Coming off Flecainide

[Jholl]

Hi - does anyone have any experience of coming off Flecainide and how to do it? I’m on 50 mg twice a day. Was thinking I should reduce rather than stop, so does halving the dose for a week before coming off it altogether sound reasonable/safe?

[faridaro]

I've been taking Flecainide 50mg 2xday for the past several months and last week was told by my EP to start reducing it by taking 1/2 tablet 2xday for about 2 weeks (or if not able to cut to take 1 tablet/day). Then to reduce it to 1/2 tablet 1xday for 1-2 weeks and see how things are.

I think that gradual reducing should be better, although have seen some posts here saying that they stopped Flecainide immediately with no problems.

[Paulbounce]

Jholl - yes I think you should reduce over 3 weeks as suggested by Faridaro. This seems to be the norm.

However to play it safe I strongly recommend talking to your doctor or pharmacist before doing anything. They will be best advised to tell you the route to take.

Enjoy your day.

Best,

Paul

[wilsond]

Well,check with your prescriber first,but my experience was ok,gradually reduced one tabket a day for a week then every other day and so on. Now just use as a pill in pocket as required.

[BobD Volunteer]

I used propafanone not flecainide ( similar anti-arrhythmic) and redcuced my does over about a month. I think just stopping carries a risk of re-bound reaction.

[secondtry]

I would reduce it over a longer period, say a couple of months at 75mg/day then 50mg for 2 months and 25mg for 2 months. Irrespective of the EP's advice I would only start this when I felt confident I had addressed as many lifestyle issues as practical and had the new regime in place for 6 months. Good luck and keep us informed as I am on 200mgs/day and hope to do the same next year.

[AIW58]

I was going to ask how people got on stopping Flec after an ablation. My EP said no need to wean. I'm on 50mg twice a day. Had an ablation 8weeks ago. EP said stop 2or 3months post ablation. So that'll be next month Since it's used as a PIP I'd think it has a short half life so doesn't have a cumulative effect.

Worth checking with your doctor if she/he has said to stop it.

I plan to carry some with me once I stop the daily dose. Not had any AF since starting it last Sept. I had to stop 5days before ablation and no problem.

Amanda

[Bawdy in reply to AIW58]

I have had several episodes of hallucinations since starting on Flecainide so getting off it will be good thing. My ablation wasn't 100% successful but hoping for the best.

[Thomas45]

I was on 150mg twice a day, and had been for 11 years when I was found to be in asymptomatic persistent AF. My GP who is very knowledgeable about AF and served on the NICE committee on AF told me that I should just stop as it was no longer doing me any good.

I was wary of this advice thinking that it would affect my AF if I just stopped, but having complete trust in him I did just stop and nothing adverse, or otherwise, happened. Listen to what your doctor is advising. Your situation and reason for stopping may be different from mine.

[CmsUK]

On the advice of my consultant, I stopped Flecainide straight after having my ablation in early March 2019, no AF episodes for 6 weeks.

As expected/warned, some episodes of different arrhythmias have occurred, which I’ve controlled with PIP of Bisoprolol and Flecainide.

Have found out the different arrhythmias are Bigeminy /trigeminy.. totally different feeling to the AF, it’s going through the settling stages, so I’ll see how it goes.

Good to hear others experiences on here.

Craig

[pilgarlick]

I had been taking Flecainide for twenty years until, recently, I was considered too old (77) for the drug and switched to a beta blocker. (For rate rather than rhythm control). I have had no side effects at all from stopping, but have still had a few breaks-through into AF. I am still "allowed" to take Flecainide as a pill in pocket when I get AF and that seems to do the job just as well as having taken it as a prophylactic all those years. Stopping the drug does not seem to have changed the frequency of my AF attacks, which makes me wonder why I took it for so long.

[cuore in reply to pilgarlick]

I would think that taking Flecainide for twenty years would have a greater impact than your being too old. I am 76, and my EP has no problem with my taking Flecainide.

[Moenvk]

After my ablation the doctor told me to stop flecinide cold turkey. She said there was no reason to reduce dosage. I would ask you Doctor this question.

[Jholl]

Thanks everyone for your comments and advice! As a bit of background, I have had persistent AF for years, have had 6 cardioversions and two ablation procedures, nothing has worked for long. Am on bisoprolol permanently, the reason my consultant put me on Flecainide was to see if, when I had my sixth cardioversion, it would help my heart stay in rhythm longer. It didn’t - in fact it went back out of rhythm the same day! So I see no need to stay on the Flecainide, which has increased my weight even more, is adding to my breathlessness when walking and is generally making me feel lethargic and slow witted. I would like to check with my consultant but will have to wait months before I can see him. I asked the arrhythmia clinic at the hospital, which seems to be the go between, if I could come off it and was told Oh no, stay on it until you’ve seen the consultant. So either I stay on it several months longer, (when I suspect he’ll tell me yes I can come off it) or I take matters into my own hands. So I’m doing the latter. I do find it really frustrating that once you move from being under a doctor to being under a consultant you find yourself having to wait months before you can see him or ask anything. There needs to be someone in the middle who can refer your questions on or give you advice in loco parentis so to speak. Anyway, rant over ha ha! Thanks again for replying so quickly - this is a great resource.

[Jholl]

PS Bearing all your comments in mind, I’ve decided to play safe and reduce to one tablet a day for a week and then none after that. Thanks again.

[Hidden]

Are you sure it’s not the Bisoprolol giving you symptoms of lethargy & slowness? Many on here who have taken it felt that way and improved after swapping to a different beta blocker.

Pat x

[Jholl in reply to Hidden]

I’ve been on bisoprolol for years and yes I have had some weight gain/lethargy/slowness from that but it definitely all increased when I added Flecainide to the mix. They tried me on Sotalol before my last ablation and that did the same but ten times worse. So am pretty sure it’s the antiarrhythmics that are making things worse. And it’s not as if they’re working for me anyway so may as well come off them and see. Ideally I’d like to be off the bisoprolol too but appreciate I need some rate control. I might try reducing it from 2.5 mgs back to 1.25 which I was on originally and see how my pulse rate goes. But one step at a time!

[Jholl]

Though it’s interesting what you said about people swapping from bisoprolol to a different betablocker to avoid those symptoms. Would be interested to know what they swapped to and if they worked. Could you direct me to the thread at all?

[Hidden]

Can anyone else help Jholl with finding a thread about changing beta blocker please? I’m not techno savvy enough!

Pat x

[Jholl in reply to Hidden]

I guess I could just try searching for Bisoprolol and find the thread that way.

[Haveafib]

I believe reducing the amount taken gradually is the better approach. I stopped cold turkeybut had no choice because my pharmacy could not fill my Flecainide Prescription for 4 days. I had been on 50mg twice a day for 3 years. After the 4 days I felt okay and now after 3 weeks I still feel fine. Stopping the Flecainide cold turkey had no adverse effect on me. However, we are all different so my experience may not be the same as others. I do keep the Flecainide now as a PIP but will not take it as a maintenance dose anymore. Besides, Afib hits me about once every 14 days for a few hours whether taking Flecainide or not - but it is not debilitating. I am a male, 67 years old and have had Afib for 3 years. Wish you the best!

[KMRobbo]

Yes, I just stopped. 5 weeks Prior to my 3 month post ablation follow up with my EP. He said stop so i stopped. Did not have a problem. I assume he wanted to know that the AF did not return BEFORE the appointment. I was on 50mg every 12 hours

[Jholl]

Okay, thanks.