it.

In answer to your question I have normally taken it as soon as I am sure AF has set in and that it is pretty clear that my heart won't revert to normal sinus rhythm on its own accord.

I think you should also talk to your EP or Rhythm Management Team if you have their contact details.

Pete

[jennydog in reply to pottypete1]

I totally agree with Pete.

I take 2.5 bisoprolol daily and use flecainide as a pip. I try to minimise my drug intake so, if convenient I will wait to see if I revert naturally. This has the added advantage that I will be taking the single 100 tablet on an empty stomach which is best for flecainide. It is usually effective within 2 hours.

Sometimes it is important to stop the symptoms quickly because of commitments so I will take the tablet immediately. I know some people take larger doses as a pip. I started by using 50 but find 100 more satisfactory. I always carry a tablet in my purse, have some in the kitchen and some in the bathroom, for convenience and to give me confidence.

[Rellim296 in reply to jennydog]

I'd echo much of what jennydog says, except I take atenolol not bisoprolol. I always have flecainide with me.

I was told to wait an hour after AF has started and then to take 50mgs and if no joy after an hour, another 50mgs. This isn't very practical on the breakfast front if one wakes with AF which for me is usually the case. I now wait a few hours in the hope that the AF will subside spontaneously. It often does sooner or later so I assess the situation an hour before lunch when I take 100mgs if it appears to be a good idea. I'm not suggesting that this is what you should do Von19 but I've found over the past three years that it 's what works best for me and keeps down the amount of flecainide I take.

There are no guidelines on the information that comes with the tablets about taking flecainide as a pill in the pocket.

I think much depends on the demands of the day and how AF affects one. I don't find it very debilitating and the AF I get now is normally more vigorous to start with and then slows and peters out or turns into tachycardia over a few hours. I used to revert to normal rhythm suddenly and noticeably but that doesn't happen now. While I have no doubts that I have AF to start with, I find it quite hard to tell when I am fully back in normal rhythm. I find my pocket monitor very helpful.

[BobD Volunteer]

We really should not comment on that as we are not medically trained and your EP team or arrhythmia nurse specialist should have instructed you on when and how much to take. This drug would normally only be prescribed in the first instance by consultant level. and as Jennydog mentions alongside bisoprolol or a similar beta blocker to prevent unwanted side effects.

[Bagrat]

As Bob said. This is something to discuss with your consultant or his AF nurse if he/ she has one. Flecainide is a fab drug but potent too and needs to be used appropriately to your needs as diagnosed by your specialist team.

[ILowe]

I am surprised when your PIP was prescribed, when to take it, dosage, etc, was not clearly discussed. I think you have a right to have this put in writing. Or, when you go to the consultation, ask the doctor to dictate instructions to your smartphone. Even I, when I am with a doctor talking about myself am so involved in the tenseness of the discussion, that I easily forget, and easily do not hear correctly.

Ask for a copy of the letter sent to the GP. This should state the protocol. I have routinely seen those used for CF, and the protocol clearly states the range of freedom for the patient. I have many times though had to flag the dosage and (by email) seek clarification. I believe every patient has the right to double check dosages, and the right to seek professional advice from a pharmacist, who has the knowledge and authority/duty to challenge a doctor.

What we can do here though is suggest options and possibilities that you might want to discuss with your doctor.

[Von19]

Thanks I see thecardiologist at the end of July and will discuss with him I wont take it til then Repeatedly asked GP to be referred to an EP without success so have made another appointment to see a different GP to see if I have more luck there

[jennydog in reply to Von19]

In my case it was the Cardiologist who referred me on to the EP. He actually told me that he didn't know much about the heart's electrics. It may be that your GP doesn't know about EPs.

[pilgarlick]

My own experience may help. I have been taking 200mg a day for almost twenty years. My consultant's advice was to take an additional 150 whenever I went into AF. Which I do about three times a month. Having taken the extra 150, my AF then normally goes off within 4 hours and very occasionally longer. I have no means of knowing,of course, if it's the flecainide that puts me back into NSR, but I'm happy with the result either way!

[BobD Volunteer in reply to pilgarlick]

300mg per 24hour period is the dose permitted !

[Von19 in reply to BobD]

Thanks I wasn't given much information

[pilgarlick in reply to BobD]

My leaflet gives 400mg as the maximum. Perhaps it varies from county to country. I don't suppose that I should take the extra 150mg immediately if I had only just taken the routine 100mg. The half life of the drug seems rather variable.

[Coco51]

First I took 100 Flecainide and an extra 1.25 bisoprolol after 20 minutes in AF and then another Flecainide 3 hours later if the AF didn't stop (the bisoprolol was only once though). When it worked it usually took 8 hours. Then it didn't work so the advice was take 200 straight away and 100 12 hours later. That worked for a while. Then it didn't. So I was told to take 300 per day in 3 doses of 100 each time 8 hours apart, and that worked after 2 days but made me feel extremely giddy. Of course I'm not a doctor, you need to check with yours, but this is the advice my consultant gave me.