I’m wondering what I should expect and how fast does flecainide work?
Has anyone transitioned from metoprol... - Atrial Fibrillati...
Has anyone transitioned from metoprolol to flecainide? I am suppose to taper off metoprolol while starting 50 mg of flecainide.
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Lawson101
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I took 2 x 12.5mg of Metoprolol alongside 2 x 100g of Flecainide. I would say that Flecainide takes effect within about half an hour to one day.
Jean
They do different things so not sure what you mean you are going from one to another. Most people, myself included, seem to be on both at the same time. As I understand it, Flec is for rhythm and metoprolol is for rate. I recently stopped taking Flec (post ablation) at my docs direction. I just asked him if he would consider taking me off of the metoprolol and blood thinners now as well. Would like to get to a pill in the pocket situation and get these chemicals out of my blood! Good luck to you!
My blood pressure is 98/66 and even lower 87/60. I’m losing hair, fatigued, and having depression. That is why he is switching me to flecainide only 50 mg twice a day.
in reply to Lawson101
Hi Lawson101, of course, I'm not a doc and I don't know you at all, but what I can share is that both Toprol and Flecainide, each in their own ways and at different times, left me feel quite dragged down, low energy, lethargic, and depressed.
At the most basic level of understanding what they do, they slow things down. Which is great if the heart is going crazy with high rate and wild arrhythmia.
For me, with my very sensitive nervous system, I have found that the depressive effects of Flec were not worth any possible benefit of taking it all the time. The hallucinations didn't help, either! 
I started taking Metoprolol after my first ablation in 2013 and my EP at the time left me on it for years. When episodes started up again in 2017, my new EP recommended Flecainide as Pill-in-the-Pocket. So for a while, I took both.
After I discovered this forum and Dr. Gupta's videos, I wondered if I really needed to be on Metoprolol, so I discussed it with my EP, who was fine with me going off of it. I was taking a very low dose anyway, but still tapered off. It was a bit bumpy for a few days, maybe a couple of weeks (don't recall exactly), but I'm glad I did get off of it. My rate has stayed pretty stable and has only spiked during an episode when I'm teaching, but then it calms after I take Flecainide. I felt infinitely better once off it. A fog lifted and I had more energy.
I noticed that my Ha1c had been pre-diabetic the entire time I was on Toprol, but dropped to normal in the very next test after I went off it, so I was grateful for that.
Now I only take 100 mg Flecainide as PIP. Can't tolerate any more of it. Usually it stops an episode within a couple of hours. I've had the experience, too, of it making the episode worse.
Lawson101 in reply to
Interesting bc my Ha1c has been mildly increased on metoprolol.
How do you feel when flecainide makes an episode worse? You just take it as a pill in the pocket?
in reply to Lawson101
I remember learning during that time of research that Toprol (maybe it was beta blockers in general, don't recall) is linked with raising glucose levels. That was part of my reason for wanting to get off of it. I learned from the experience to dig into research and take matters more into my own hands. My EP had put me on the stuff and just left me with it without following up and certainly with no education about side effects, etc.
As for Flec, yes, only PIP. It's just way too much for me otherwise.
Several months ago, when I'd have an episode, it would be rather physically intense. Not super high heart rate, even off of Toprol, but I could feel the intensity of the irregular beats, I felt more intense anxiety, discomfort in general, miserable, very hard time focusing, really like I was being held hostage.
To learn more about the supplements for the heart and balancing hormones, I recommend that you look up my posts. I've written about it, with references to where I discovered the information. But, in brief...
I made certain changes in my life that I came to discover had been strong, underlying sources of stress I hadn't realized till I cleared them out.
Then since taking the supplements that are known to nourish the heart cells and support cell metabolism, overall I have felt remarkably better. Clear-headed, stronger heart, just a normal heart in NSR, not that familiar, weak, twitchy feeling in my heart that meant an episode might hit.
After several weeks, I started taking MacaPause (you can also read about it in my posts) and noticed further overall improvement.
Then I hit a phase a couple of weeks ago when I needed to adjust the doses cause they were too stimulating and would trigger AF.
So I've felt this sense of improvement, stronger heart, etc....if I had an episode, it would definitely not be as intense as several months back. Completely different, especially emotionally. I'm certain that the supplements have made a difference.
As for the Flec, I have a hunch that my heart is somehow actually getting stronger, getting "fertilized," as the naturopath described it. So now if I do have an episode, I'm really wondering if the proarrhythmic effect of the Flec kicks in sometimes. The episode switches in intensity and discomfort level, getting worse, till it finally stops.
To contrast, the day before this recent more intense episode, my heart slipped into what my Kardia showed was AF, but felt really mild. This was after 3 hrs of teaching. An hour later, with no Flec, it returned to NSR on its own.
Acwm in reply to
Hi,
Been reading your replies here abs learbes about your posts. May i know where to find it? Hope you are doing well. Thanks.
Nella - you are where I want to get to - Flec as a PIP only. My goal is to get off the metoprolol as I have gained 80+ pounds because it puts me in a half alive state where I have zero motivation, head fog and little energy. Sounds like it had a bad effect on you as well. Was curious about your statement that flec has made some of your episodes worse...was it the flec or was it just going to get worse anyway? Thnx
in reply to Jafib
Jafib - I was prompted to look into getting off of Toprol after discovering Dr. Gupta's videos and learning about vagally-mediated AF, which seemed to be what I was experiencing. He didn't recommend beta blockers for this type of AF.
I consulted with my EP before moving off of it. I felt a fog lifting once I got off of it. It had been like driving with the brakes on and I lost weight. Of course, it's wise to consult with your doc before doing this, since each case is different.
Flecainide is known to have proarrhythmic effects. Here's my experience.
Once, maybe twice, don't remember, I felt my heart go into AF, checked with my Kardia Mobile and yes, it showed AF. My EP had advised promptly taking Flec, so I did.
I checked Kardia in 15 minutes and it showed NSR and I felt fine. What transpired next is that after a short while, I went into AF again, only much worse.
From all my various experiences with AF & Flec, suffice to say that I've discerned a palpable difference in the experience of an episode when it kicks into the proarrhythmic Flec side effect. It doesn't happen often, but it happened the other day.
I've been taking various supplements that I posted about in weeks past. My intention has been to use the research I did on the value of these supplements in nourishing the heart so that it's not so easily triggered into AF. I've also been balancing my hormones. Going after any and all underlying health issues that might support my heart.
It's been quite interesting! I can definitely feel that my heart is somehow stronger - that's the best way I can describe it. It's not quite as easily triggered into AF. But then I've needed to stay on top of the dosages; I've seen that as my hormones have gotten balanced, I need to reduce dosages or else the supplements will be too stimulating and trigger an episode. My heart will more frequently reset itself back into NSR these days, too.
Most of the time when I've gone into AF, I've been able to take 100 mg of Flec and within 4 hrs, my heart will be in NSR and I'll feel like a light switch went off and feel better. The other day, the episode felt much worse after I took Flec and I felt really depressed. It's partly why I can't take it on a daily basis. It's just too strong for me.
I know that I'm unusual in that my nervous system is really sensitive. Other folks report taking much higher doses.
Lawson101 in reply to
I’m curious about your supplements, hormone triggers, and where can I watch Dr G’s videos? Thank you so much for your reply.
in reply to Lawson101
Dr. Sanjay Gupta, York Cardiology, has a wonderful YouTube channel and website. There are posts about him on the forum, too. That's how I learned about him.
I'll probably write an update post soon, but in the meantime, as I mentioned, you might read my past posts I wrote as I started using the supplements. I shared a lot of resources you might be interested in exploring. Happy to chat, too, if you'd care to message me. I have learned a lot from people here and so am happy to share what I've found helpful.
The work of Dr. Stephen Sinatra has been really helpful. I recommend reading his book, Metabolic Cardiology. He has some great YouTube videos, too. He talks about the various supplements in depth and offers dosage suggestions. Great book.
I discovered that his son is a naturopath and is only 30 minutes from me, so I went to see him, knowing that he has experience with AF. He and his dad have consulted and do videos together on integrating these approaches.
As for hormones, my naturopath did a bunch of blood tests to check on underlying issues and my estrogen level was the lowest possible. He recommended that I try MacaPause, an adaptogen that gets the body to re-balance the hormones naturally. This is quite different from hormone replacement therapy.
I wrote a post about it when I started taking it. Great stuff! The customer support offered by the company is impressive (and I am not getting a commission or here to sell anything, just pleased by the product's impact on my health). They have a team of doctors who provide support by phone or email; I've had an ongoing email conversation with one of the naturopaths for weeks now. Then their director of education reached out to check on me and provided interesting resources. We've also had an ongoing email conversation. They want people to have a successful experience, so they want to be sure to provide excellent support. I find the support reassuring. I've not experienced anything of the sort from the heart docs! Which is how I ended up on Toprol for 4 years with no one even asking about it.
It's worth mentioning that based on what I've learned, I definitely would not recommend taking any off-the-shelf maca product. I explain why in an earlier post. There's a huge difference between MacaPause and the many varieties of maca on the market.
Hope that helps! I'm happy to chat with folks who are interested in exploring these approaches. My EP told me flat out that he had pills and procedures, that was it. So I dug into researching what else I might be able to do that was reasonable, grounded, based on research, helpful, and didn't make me feel as awful as the drugs.
take care about changes and discuss with your doctors! Some, not all, consultants have said you should take both together so that flecanide doesn't produce dangerous ventricular problems. That's not to say you couldn't take them both together as pill in the pocket but you'd need to check this out with medical advice
I was doing fine until my doctor left I got new doctor as a primary care and he said he wanted to try metoprolol. It caused me have very bad allergic actions and triggered my asthma so bad. My new pulmonologist said stop it's a beta blocker and he found out it was triggering it and immediately stop it. I never took flecainide. But I hope you find some answers to explain everything that you are going through
Many of us on here have been on Flecainide with few significant problems. You can get a few side effects to begin with, but as your body adjusts, these subside. I had visual disturbances, scary dreams ( now they are just interesting) & a bit of dizziness for 4-6 weeks, but now I’m fine.
Some are on Flecainide (rhythm control - it doesn’t slow heart rate) plus a beta blocker, but I & many others are just on Flecainide and an anticoagulant and doing fine. I couldn’t cope with even the lowest dose of beta-blocker, I felt tired, my pulse & BP dropped too low & I felt as if I was ‘wading through treacle’ when out walking.
We are all different and some do better with Flecainide as a PIP or take a regular daily dose with extra as a PIP if an episode breaks through.
Go with your docs suggestion and go back again if it doesn’t suit. There are lots of alternatives.
Most of all, try not to worry.
Pat x
Horse57 in reply to
Pattering, have you had an ablasion? Are you a candidate or have made a decision not to have one? Just curious
in reply to Horse57
No ablation. Unlike many on here, I chose to see a cardiologist rather than an EP as I had only one diagnosed full on episode last July, preceded by several which I put down to stress, dehydration, illness with a chest infection etc, never thinking I might have a heart problem.
After the episode that landed me in A&E, where they were about to cardiovert me but my heart decided at the last minute to convert itself, I was sent home on 1.25mg of Bisoprolol. It plunged my HR to under 40 and lowered my BP so I could hardly stand and was left on no treatment, waiting for a cardiology appointment (8 weeks) with a jittery heart, often beating up to 120 resting but mostly regular with ectopics and feeling dizzy & miserable.
I saw a Cardiologist privately after 10 days who arranged an echo & 24 hour Holter - both normal. He put me on Flecainide 50mg and Apixaban 5mg both twice daily and told me to take an extra Flecainide if I have a breakthrough episode. I haven’t had to do this yet, though I have had a couple of short - 30 min- 1 hour AF episodes which I have controlled with deep breathing - thanks to advice I’ve picked up through reading this forum. So far, so good. I only had 2 private consultation and I’m now back under NHS care.
The future plan is to continue as I am unless breakthroughs become problematic when an increase in drugs or an ablation might be considered.
I’m happy as I am, apart from a few jitters this week as the pharmacy gave me a different brand of Flecainide - see my recent post. I do have a friend who was given an ablation as a first line treatment which was successful and she is on no drugs. Everyone is different.
Pat x
When I was first diagnosed with Afib last year, my PCP put me on metoprolol 12.5 mg. twice daily. Then upped it to 25 mg. twice daily.
It slowed everything down but I felt like a zombie. My cardiologist put me on flecainide 50 mg twice daily which, after an acclimation period, evened out and is mostly working. Recently, I started having some arrythmia....not afib....at night so he upped the night dose of flecainide to 100 mg. So now I am on 150 mg. daily. I continued with the 25 mg. of metoprolol all this time but, after the night episodes, I asked him about lowering it and possibly stopping it. He said to cut the night dose in half. I went ahead and cut both day and night doses in half to 12.5 mg. Now I feel much better and have more energy. I may just try it without the metoprolol at all because I didn't have those very rapid heartbeats to begin with. (e.g. over 100 bpm and higher, etc.)
What was your acclimation? I have a physical and active job. I think I’m concerned about having episodes and not being able to function well. I have what they think is multifocal atrial tachycardia and had an unsuccessful ablation for Avnrt.
I am a clinical psychologist so do not do physically-demanding work. It was the metoprolol that caused me to be dragging and slow with little energy, not the flecainide. The flecainide keeps your heart in Sinus but isn't a rate controller. The metoprolol slows down the heart to keep it from speeding up.
I was put on Flec and at first had high blood pressure. My diastolic climbed to 98 and 100 for a couple of days. I was really feeling poorly to say the least and was chasing it with BP meds and a beta blocker. I now take only 25 mgs (I cut a 50 in half) at night. I put it under my tongue and it stops the AFIB immediately. I have only been having AFIB at night when I lay down. This is new! What I have noticed being on Flecainide at night is that the next day I feel really good. I feel like my heart is very settled and the interesting thing is that my BP is very low running 105/55. I do take Telmesatan for BP and I see now that when my heart is efficient my BP is most likely normal. I am going to cut my BP medicine in half and see what happens. I am scheduled for an ablation on May 22nd. As for metoprolol I had a severe reaction to it. I have Bystolic 5mg if needed and even that I have to cut in half. My heart rate drops way too low. I am also wondering how many people on this site have elected not to have ablations for various reasons. I truly feel I am on the fence.
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