How quickly does flecanaide work ?

[Poodlewoman]

I recently went into afib during a 4 week bout of flu and took one 100mg flecanaide as prescribed waited 30 mins still had not worked and took a second dose as directed by my cardiologist. However after a further hour nothing had happened so husband called ambulance. As it turned out by the time I reached hospital my rate started going down and I went back to normal rhythm....... how long should I leave it? This was my first time taking it as pill in pocket .,,. Would like to know for next time ! Thanks

[Drounding]

This is really a question for your cardiologist. Everyone I suspect may be different but here's what I do...

I carry 50mg Flec as pip and take either one or two tabs initially depending on whether I'm going in and out of afib or staying in. If I'm going in and out then I'll take one but if it's staying put then I'll take two. Then I wait for maybe two or three hours and take another one. And if it still persists, which would be very rare for me then I might take another or pop down to A&E. I have been advised not to take more than 300mg a day but you should follow what your cardio says. Also of course if you experience any pain then call an ambulance or go to A&E.

[Poodlewoman in reply to Drounding]

Thankyou 👍🏻

[Hidden]

Hello Poodlewoman, because we are not medically trained, we cannot comment on prescribed medication. However, the leaflet makes it clear that the maximum dose for Flecainide is 300mg within any 24 hour period and it sounds as though you might be exceeding this. Most posts here about PiP suggest that it can take up a couple of hours before a steady rhythm returns but this varies enormously because we are all different. Both my earlier Cardiologist and my current EP asked me to take the full dose (300mg) when necessary and on occasions it has taken 12 hours for steady rhythm to return. I suggest you contact your doctor and make him/her aware of what has happened to you, and to confirm the maximum does you should take. Hope this helps.......

[Poodlewoman in reply to Hidden]

Sorry it’s a typo ..... my dose is 100mg then a second if no improvement (total 200mg) 👍🏻

[Poodlewoman]

👍🏻

[Rubymurray25]

Hi Poodlewoman,

I am currently on Sotalol and I was given Flecainide as a PIP following a visit to an away from home hospital ( on holiday ) last August. I had an AF episode a few weeks ago and decided to take my first 100mg Flecainide , I sat down at midnight and within 30 mins I was back to almost normal, the best feeling ever knowing it worked so quickly. Sadly a few days later I had another episode , it was at 5 in the morning so I decided to take my 80mg Sotalol 2 hours early but it didn't work so I proceeded to take a 100mg at 7 ( 2 hours since the Sotalol) but it didn't work so as instructed I took another 100mg Flecainide. I waited 90 mins and thought it was time for A&E. Within one hour they had given me a Cardioversion. So I guess it is the old chestnut, no real answer unless taking the Sotalol early was my mistake and should have gone straight in with the Flecainide ) but taking the Sotalol early has worked in the past! Good luck and I know for sure reading others experiences have often helped me understand the complexities of dam AF.

[Hidden]

A cardiologist said that there is no such thing as a Pill in the Pocket for AFib. I was prescribed Flecanide as a daily pill for about a year but was switched to Bisoprolol when Flecanide started to go wrong with the heart.

We are all so very different, and so are medics and consultants. Best wishes to all.

[ILowe]

"Peak plasma levels are attained at about three hours in most individuals (range, 1 to 6 hours)" drugs.com/pro/flecainide.html

"Flecainide has high bioavailability after an oral dose,[25] meaning that most of the drug that is ingested will enter the systemic blood stream. Peak serum concentrations can be seen 1 to 6 hours after ingestion of an oral dose. While the plasma half-life is about 20 hours, it is quite variable, and can range from 12 to 27 hours.[26] During oral loading with flecainide, a steady state equilibrium is typically achieved in 3 to 5 days." Wikipedia. Trustworthy because only medical people can edit medical information on Wikipedia.

See also ncbi.nlm.nih.gov/pmc/articl... "Twenty-five years in the making: flecainide is safe and effective for the management of atrial fibrillation."

[irene75359]

Two to four hours for me. Never been less than that, and I find if I am patient it works (touch wood!)

[MS444]

" took one 100mg flecanaide as prescribed waited 30 mins still had not worked and took a second dose as directed by my cardiologist." However after a further hour nothing had happened so husband called ambulance. As it turned out by the time I reached hospital my rate started going down and I went back to normal rhythm......."

As mentioned above peak levels are achieved 3 hours after taking the pill. also, there are statements on the web referring to the rapid increase in blood concentration of flecainide contributing to "kicking" you back into normal rhythm.

So what surprises me is that your doctor advised you to call an ambulance 90 minutes after the onset of PAF. Is he a GP or a skilled specialist?

[MS444]

Sorry; I see you referred to him as a cardiologist. It's just surprising to push the panic button after 90 minutes unless you have vast experience of knowing that you will never revert to normal sinus rhythm.

[Poodlewoman in reply to MS444]

Hi.... thanks for that ...,,

It’s the first time I have had to use the flecanaide so it just says on the instructions to take one wait 30 minutes then take another. It was not explained to me about any time to wait after the second dose except that if it didn’t revert to go to hospital. I’m on warfarin and already had a cva and my heart rate was up to 190 at times .....

the other effect which was most unwelcome was that The flecanaide appears to have completely upset my INR levels from my steady 2.7 right up to 5.7 !

[ILowe in reply to Poodlewoman]

Hmm. I have never heard of flecainide upsetting INR before. A cardiologist once told me that 'flukes' do happen. If I get a suspected fluke, I need to carry on as normal for dosing, then the next day repeat the test, preferably at another lab. How did you handle it?

[Poodlewoman in reply to ILowe]

Hi.... my warfarin team lowered my dosing immediately until I went down to 1.7 then restarted my 6mg a day which keeps me at about 2.5 to 2.7.

I have my own INR testing machine so I do home tests and ring it in to the warfarin clinic at the hospital 💐

[ILowe in reply to Poodlewoman]

Fair enough. It worked for you.

[eleanor--1941]

I was advised by my Cardiologist,to wait 10mins then take 300mg,which she said can take up to 8hrs to work.

I have been using this for many years now,every time I take it,it works for me 40mins to 4hrs,no problem.I have Paroxymal AF.

Also advised me if it does not work by 8hrs,to go to A&E.I have never had to do this,since using Flecainide as PIP.

I can go a year plus without an episode now,a wonderful Drug for me.

Stay well as can be.

Eleanor.x

[Poodlewoman in reply to eleanor--1941]

Thankyou

[yanbart]

For me it's quick. 10-15mins before it kicks in. I think it's bloody amazing to be honest!

[Tantaanna]

When I did the PIP (before my ablations) I took 300mg on onset- if I was home. At first it worked in 30 minutes- as time went on with more AFIB eventually it took as long as 12 hours - and the flecanide may me dizzy and wiped out - especially when having two episodes a week. Then I got scheduled for my first ablation.. good for eight months and then another AFIB event- after cardio version put back on Flecanide and felt miserable. Then scheduled another ablation.

[Poodlewoman in reply to Tantaanna]

Oh I am sorry to hear that. 😕