Flecainide- Time to work? Sinus rhythm!

[Edstiffler13]

How long does 100mg flecainide take to convert to sinus rhythm once afib has started? Just an idea would be great so I know what to expect if I have an episode. This is new to me. Thanks!

[pottypete1]

I take it you mean when Flecainide is taken as a “pill in the pocket “.

I have taken Flecainide daily for 25 years but also as a PIP when I had an episode of AF. On the majority of occasions it worked but not always.

If it works normally I revert to NSR between 1 and 5 hours. It has very occasionally been up to 10 hours.

Pete

[Edstiffler13 in reply to pottypete1]

Thanks for the info! I hope to not have to take it but I’m sure I will. I just hope I’m not in the middle of nowhere on my Harley when AFIB happens.

[BobD Volunteer]

Short answer is it may not. 100mg is pretty low dose and sounds more like a maintenance dose than a recovery one. When I used Flecainide as PIP it was 300mg . NB that is maxiumum in any 24 hours.

[dmac4646 in reply to BobD]

Agree totally with Bob there is a difference with me between maintenance and having an episode - i take 100g every day , but if I have an episode I need a further 200mg - pretty well the max depending on when the last does was taken that usually kills it in 2- 3 hours - they say it takes 6 to max out in the system but I find I need a bit of a sledgehammer rather than a gradual increase - if it is a chest infection that is driving the afib even that may not work -but never ever be tempted to exceed 300mg in 24 hours or you can cause another set of issues.

[jennydog]

I take 2.5 bisoprolol daily and use 100 flecainide as a pip. It usually works within an hour. EP says to take another 100 in 3 hrs if necessary. 300 is the maximum daily dose.

Always have a tablet with you. I have a single tablet in my wallet and others In the bathroom and kitchen for convenience.

Remember that flecainide is best on an empty stomach.

Take the pip within 20 mins of becoming aware of the AF ( Is this EP instruction to prevent the heart getting into the habit of fibrillating? ) My EP was not happy with me waiting to see if the AF would stop by itself, and thereby saving a tablet. ( Flecainide is very cheap but I'm not an avid pill taker )

[Buffafly in reply to jennydog]

When I went to A&E recently (after 40 hrs in AF) the doc said the longer you have been in AF the harder it is to get you back in NSR quickly.

[Edstiffler13 in reply to jennydog]

I can tell within 1 second when I go into AFIB. And I guess where it’s been so many years since I’ve been in afib they have me on a low dose? And maybe where I’ve had an ablation?

[Hidden]

We are not medically trained but when the question of using Flecainide as a PiP is raised at our AF support group we are told to take 300 mgs within 20/30 mins of AF starting BUT no more for at least 24 hours. In my case, results have varied from 30 mins to several hours but it is important that you follow the advice of your doctor.

[Edstiffler13 in reply to Hidden]

That’s weird he only wrote 100mg. Maybe because mine only happens every 5 years so far. And I’ve had a heart ablation?

[Hidden in reply to Edstiffler13]

I’ve only been advised to take an extra 50mg after 4 hours & go to A&E if that doesn’t work after another 4 hours. Mercifully I haven’t had to take it as a PIP yet as my maintenance dose of 50mg night & morning seems to have kept AF at bay apart from the odd 30 minute episode I’ve dealt with by relaxation & deep breathing.

From what I’m reading here a 50mg PIP sounds like a chocolate teapot, but I would be reluctant to go against the Cardiologist’s advice as every case is different and there seem to be as many levels of severity of AF as there are people with it! Also, I guess height/weight/gender can make a difference.

Take care

Pat x

[Jay10 in reply to Edstiffler13]

I only take 100mg as PIP and that usually works within about 30/45 mins if I need to I can take an extra 50mgs. I had a cryo 10 years ago.

[Edstiffler13 in reply to Jay10]

Do you feel bad after you go back into sinus rhythm from the flecainide? Does it have side affects?

[Jay10 in reply to Edstiffler13]

No side effects apart from feeling a bit tired from the PAF episode.

[wilsond]

I was told to take 100 mg if it starts,and if not calmed down after an hour,another 100 mg. Not to take more than 300 mg in 24 hours.

Most of the time I just take the one and it works for me. Other people have different experience s though. Best wishes

[Edstiffler13 in reply to wilsond]

That’s what my doctor said as well. Does yours usually calm down In an hour? How often do you have your episodes? Have you learned to let them not scare you?

[Elsieclarke in reply to Edstiffler13]

My cardiologist said 150mg after 15 minutes and another 150mg after an hour. Mine usually stops within the hour before taking the second dose. I have never learned to let them not scare me and am always so dissapointed and depressed when I get one for several days after.

[Edstiffler13 in reply to Elsieclarke]

You mean you get them several days in a row? And have to take PIP

[Elsieclarke in reply to Edstiffler13]

No sorry - I meant I was dissapointed and depressed for several days after. I’m not great at coping with it phsychologically.

[Edstiffler13 in reply to Elsieclarke]

Yeah I got out of hospital Friday night. I spent from Wednesday at 7pm till Thursday at 1 around 160bpm till they cardioverted me. About 18hrs. I’m still exhausted I’ve slept all weekend lol. It’s so weird! I havnt had any episodes in 4 years since ablation. Then it hit me! But I started back drinking beer on weekends again over time. It was just a matter of time. I thought I was cured. Gotta take care of my body better.

[wilsond in reply to Edstiffler13]

Hi well its hard to say,as we all know AF comes when it wants to! I think you do get used to it,although still very unsettling.Ihave been diagnosed since 2013.

Flecanide didnt suit me as a daily dose nor bisoprolol,so now we are going with Pip approach,which seems to be better for me and works well,fingers crossed.

Remember the aFib wont kill you .....although very scary sometimes.I fear stroke as mum,granma ,dad and his dad had them.I am on apixaban,are you anticoagulated?

Best wishes

[Edstiffler13 in reply to wilsond]

I just take a baby aspirin. I’m always in constant sinus rhythm. They say I don’t need blood thinners because I’m either full blown AF or nothing for years.

[smwdorset]

Hi I guess everyone is different . Flecanaide was the only drug that worked for me and I only had it when I was in fast AF. C 200bpm which my AF always was - so always noticeable! And because of other heart defects I had to have it in A and E under supervision. If there was no cardiologist on duty I had it through a slow IV drip - always 150mcg in a litre of saline and over about 1 hour - it usually worked during that time and occasionally within 30 mins afterwards. If a cardiologist was available they gave 100 mcg to me through direct IV injection in a v high concentration but slowly over about 5 mins and it worked immediately - in fact often I went back into SR before the whole does had been administered .

This worked every time - about 15 times - over the course of 20 years. The one time it didn’t work I then saw my cardiologist who organised a ‘spark’ cadioversion and then a few weeks later I had an abalation .

[Edstiffler13 in reply to smwdorset]

You sound just like me! When it hits every few years it hits hard and my HR is 200.

[Profound15]

I was told by my cardio to take one immediately afib rears it’s ugly head then another one an hour later. If that didn’t work then a final one again one hour later. Take no more than 300mg in a 24 hour period. Does anyone know if you don’t convert to nsr do you start the same regime again next day (after the 24 hours have elapsed)

[Edstiffler13 in reply to Profound15]

I’m not sure since I’m new to PIP. My bottle just says take 1 100mg and if that doesn’t work go to hospital.

[wilsond in reply to Profound15]

Im not sure but I think if youve taken the 300mg and its still going that then you ring the arrthymia nurse if you have one or go to A and E. Good question ,must check it out!

[Profound15]

I probably need to email my cardio and ask him that question regarding after 24 hours. I don’t have a contact for an arrhythmia nurse.