Sotalol<—>Flecainide

This is just a brief post concerning what I was told by a cardiac nurse at a recent appointment. It might be of use to someone who is having a problem with their medication. She said that sometimes the heart “gets used to” a particular medication and it can be effective to switch from one medication to another (e.g. Flecainide to Sotalol) and then back again if necessary. I hadn’t heard this before but thought it was interesting and possibly important. If anyone knows any more please let me know.

[BobD Volunteer]

All I can tell you is that unlike narcotics, these drugs do not have receptors in the body to attach to so the body can not "get used to it". It used to be thought that flecainide lost efficacy over time but it is more a case that the AF get worse.

Sotalol as we often say is not widely used here in UK.

[Hidden in reply to BobD]

Interesting reply which makes sense. When I next see an EP I will try to get some more detailed info.

[Cat04 in reply to BobD]

Sotalol seems to be more common than you realise Bob - see 4th question, 4th paragraph of British Heart Foundation article where it states that sotalol is commonly prescribed.

bhf.org.uk/informationsuppo...

[Janith in reply to Cat04]

That is precisely what my cardio and pharmacist both told me. I seem to have zero issues with it. I take the lowest dose recommended. I have had three episodes of afib in four years.

[Hidden]

I found a few references to Sotalol tolerance but none for Flecainide.

msdmanuals.com/en-gb/profes...

[Bmwpaul1971]

Seems quite a few on here on Sotalol. Maybe they are USA based?

[vanrick]

I was on sotalol for 17yrs (uk) and now on nebivalol..i was lucky that i didn't really have any side effects.so still readily available.and tempted to go back on them.as the latter and others ive tried ie: bisoporol wasnt working either.or perhaps it could be my AF has just gotten more problematic as ive aged.its on going anyway.haha.

[Hidden in reply to vanrick]

I would be interested to know what your experience of Sotalol was over the 17 years. Did you have many episodes of PAF (or permanent AF)? Did it become slowly ineffective over time requiring a larger dose? Any side effects? I ask because I have been on Sotalol for about 10 months (2x60mg per day).

[vanrick in reply to Hidden]

Hi Samazeuile.

I started with Af at around 37 (now 53) years of age.my then Cardiologist put me on a course of sotalol 40mg twice daily (low dosage) and also aspirin (rivaroxaban now) (NO PROBLEMS OR ISSUES WITH EITHER). He then sent me away. And that was it for most of them years. My lifestyle in honest wasn't great. I was drinking playing in bands and generally socialising quite a bit. Anyway long story short.id also developed a bit of asthma .I started with the flutters again.My new doctor doubled the dose too 80mg ,and in honest my body didn't feel good on it.! Then by luck I found this wonderful website.i couldn't believe how helpful people was all with a similar issue.Also what bad press SOTOLOL had with various people.!! About a year ago and decided to book an appointment with a new cardiologist.He took me off Sotalol.i tried verapamil.didnt do a thing.bisoprolol was awful felt tired all the time.Then someone suggested nebivolol of which seems to be ok with no side effects I'm aware of.but I still don't feel great (gave me a small headache) .so im going to give it another month and maybe go back to cardiologist.sorry for the grammer.it was written at speed.haha.hope its helped.id keep to a lower dosage of sotalol if possible.it worked great for many years in my case.i do hear it gets a bit nasty with high dosage,But everybody is different.!! good luck.

[vanrick in reply to vanrick]

p.s.. interestingly I've just noticed is that you say 2x60mg . I didn't know they did 60mg. my thoughts was only 40,80,120mgs with sotalol.

[Hidden in reply to vanrick]

You are absolutely right- they don’t do 60mg. I use a pill cutter which is highly unsatisfactory as however carefully you use it results in the two “halves” being very unequal. I suspect a lot of the time I’m taking 50or 70mg not 60mg. I’ve mentioned this to various medical people but nobody seems very concerned.

[vanrick in reply to Hidden]

I also use a pill cutter for nebivolol 5mg to 2.5 my doctor and chemist who is also educated to a similar level said theres no problem with it.so again.different opinion.so your doctor told you to cut in half?

[Hidden in reply to vanrick]

The doctor said take 2x60mg. I assumed there was a 60mg tablet but a nurse later told me there wasn’t and gave me a pill -cutter. I’d never used one before and assumed they were highly accurate. The problem is that Sotalol doesn’t have a small indented line across the pill which is needed for good pill-cutting (apparently). Perhaps there are really sophisticated pill-cutters which can deal with this problem and deliver an accurate dosage!

[vanrick in reply to Hidden]

Thankyou for the information.yes agreed unlike some tablets there is no cutting groove as I recall.probably been better a 80mg at night and 40mg in the day.anyway thanks again.!

[Janith in reply to Hidden]

Mine has the little indentation in the center for precise 'breaking' … how strange that yours does not??? I'm in America.

[Hidden in reply to vanrick]

Thanks fo the reply. I’ve been ok with Sotalol so far- although my dose was increased from

2x40mg to 2x60mg a few months ago. My EP suggests a

switch to flecainide as he says it might be better for ectopics, but I haven’t done this yet. It’s reassuring to know that you can take Sotalol over 17 years without any really major problems.

[vanrick in reply to Hidden]

in my case I never had a problem with it..you've kind of made me question about the 60mg dosage also.ive not tried flecainide.

[vanrick in reply to Hidden]

Update: back on sotalol 60mg twice daily.Back to cardiologists for a review on future meds.have asked about flec.doctor said he could not put me on it without cardio say so.oh well bk to drawing board.🙄

[Hidden in reply to vanrick]

Yes, GPs won’t change you from one to the other- the decision has to be taken by an EP. It entails not taking Sotalol for one day before commencing flecainide. In my case it’s proposed that I take digoxin alongside the flecainide.

[Patsy10]

Hi,

I totally agree with what the nurse said. From my own experience, I was initially given Sot., after a couple of years it just did not seem to work the so well and Flec. replaced it.

For two years which were mostly AF free it really worked well, the AF then started to kick in again and it was replace by Bisop! Now I am on a low dosage of Flec. twice daily and Nebivolol at bedtime which seems to be working quite well.

During all this time there were also three ablations. I do believe that your body can get used to the same meds and eventually they can become less effective. My Dr. also agreed with this idea when I discussed it.

[Hidden in reply to Patsy10]

Did you find that flecainide was more effective in dealing with ectopics (assuming you had them)?

[Patsy10]

When I was on just the flecainide, it was brilliant. It was actually a trauma surgeon who recommended it and told me to ask for it as he had found it to be amazing. It truly was.

For the period that I was on Flec. alone I was almost AF free., at that time ectopics were not an issue.

With regards to Sotalol, my hubby who was unbelievably fit was put on them like Vanrick at the age of 38 by a Leading Cardiologist whilst we were living in Germany. He remained

on them for about 20 years but it was not prescribed for AF. He had no problems with them whatsoever.

Hopefully you will be able to make some decisions when you have gathered enough info.

Good Luck

[Seahorse8]

I am concerned whether the repeated criticism of Sotalol is well founded in all cases. Should I be worried or should I trust my cardiologist who I see every six months? I have discussed with him the concerns expressed by some contributors to this forum about Sotalol. He continues to prescribe it to control my AF. I have been taking 80mg x 2 daily for past 8 years without problems . I have required cardio version on a number of occasions over that period ( due largely I believe to my own over indulgences) but generally it seems to be very effective.

[Hidden in reply to Seahorse8]

If it works for you and you have been taking it for 8 years I would not see any particular reason to be concerned. You are not taking a particularly high dose either. To what extent has it managed to stop AF during this period?