Flecainide advice

[Annejos]

Good Morning. I have just been prescribed flecainide as a PIP. I get fast atrial fibrillation and flutter. The dosage prescribed is 100mg Max 200mg in one day. I get irregular rhythms lasting circa 24 hours or so every second day ish.

I took my first PIP dose yesterday of 100mg - at about 10pm. within an hour my heart rate returned to sinus rhythm, but then I woke up in the night with my heart racing like a dog had been let off a leash. A few hours later my usual irregular rhythm returned, which to me felt much better. Back in sinus rhythm by 8am but feel like my heart went through hoops in the night.

Any advice .... Does it sound like the dosage was too low or too high or otherwise ?

I appreciate the advice.

Thanks

Anne

[Juliesk]

Hi, I have taken Flecainide for more than 5 years until last week. I changed cardiologist/EP last year and he really doesn’t like Flecainide as although it can help with AF it can also trigger further arrhythmias. I have suffered similar problems to you so I understand your concerns. I suggest you go back to your cardiologist/EP to discuss. Good luck🍀

[Annejos in reply to Juliesk]

Thanks Julie. I appreciate that.

[BobD Volunteer]

We should not advise on dosage of any drugs so please discuss with your medical team. I do know that the maximum dose of flecainide permitted in any 24 hour period is 300mg not 200mg so maybe your doctor has told you 200 for a reason.

[Annejos]

Thanks Bob. I intend to ask them.

[rosyG]

If you don't get to talk to your specialist before needing your next PIP I would attend A and E if your AF is bad. Explain what happened last night . Flecanide can cause 1.1 conduction from the atria to the ventricles which is why some, but not all, doctors prescribe a beta blocker to take at the same time. However this isn't suitable for everyone and other drugs, such as channel blockers, may be given instead of beta blockers- this is very individual to you so needs discussing carefully with your doctor.

If you needed the Flecanide and were in A andE you would be in a safe place if they thought it was the best treatment for you.

I have had these conversations recently with EPs as I have Flecanide to take as PIP for the first time if needed when abroad later on this week.

It is very confusing as there are different views and I still am unsure about what I will do if it's needed! I have got both Flec. and a beta blocker, but have vagal AF where beta blockers are not recommended. I will have to decide at the time- balance of risk I think11

PS The guidance is to start Flecanide under hospital scrutiny- but it's just not feasible for everyone to do this- so don't feel bad about turning up at A andE tThey will understand when you tell them about last night's experience

[Annejos in reply to rosyG]

Thanks Rosie. My episodes are so frequent that I will most likely have to decide what to do in the next day or so. I will visit GP tomorrow for advice and email the hospital at the same time.

Thank you

[rosyG in reply to Annejos]

That's good- if you don't get advice before your next dose do take yourself to A and E as I think it would be risky just to be at home- your GP may not have enough info on this so hospital advice is needed- ask about beta blockers etc too.

[Hidden]

Hello Anne, as Bob says, we cannot comment on dosage. Can I suggest you re-affirm the maximum dose your Specialist recommended. Normally, for the PiP regime to be effective, the full prescribed dose should be taken between 30 to 60 minutes after the episode begins and I suggest you confirm this with your doctor. It is potentially dangerous if anyone takes more than 300mgs in any 24 hour period unless prescribed by a Doctor (which would be unusual).

[Annejos in reply to Hidden]

Thanks Flapjack. I will go to my GP tomorrow for advice. I don't feel comfortable increasing the dose to 200mg without the advice of GP or Hospital.

Hopefully it's just a blip

Thank you

[Hidden]

Anne, what puzzles me is why it's been suggested you take flecainide as a PIP when you have AF so frequently. Surely a low dose on a daily basis might be considered by your advisors. It's best taken on an empty stomach which isn't always easy if you are using it now and then.

Many use flecainide as a PIP but many of us take it daily, either 50mgs or 100mgs at twelve hourly intervals. Some have been prescribed 150mgs twice a day.

Hope you can sort out a dose which keeps it under control.

[Annejos in reply to Hidden]

Thanks Rellim. I was curious also about why a PIP and not every day. I only thought of that after my consultant visit though.

Anyway thank you. Hopefully I'm on the way to getting to the bottom of it and getting a dose to to keep it under control.

[jeanjeannie50]

Hi Anne

I took Flecainide as a PIP and at first it worked well, but my attacks became more frequent and I now have to take it all the time 2 x 100mg daily. If you are getting attacks of AF every other day I think talking to your GP about taking it more frequently may be a good idea.

Let us know how you get on.

Jean

[Builderpete]

Hi Annejos

I’m on the same dose and have been for four years, I get same symptoms as your describing but can also go long periods without any. I find flecainde ok compared to some meds I’ve been on before, maybe check with your gp for reassurance.

[Annejos in reply to Builderpete]

Thanks Pete. Appreciate that

[secondtry]

Hi Anne, from my experience you need to suggest to your cardiologist that you go on 200mgs Flecainide per day on a regular basis not PIP. I have Lone PAF with no other comorbidities and 100mgs Flec per day didn't stop it but 200mgs has worked well for 4 years nb part of this success I attribute to taking Mg & CoQ10 supplements and changes in diet (e.g. 80% gluten out, 50% sugar out) and lifestyle. Good luck.

[Annejos]

Thank you. That's reassuring. Many thanks.