The PIP approach: I'm fairly new to the... - Atrial Fibrillati...

Atrial Fibrillation Support

32,400 members38,733 posts

The PIP approach

Nanfranz profile image
18 Replies

I'm fairly new to the idea of using one of my two daily Flecainide doses as a PIP, and until this week my daytimes have been smooth sailing so I have not had to use a PIP. However, I'm now having an occasional daytime A-F episode and some questions are now coming to mind:

1. Those of you who state that you have Persistent A-Fib -- does that mean that the A-Fib is happening 24 hours a day, but you don't take any anti-arrhythia med, either as a preventative or as a PIP? Or that your A-Fib medication does not always stop an episode?

2. Those of you who have Paroxysmal A-Fib but have frequent several-hour episodes . . . do you just live with it, waiting to see if it stops on its own, or do you pop a PIP right away, hoping to stop it in its tracks?

3. So long as a person is taking an anti-coagulant, how long is it safe to wait-and-see before taking the assigned anti-arrhythmic PIP?

Thanks to all!

Frances

Written by
Nanfranz profile image
Nanfranz
To view profiles and participate in discussions please or .
Read more about...
18 Replies
jennydog profile image
jennydog

At my last visit to my EP we discussed using flecainide as a pip. I explained that my episodes of AF were milder since my ablation and that I tended to wait for them to stop, often by going to sleep. He shook his head and looked very disapproving. He told me that I should take a 100 tablet if the AF didn't stop within 20 mins. If that didn't work within 3 hrs to take another 100. Max is 300 in 24hrs.

All this begs the question DOES A FIBRILLATING HEART GET INTO THE HABIT OF FIBRILLATING? I rather suspect that it does.

PS I understand that flecainide is best taken along with bisoprolol and I do take 2.5 bisoprolol daily. If I start having more than 3 episodes of AF weekly then I am to start taking 2x50 flecainide daily.

rosyG profile image
rosyG in reply tojennydog

Good you take beta blockers with flecanide. It’s very important

BobD profile image
BobDVolunteer in reply tojennydog

Yes. AF begets AFas has been said so many times.

UScore profile image
UScore

2) I've always taken my PiP(s) as soon as I get AF. When I get AF I get AF, it doesn't come for 10 or 20 minutes and then go by itself. Before I started using PiP, episodes would last 10-12 hours.

Hi Nanfranz,

I'm not medically trained but the following is based on what I have been personally told by my EP and what I have gleaned from qualified EP's and Cardiologists who have spoken at support group meetings. It will be interesting to see if others agree or disagree!

1. Generally, at our level it's a bit difficult to make a distinction between persistent and permanent AF, but with permanent AF, it is probable that AF will not be stopped by any form of treatment. Persistent AF however, is likely to respond to forms of treatment but when this is no longer the case, it has become permanent therefore rhythm control drugs are no longer effective.

2. When I was prescribed Flecainide as a PiP, I was advised by my EP to wait no longer than 30 minutes and then take the full maximum daily dose of 300 mgs in one go. I was told that it would dilute the effectiveness of the drug if I took it in stages. At one point I was taking a daily maintenance dose of 2 x 50mgs of Flecainide and this had to be taken in conjunction with either a daily beta blocker or calcium channel blocker. I was told that if Flecainide was taken as a PiP only, it could be taken on it's own without betablockers or calcium channel blockers. I was encouraged to use Flecainide as a PiP and a maintenance dose to maintain sinus for as long as possible between my cardioversion and subsequent ablation.

3. As with everything to do with medication and dosing, you must follow the recommendations and advice given by your Doctor because he should have a clear understanding if your condition.

As I mentioned earlier, this is what I have been told in connection with my condition and this should not be seen as suitable for everyone.....we are all different!!!

CDreamer profile image
CDreamer in reply to

Exactly what I was told and my understanding and experience of using Flec as a PIP.

I didn’t take beta blocker whilst taking Flec as a PIP or when as a daily dose as it made me very ill and I don’t get why there is a difference between advice?

wilsond profile image
wilsond in reply toCDreamer

The only thing I can add is that I was prescribed 100 mg x2 daily after a prolonged AF episode,and taken off my betablocker immediately at the same time.One week later, I had gone into AFlutter...

in reply toCDreamer

I will find out CD, unfortunately the next meeting is not due til April, but if RosyG sees this, she may remember....John

in reply toCDreamer

About a year ago, ILowe did a detailed post about taking beta blockers with Flecainide and the replies are interesting too....

UScore profile image
UScore in reply to

It is interesting because the 2 EPs I've seen said you needed to take a betablocker with the Flecainide. I only take 1.25mg of bisoprolol, although I take that with each 100mg of Flec that is required. No-one's ever told me to take the full flec dose in one go either.

When I was in hospital being given Flecainide by IV, they give it very slowly over 24 hours and then stop as soon as you return to SR. Also, when I was in hospital and taking Flec by tablets they made me wait aaaages between each 50mg tablet.

in reply toUScore

That’s interesting, when I saw the instructions for Flecainide as a PiP, it said the first dose should be taken under medical supervision but my Doctor said that it would be OK for me. This is why I am very cautious when discussing medication, there are so many conflicting views out there!!

UScore profile image
UScore in reply to

My first time with Flec was in hospital, on the IV. I didn't have any medication to take at that time as I was still waiting for my appointment with an EP.

So when I was given it as PiP I guess they thought the IV counted as the first time as I wasn't told I needed medical supervision for it.

BG2017 profile image
BG2017

Hi Nanfranz,

I take 50mg flecainide twice a day and have not been given an anticoagulant or a beta blocker. I was also told to use up to 300mg of flecainide in 24 hours to stop an af episode.

I always saw this as a last resort and will usually wait until the second day in a row of being in af (usually 120 - 160bpm) before taking it. If I am over 200 bpm I will give in sooner as physically it is harder to cope with all the other things I need to do. I have episodes roughly 3/4 days per week and they can last 30 minutes to a coupe days.

I am genuinely not sure how long to wait before taking a PIP as I thought it was for when I can’t cope with an episode any more - so I am reading all the comments with interest!

Kind regards

Becky

ILowe profile image
ILowe in reply toBG2017

To take or not to take, that is the question.

To take not, and the problem goes away vs never stops.

To take, and a positive result, that may have happened anyway.

What is the harm in taking? Depends on how you react. For me this was the definitive question. I resolved henceforth to always take, and take promptly. My risks in taking are small, with enormous gains.

UScore profile image
UScore in reply toILowe

I never noticed any side effects from Flecainide so I've never seen any point in holding off.

ILowe profile image
ILowe in reply toUScore

Exactly. The main risk is that if you take too much you can make it worse. This is well documented and well known. That is a major reason for taking a little bisoprolol with the flecainide if you are not already taking it.

The other choice for you/your doctors is do you take a little, then some more later if you need to, or do you hit it, with one high dose. The absolute limit is 300mg per 24 hours. My prophylaxis dose is 50/50 daily. When not taking flecainide, hitting the system with 100 makes sense, with another hit of 100 four hours later. The idea is that a bolus dose creates a peak that passes which is a mini shock. Not every doctor understands this method.

I get myself into trouble sometimes by my strong tendency to avoid medicines. Sometimes we need to take them to avoid a bigger problem.

WendyWu20 profile image
WendyWu20

I was given a diagnosis of 'persistent' last year when having episodes about twice a week, lasting for days at a time. After various beta blocker meds, having no effect, I'm now on Flecainide 50mg twice a day with extra for a PIP if needed.

I didn't want to take daily Flec but the local pharmacist recommended it. I now only have episodes about once a fortnight, and take 100mg straight away when it starts. The episodes now only last up to 12 hours.

It's difficult to tell if it's just the Flec which has helped, as I've made other lifestyle changes at the same time, such as eating more healthily and losing weight. So it will be interesting to see what happens as I intend to wean myself off the Flecainide in a couple of months when I've reached an optimum weight :o)

Jackrider profile image
Jackrider

Flecainide made me so sick (especially nauseous) and anorexic, and, and..., that I became suicidal. I had every side effect, along with the toxic amiodarone, that life was spent on a couch for 8 months. It is simply not to be taken cheerfully. Oh yes, intestinal blockages more painful than childbirth. My a-fib was persistent, but what is the difference between that and permanent?

As an aside: cardiologists always look disapproving, but I may be saying that because they took my mental state dismissively and didn't believe the drugs had any part in it. I was a "difficult" patient as I didn't conform to their notion of outcomes.

Not what you're looking for?

You may also like...

Daily meds vs PIP meds

Will try and make long story short: 21/2 yr of PAF, started with sotalol, cardiologist wouldnt hear...

Flecainide as PIP question

Recently I had a pacemaker implanted. . Prior to that I was unable to tolerate taking flecainide....
Tux18 profile image

What do you think?

Opinions please, I know we arent docs, just wondering if I should shut up and b a good patient or...

Flecanide PIP dose

This has probably been asked before, but, if you've been directed to use Flecainide PIP at the...
Racquet profile image

How soon do you take PIP Flecainide once AF starts.

Just wondering what interval you leave between AF starting and taking your PIP Flecainide for those...
Tyson4ever profile image

Moderation team

See all
Kelley-Admin profile image
Kelley-AdminAdministrator
jess-admin profile image
jess-adminAdministrator
Emily-Admin profile image
Emily-AdminAdministrator

Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.

Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.