Pill in the pocket approach

[Slattery]

Is anyone in this form doing the pill in the pocket approach? Does it work for you and what medication are you taking?

[pottypete1]

For many years I was advised to take Flecainide as a PIP. It worked 90% of the time. When it didn't work I had to be cardioverted.

At the same time I was also on a regular daily dose of Flecainide and Bisoprolol.

Pete

[nikonBlue in reply to pottypete1]

me too pottypete, apart from the cardiovasion, although that has been mentioned. I still use my flecainide as a pip when also taking the same meds as you. I also take Bisipolol in the morning.

stay well

Blue

[BobD Volunteer]

Very common treatment usually with flecainide. Max dose in any 24 hours is 300 mg . Some people also have regular smaller doses of flecainide and add the extra up to 300mg if breakthrough occurs but could I never understand that. If it isn't working in the first place something is wrong I would have said.

[NLGA in reply to BobD]

I think my 200mg dose isn’t working it’s 8 weeks now and still breathing issues and irregular heart beat

[Rellim296]

Yes, I've been taking flecainide as a pill in the pocket for three years. Until fairly recently I have often taken 50mgs (and occasionally a second 50mgs) if I have had AF and have returned to normal rhythm. It hasn't always been effective and I have found in fact that if I don't take any flecainide, I still get back to NSR after a while and have, of late, not bothered with it.

[jeanjeannie50 in reply to Rellim296]

Interesting Rellim.

[Slattery]

Thanks everyone for your replys.

[Pappamole]

Hi, I've been on PIP for nearly 2 years now and I've had 4 af events since I've been on it. Each time I have reverted 6-8 hours after I took my medication (2.5mg Bisoprolol & 150mg Flecainide followed by another 150mg Flecainide a couple of hours later). So far the PIP has worked every time for me and seems to do the trick. I'm not on any other medication. I'm "only" 52 and a bit of a cycling nut, so I'm quite fit.

[Rellim296 in reply to Pappamole]

So you are taking 300mgs of flecainide in the space of a couple of hours?

[Pappamole in reply to Rellim296]

Yes, that's what the EP told me to do. Specifically, I take 150mg straight away and another 150mg 2-3 hours later if I don't revert. So far I've never reverted within that time so have always had to take the 2nd dose.

[Rellim296 in reply to Pappamole]

I am surprised that you have been told to take so much in a short space of time. 300mgs is the max daily dose.

[Pappamole in reply to Rellim296]

Well now that I can see what doses others are on I'm inclined to agree with you. However this dose was set by the consultant at Broad Green, so I assume he knows what he is doing. I was told that I should not take the full 300mg at once because it can have an adverse effect, so that's why I have to take 2 smaller doses a couple of hours apart.

[Rellim296 in reply to Pappamole]

Well, your events are infrequent so you are not taking a lot of it, but it seems a bit hefty. When I was taking flecainide daily I was taking 150mgs twice a day. When I stopped it on a daily basis, I was told to take only 50 as a PIP and then a further 50 an hour later if needed. I sometimes take 100mgs right away but am tending to wait and often the AF subsides and it no longer seems worth bothering with the flecainide.

[Bagrat]

On flecainide. No coronary angio, I had an echo cardiogram and an exercise ECG. That was 6 years ago. Since then I get an ECG at surgery when I remember to ask!! Still here so far.

[UScore]

I've only had the echo, no angio or exercise ECG. I've got flec as Pip. (Though haven't had need to take it yet).

[Hidden]

I was only told about PIP after many trips to A&E and chemical cardioversions. OMG I wish I had been told about them before that as ever since I have never been back to A&E - so much relief. Was on 150mg Flecanide + Apix + Biso 2.5 and when I got AF was told to take 100mg Flecanide. On each occasion came back into rhythm within 3-4 hours no problems.

On the last two occasions have even gone into AF taken the tablet and woken all settled - even better! My only problem is the extra dose does wipe me out for a few days and also I get some raw pain in heart area for a few days but it passes - that is not typical of everyone but it is very typical for me. I've since stopped Apix and normal Flec dose but still have the Flecanide as PIP but not needed it since then but did have 2 episodes of PIP post ablation in Jan and before stopping tabs. Certainly feel more in control about that aspect of AF using it as you never know when it will happen.

[KathFrances]

I've got two PIPs and the instruction is to take them both together - 1.25mg Bisoprolol and 50mg Flecainide. I was told that the Bisoprolol is because Flecainide can occasionally increase heart rate. I haven't had to use them yet. Am not on anything daily except anti-coagulation.

[Alemo28 in reply to KathFrances]

I have used a PIP approach for a quite time. When I had episodes of AF often, cardio dr. prescribed Flex 50 mg , than 100 mg twice a day. I always felt week after, though the AF still happened.. I came to the conclusion that in my condition perhaps PIP works better.

First I am taking Busoprolol 2.5 -5 mg. If it is not helping ,I take Flex50-100 mg depends of the ectopic length. Usualy last for a couple hours, and reversed to normal

Interesting, that I feel headache at the beginning of AF, and take Tylenol 350 mg..

As a blood clock prevention I am taking Apixaban and watch for the vessel reaction It works for me, in spite of dr. Recommendation.

I do not smock, do not drink,no coffee, old enough, eat mostly diet, active, but do not exercise .Had a lots of stress.

As I said before, different heart work differently in each body.

Will see the next stage.LOL

[WendyWu20]

As someone having persistent AF, I've asked about taking Flecainide as a PIP a couple of times, but GP/other docs have all brushed off the suggestion without giving me a reason why. I've always felt too ill at the time, to question further. I'm wondering if it's because I'm asthmatic?

Does anyone else here take Flecainide as a PIP and have asthma?

[Afibflipper in reply to WendyWu20]

I take Flecainide 100 twice a day but NOT PIP and 10 bisoprolol (was on 15 bisoprolol) - it’s not affected my asthma. Isn’t PIP for Paroxysmal not Persistent AF I’m not sure!?

[Rellim296]

I'm the same - had a couple of echoes and ECG, no angio or exercise ECG. I took the maximum daily dose of flecainide for a while.

[WendyWu20]

Well I do get AF-free days in between my bad times...generally manage about 4 days at the moment between AF episodes.

[Alemo28 in reply to WendyWu20]

And...... Are you on PIP of Flex? Unless, people have some other health issues that have to be discussed and properly evaluated with Drs , it is worth to try.

[UScore]

I wonder if it was a decision based on my relatively low age (40), and because I'm generally quite fit and healthy, vs the invasiveness of an angiogram.

Actually, are they still invasive or do they just do CT scans now?

[UScore]

I guess you don't necessarily want to be exposed to all that radiation unless it's vital.

[jeanjeannie50]

My need to take Flecainide tablets as a PIP grew and then within months I had to take them all the time. It's been the best preventative of AF for me, but I have mixed feelings, as I do wonder if the PIP method made my attacks more frequent.

Jean

[UScore in reply to jeanjeannie50]

why do you think they made them frequent? What do you think an alternative could have been?

[jeanjeannie50 in reply to UScore]

My attacks just became more frequent very soon after I started taking them as a PIP. At first I thought they were great but after a few months it changed. Instead of getting attacks every 4-6 weeks, they started happening every week or two and then I ended up having to take them all the time. I believe others can take them this way really well.

If I had changed my diet and cut out wheat and artificial additives at that stage I may not have needed them.

I've been AF free for about 4 months now and have just today started to decrease my daily 2 x 100mg of Flec to 2 x 75mg.

Jean

[Spoiler]

I was on flecainide 50 mg twice a day for 7 months, worked perfectly as I also have a pacemaker and it tells the story. I recently did a stress test for my 6 month check up and failed, going into vtach. My EP took me off of it saying, it is not worth dying for. I said, but it works for my afib? He said, yes but afib does not have the risk this drug is for you. When I go into afib, it is persistant. I have had 9 CV in a little over 3 years. Flecainide did convert me in a hospital setting, the second 100 mg dose worked. I am just home last night from the 9 th CV,, was afib free 2 months only taking metoprolol 50 twice a day. Since I went to ER within 48 hours did not require a TEE before the CV. Flecainide was so so great for me, but now he says no. It was a total let down for me.

[JuliaJa]

My pip is Metoprolol tartrate 25mg. It usually stops AFib in two hours.