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AF Association
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On Sotalol and Apixaban for PAF

I read on here that some folks are on Pill in The Pocket,; I went into Resus 18 months ago with severe AF, and stayed in hospital for a few days until my AF settled.

I was prescribed Sotalol twice a day and following a consultant review was discharged to GP.

I wonder why I am on drugs constantly rather than PIP, never thought of asking at the time.

Appreciate any comments from you learned guys

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Interesting question. NICE guidelines don't seem to have much to say about pill in pocket for AF, apart from mentioning Flecainide and Propafenone (Class 1c antiarrhythmics) as suitable for pip

I can't answer your question but my guess is that cardiologists who use sotalol ( class III like amiodarone) would prescribe a regular dose and say an extra dose could be used as pip if necessary.

I took Sotalol for 8 years up to 240 mgs total daily eventually. I never knew whether it helped but it didn't seem to give me any problems.

I remember a cardio saying that my initial dose of sotalol 40 mgs twice daily was subtherapeutic, presumably he meant too low to be effective, but as ever we are all different and only the medics know the specifics of our situation.

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Thanks Oyster, interesting I'm on 80mg twice a day, and my EP was a youngish chap so one would imagine up with the latest techniques.

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What dose are you on and is it keeping the AF under control?

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Hi kaz747, I'm on 80mg twice a day, I still get AF every couple of months, mostly mild but my last one was severe, very breathless, dizzy and unable to get about etc, rather like before the tabs. Only last 2 days though.

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When I was on 80mg twice a day, my doctor advised me to take an extra tablet if I went into tachycardia (at that stage I hadn’t been diagnosed with AF). I’ve had a tough 6 months with atrial flutter and AF and my dosage was increased to 120mg x 2 and then 2 weeks after my ablation in September when I ended up back in hospital y dose was increased again to 160mg x 2 and Digoxin was also added. I’m still getting daily AF episodes so not sure what is next. I was previously on Verapamil and Flecainide. I guess you have to be guided by what your doctor recommends.

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Thanks Kaz, hope you are sorted now. My dose seems low then and I will ask about taking extra when in AF.

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Here in UK sotalol is not approved by NICE for rhythm control in AF although some EPs do still prescribe it. It has two functions both as a rhythm control drug and also a rate control drug but can be pro arrhythmic for some people. It is not a drug which would be used PIP any more than beta blockers should be.

The point to understand is that any and all treatment for AF is only ever about improving quality of life (QOL) . Surely it is better to try and prevent the events rather than treating them when they occur? If on the other hand a person has few and far between events then a suitable PIP such as flecainide or propafanone would reduce the incident of side effects thereby improving QOL for most of the time.

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My EP in UK is prescribing me Sotalol as pill in pocket post RF ablation.

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Cheers Bob, that makes sense as I had events prior to seeing EP about every month or so.

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I was on Sotalol for several years, after Norpace and a couple of others really didn't help. I would still have about 15 episodes every month lasting from 2-10 hrs - and this after 2 failed ablation procedures. My MD had been encouraging me to try his "Magic Bullet" as he called it for a few years, but I was reluctant due to the 3 day hospital stay required or safe dosing. I finally decided to give it a shot and it has been life changing. Far fewer episodes, but moire importantly the duration has gone from hours to minutes. Unfortunately, this drug: Tikosyn ( dofetilide) is apparently not available outside the US., though. I hope that could change for you all in the future.

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Many thanks, glad you have found a solution.

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Yeah I have been thinking the same thing. I had a paf episode 20 years ago which reverted with Flecainide. Then a few months back went into persistent af which has reverted with CV. There have not been any other real episodes in those 20 years (No paf for more than 10 seconds but would happen every now and again and etopics)...but I am now on bisoprolol & flecainide. Don't understand why I can't be PIP. Guessing once had persistent af it all changes?.

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You seem to have done well , perhaps now they want to keep you as well.

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We all have different health issues and although I am on Apixaban and Soltorol like you. I have AF which caused a stroke last year but also have a heart valve problem. Maybe your condition isn't appropriate for using PIP. I'm sure we would all rather take one pill every time we have an episode but we have to put our trust in someone to issue the right medication. I hope my cardiologist knows what he is doing and I hope you find the best options for you. As Bob D often says knowledge is power but sometimes with me it's a case of ignorance is bliss.

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Cheers helpme, hope your stable now, and like your ignorance is bliss comment, often true :)

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I have been on Sotalol (prescribed by EP at South West Cardiothoracic Centre)) and Apixaban since hospital admission with AF one year ago. RF ablation 3 weeks ago, continuing on sotalol before weaming off it after a couple of months. Then to carry "sotalol as PIP as it is a drug known to me to be effective should I experience any breakthrough AF".

I too have a "youngish" EP and as I am participating in a trial under the auspices of Imperial College London I have every confidence in them following the correct recommendations.

NICE recommendations for prophylaxis of PAF - it gives dosages and indications for use of Sotalol in uk

bnf.nice.org.uk/drug/sotalo...

NHS info on Sotalol for AF

nhs.uk/medicines/sotalol/#h...

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Good links Cat, thanks. Your experience seems similar to mine so I'm a bit more relaxed about my dosage.

Not had any side effects other that the tiredness.

Take care

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After my first episode & emergency admission I was prescribed Sotalol, as you. However, it did not suit me at all, it brought my heart rate down to low - room spinning etc. I was told to stop taking it. My consultant put me on PIP (flecainide) should episodes kick off. Fortunately I have only had to resort to it a few times in the four years of diagnosis. Of course if AF is persistent then regular meds are prescribed.

I like to know how my heart is behaving & I think PIP is the best way (for me)

Best wishes Ally

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Thanks Ally and best wishes.

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