Does anyone know about Flecainide and Nebivolol together?

[Patsy10]

Hi, I'm new here but it's time for me to 'jump in'.

I have been following the posts on here for a while now, finding them both interesting and informative, sometimes even quite amusing.

A few weeks ago the decision was made to change my 50mg flecainide PIP to a regular dose (2 x 50mg) one in the morning and one in the evening. I took it for a few days and seemed to have more PAF episodes so dropped down to one in the evening. Two weeks ago I started taking two again but I am still not convinced. Does anyone know how long it takes to 'settle down'?

Also, my evening dose of 2.5mg Bisoprolol has been changed to 2.5mg Nebivolol due to various side effects. I started on this five nights ago. Does anyone know if this takes very long to replace the Bisoprolol in your system?

This week I have had twelve episodes, which have varied from 30mins to 7.5hours. But I did have two days without any when 'normal' life was resumed. This is pretty much what it has been like for a few months and it is really wearing me down.

I have had three ablations, the last one 1st March 2017 so I imagine that I shall need to give some thought to whether I want another one. Really I would like to feel better than this before Christmas!

Thanks in anticipation for any responses.

[Hidden]

Are you sure this is fibrillation rather than flutter or atrial tachycardia?

[Patsy10 in reply to Hidden]

Thanks for your response. I am pretty sure it is PAF, although it is far too frequent at the moment I am not in it for days and days. I did see the EP Consultant three weeks ago and he had a recent 24hr tape which had recorded two episodes to look at. He referred to it as AF so I have no reason to doubt him.

My first ablation was for flutter and as they finished I went into AF and they cardioverted me. I was then told that I would be back for another ablation at a later date to treat the AF! Which was the case.

[Patsy10]

Thanks for your response. I do hope that you are wrong. Permanent AF has not been mentioned by my EP Consultant who said that if the meds. do not control it better then an ablation is on the table. I was asked earlier in the year when the episodes returned if I wanted another ablation but I said then that I would actually prefer for it to be controlled with meds. if possible. I do monitor the rhythm but only during an episode and not with

a Kardia.

[Hidden]

The elimination half life for both the beta blockers is around 12 hours unless you are a slow metaboliser. So each disappears pretty much in 3 days. Steady state levels are apparently reached in 24 hours normally for Nebivolol so after 5 days your changeover is complete.

The ACC recommend waiting at least 4 days to achieve steady state plasma levels for flecainide before considering increasing the dose. Don’t increase it without talking to the EP. Flec can provoke flutter. A rate control drug like Biso is given alongside to mitigate that.

[Patsy10 in reply to Hidden]

Thanks so much for the info. I am definitely considering dropping to one flecainide a day

as I do seem to be having more AF episodes, a lot of them seem to start 1 - 2 hours after taking a tablet! It can really get you down when all you want is a day free.

I have had three since 11.30pm last night. Hopefully I might not go into AF again tonight and can have a good nights sleep without nightmares.

[Hidden]

I had to come off Bisoprolol as it slowed my HR too much & gave me postural hypotension making me feel faint on standing.

I started Flecainide 50mg x 2 daily in mid August and it took about 6 weeks for my heart to settle down. Lots of palpitations initially though no AF or racing rate.

Palpitations are now only rare and last a max 60 mins, but usually only a couple of minutes. So far, Flecainide has transformed my health for the better.

I think we all react differently to meds.

Pat x

[Patsy10 in reply to Hidden]

Hi,

Thanks for your response. It is interesting that it took about six weeks for your heart to settle down. I am thinking of dropping to one due to the number of episodes that I am experiencing. However, having read your comment I will give it some thought.

Thanks. Patsy

[Acwm]

Hi, I'm currently taking fmecainide 50mg bid + nebivolol 2.5mg once daily for 2.5 months now. How are you doing with the meds so far?

[Patsy10 in reply to Acwm]

Hi,

Having seen the consultant again a couple of weeks ago I am now on 2.5 nebivolol twice a day and am dropping to 50mg a day of flecainide, starting today. If this works out ok then

we are going to drop the remaining 50mg flec. in a couple of weeks and just keep them as

PIPs. I do seem to be having just as many, if not more episodes with the flec.

Although about 7/8 years ago I was on 100mg flec twice a day and it was really great.

I was not on anything else at the time though and it stopped the AF.

How are you getting on with your meds?

[Acwm in reply to Patsy10]

I just saw my EP the other week and he advised that I continue with the flec 50mg bid, while the nebivolol can be used as PIP. However, when I tried this, seems by bp went up possibly due to withdrawal of betablocker. So I just continue the betablocker to avoid this as I found out that you have to taper off bb slowly. Seems you've used flec in the past and then stopped. May I ask how old are you, how long since youve been diagnosed with Afib, and how have you been coping with it? Thanks

[Patsy10 in reply to Acwm]

Hi, Sorry to hear that you are struggling a bit at the moment.

I dropped the last flec. on Saturday and have been ok so far, but it is early days! I have however been really tired which is not surprising because I have missed so much sleep lately with AF.

To answer your questions, I am just turned 68 and have had AF for about ten years. I must admit though that I am not as meticulous as some on here with regards to keeping a full record of my previous history!!

The Nebivolol has been great, a definite improvement on Bisop.

regarding how I feel on a day to day basis, I take this purely for AF as I have never had a problem with my BP.

[Acwm in reply to Patsy10]

Good to know that the Nebivolol works fine for you. The side effect i could feel is fatigue, but my cardiologist said that it's normal, and I should allow at least 6 monthhs of use so my body will get used to it. I'm 32 years old, diagnosed with Afib just last March 2019. I'm trying out lifestyle changes to manage this hopefully without meds in the future. Is yours paroxysmal afib too? Have you been in constand medication since 10 years ago, or you managed to stop meds for some time?