Flecainide - is daily or PIP better?

Hi Wendy, I was on 150mg of Flecainide slow release and had a lot of side effects so the doctor told me to take 100mg as PIP when needed. I had a SVT last week and took the 100mg as instructed but it didn't work so I ended up in the Emergency dept where they stopped it with a chemical injection. I think if I had taked 50mg in the morning and 50 again in the evening, it would have worked as a preventative measure. When I asked the chemist she said she thought 150mg was too much for me as I'm quite small and slim and my blood pressure is only 10/5.

I've heard that only 200 or 300mg work as PIP but when I asked my cardio if I should have taken 200 instead of the 100mg, he said no. ( with no explanation as to why). Good luck and hope you get some good answers on here that will help.

Trish

Wendy, I have just seen your post about Verapamil, so you are on it too. I wasn't sure if they were both safe to take together, (Vera and Flec) but they must be if your cardio has given you the go ahead to take them together. You could maybe ask your doctor if you could take a little dose daily of Flecainide to keep your bouts at bay if they are safe to take together.

Trish

I took 100mgs of flecainide twice a day for about two and a half years. Wonderful to start with (I was AF free for just over a year) but AF crept in after a while and my cardiologist increased it to 150mgs twice a day. This brought no improvement but my EP said that without it he thought I would have AF every day. I used to get it for a few hours once in about two or three weeks.

I gave up daily flecainide completely four months after an ablation, but I still get AF occasionally.

Since then I've taken flecainide as a PIP, starting with 50mgs and a further 50 if needed, but in fact I no longer bother with it as my AF seems to be self terminating.

It is hard to say, if you are taking flecainide, whether you would be worse off when you are not taking it. I am resisting suggestions that I should be taking it daily again as I am quite happy without it, though I don't know what effect the sessions I get are having on my heart. I think I've gone 28 days since I last had AF and it's the longest clear spell I've had since April.

Trish - Well I'm trusting that the GP, and the local pharmacist wouldn't advice daily Flec if it was contraindicated with Verapamil. However, I found this on the NICE online site ... 'increased risk of myocardial depression and asystole when flecainide given with verapamil.'

If you don't hear from me again I've gone into asystole!!!! :o)

I used Flecainide twice daily at 100mg each and used a 3rd dose of 100mg if AF kicked in and didn't convert to NSR. This was in conjunction with Bisoprolol 1.25mg once a day.

I still had daily episodes, so my EP switched me to amiodarone 200mg for the short term until my ablation in 3 months time. I'm having way less side effects of sluggishness and my brain fog has cleared. I know amiodarone can have some nasty side effects but the EP says for the sort term it should be okay.

I'm a 50 year old with lone P-Af. Hope that helps. Kelli

Hi Wendy, I started taking 100mg Flecainide as a pill in the pocket almost two years ago. Up to that time I'd been getting attacks every 4-6 weeks - never ever went longer than 6 weeks without an episode. At first it worked beautifully and I thought it was amazing, but then after a short while (months) my attacks got closer and closer until I was having to take 2 x 100mg Flec every day. Once it started getting it into my system, my heart protested if I dared to try and come off of it.

Sorry, but I had to laugh regarding your asystole - sounds like you were being very rude!!

Jean

I'm a fan pf PIP flecainide and use 50mg repeated after about 1 hour if not resolved then another 50 at hourly intervals. The max total I've been up to in a day is 200mg

I use 50 mg x 2 and I think with my other drugs a few ectopics not every day I have been free from af for 2 years. Just take one day at a time not projecting into the future also told if I go into af it's not permanent to take it as a pip. Glad I haven't had to do this as yet. I feel tired but probably a bit of age plus bisoprolol and amlodapine I think the cocktail is probably the answer for me. Best wishes

I laughed at your physical description of yourself - that's me too.

I saw my EP recently and discussed flecainide. His instruction is to take 100 flecainide after 20 mins of AF. If it doesn't work within 3 hrs then repeat. Max is 300 per day. If I deteriorate to 3 attacks in a week then I am to start taking 2 x 50 daily. I also take 2.5 bisoprolol daily, and have done so since my ablation 3 years ago.

He was especially adamant that I do not ride out episodes without the flecainide. We have discussed that on here recently. The heart would get into the habit of fibrillating.

I have had Afib for 20yrs first had Flecainide as a pip but got fed up ,it only happened about 8 times a year but at inconvenient times so cardiologist told me to take it daily 100mg am and pm and was fine for about 8years then got a episode and had to have cardioversion then fine for a year then happened again last year same result and now been free for another year. The downside is that I have started Warfarin on their recommendation all the NOACS gave me very bad side effects so I am persevering with the cold hands,hair loss and also had a very bad nose bleed! I think it also affected my eyes but the Dr's all say not and that is"age related". So you can see that we are all different and just have to find which suits us the best.

Best of luck Jo.

Hi , I have experience of both, started off 10 years ago as PIP , but, I got fed up with the after effects of 300mg when I had an episode and started daily 2X50mg - I have no effects at this level and apart from chest infections or other sickness I have very little AF - longest period free 18 months - for that reason INMY CASE I am happy with using it as a prevention.

Teach2learn - I've had AF for about 13 years. Since then, as you point out, AF just gets worse over time - and mine is persistent now.

However, I've always been interested in the spiritual side of things, and have meditated daily for a long time. One of the worst things about the AF getting so bad was that I felt a failure for not being able to cure it by making lifestyle changes and/or cure myself from a spiritual healing perspective.

About a month ago I reached a personal crisis point. The combination of taking meds/not wanting an operation/feeling so ill, provoked me into a real quest for self-healing. Since then I've undertaken a lot of spiritual exploration into my individual causes for AF, and am deeply committed to unravelling those negative emotions. Most of this is done through meditative and energy work. Most people consider this to be weird, but as my view is that some illness is caused by negative experiences and emotions, then it makes sense to me :o)

And I am feeling so much better for the past fortnight - early days yet, but I'll continue working through things.

Wendy, I was diagnosed with paroxysmal AFib in 2006 (attacks that lasted up 24 hours). I attended the Atrial Fibrilation in London and was prescribed 50mg flecanaide twice daily. I was AFib free from the moment I started taking it up early 2015. In other words it worked for me for around 10 years.

My AFib started again in 2015 despite the Flecainide. I had an ablation last year and have been AFin free for nine months. I currently take no medication.

Flecainide was a great drug taken twice daily for me.

I was on flecainide 50 mg twice a day from Dec until July 11th. I did absolutely wonderful (I have persistent Afib that requires cardioversion) this drug made me feel like I was completely normal, as I had no episodes of afib via pacemaker reports. BUT, when they did my stress test, I failed at only 5 minutes into the test my heart rate started dropping instead of going higher. I had gone into a dangerous other rhythmn problem, VTACH. My EP said I absolutely could no longer take my miracle drug. I have required 2 cardioversions since being off of it. One on the 29th of August, another on the 31th. The drug was great, but I am no longer allowed to have it.

Cardiologist prescribed 300mg as PIP for me ,I take this when an episode comes on,within 40mins to 2hrs,my heart is back to normal,Taking them daily,made things much worse for me.

Eleanor.

I take Flecainide and it really did work for me. Have just had an ablation and waiting to see if it works. Probably being a bit thick here but what is PIP?

I was prescribed Flec 100mg BD plus 300mg PIP, but not told about the maximum dose, so on occasions I've had total of 4-500mg in 24 hours and I'm still here! My PAF is a lot better controlled now with the regular Flec (and 5mg Bisoprolol), and if I do get breakthrough AF (if I've had a night out an more than a couple of glasses of wine - a known trigger of mine), usually just an additional tablet of 100mg sorts it. We're all different though, have different triggers and so respond differently to treatment regimes . . . .

Hi,i am daily on flecainide and for me he work well till now

Providing you have a structurally normal heart, no coronary artery disease and no prior heart attacks, my take for what it’s worth is that Flecainide is a good option and well worth a try whether PiP or daily preventative.

I had an ablation 5 1/2 months ago. I no longer have AFib but have been plagued with horrible Ectopic beats and PACS every single day since the ablation. I was finally prescribed Flecainide 50 mg 2 X's daily and it stopped all the irregular beats. I am very happy with that of course but I don't like taking so much medication, especially the Flecainide since my EP said he normally would not prescribe Flecainide to a patient who had had a previous heart attack and stent. He said he had to think outside of the box with me since I was already on Metropolol and Diltiazen. Right now it's working for me like a miracle. I was told that they are finding out that some of these irregular beats are precursors to AFib and so the Flecainide works like a preventative in that situation. So if you don't have all those other bothersome irregular beats and only breakthrough AFib maybe the PIP is a better way to take the drug.