I have paroxysmal AF, recurred after 4 year gap, 3 episodes of 4 hours, weekly then a month gap and a further longer 10 hour. At onset of episode 3, I took a beta blocker, no apparent effect, at episode 4 I took two beta blockers, no apparent effect, GP sent prescription of flecainide for any subsequent episodes. I have read conflicting advice online re. whether it is best to take my first attempt in hospital in case of untoward effects, or simply take at home, or whether best to take a beta blocker before the flecainide. Unusually for the pharmacist, there are no instructions or leaflet in the box. What have others experienced?
I had my first Flecainide on line in hospital. Later I started taking Flec by pills at home, presumably because they knew it was safe because of the earlier intervention. Always check with your cardiologist, rather than your GP, first.
It is important your AF is stopped before it develops any further. Therefore also ask your cardiologist if you should go on a regular dose of Flec, rather than the 'roller coaster' of PIP - my cardiologist said the former was best and for me the low dose of 100mgs/day was not enough but the medium dose of 200mgs/day stopped it for 6 yrs and counting. I know nothing about accompanying BBs as I was advised due to lowish pulse & BP not to take them but again check with your cardio as this is an important area; I believe most patients do take them.
I had to go to the ER for them to try my first dose of Flecainide. They had an IV hooked up just in case. No probs but they kept me there for 4 hrs to make sure. I then used it as a PIP until my AFib episodes progressed to once a month. Then I started a low dose of 50mg 2 x day. My Cardiologist also requires me to take 1.25mg Bisoprlol daily to prevent any rapid HR side effects from the Flec. It's been + 3 tears no afib.
I had a very low grade head ache for about a year and felt drained but better that than persistant AFib which I am told you progress towards with each afib episode.
I had my first PIP dose (300mg) at my GP surgery, in a room, attached to an ECG with 15 min obs and ECG. After 3 hours observations and no ill affects I was discharged. My GP of that time had also been a cardiologist and was far more informed than the specialists at cardiology of my local hospital, who frankly at that time, I was not impressed by. Thankfully things have now changed for the better.
My understanding is that a drug such as Flecainide can only be prescribed by secondary care ie:- Cardiology.
In your position, unless you have complete faith in the competency of your GP, I would ask for a referral to a specialist to discuss all your options regarding treatment plan which would normally be drugs or ablation. AF is often progressive so the sooner it is halted, the better. Life style and treating any underlying conditions, especially Thyroid, Diebetes and Hypertension are essential to keep control of to improve your chances of maintaining NSR.
Knowledge is potential power. There is a lot of information on this forum and a host of helpful and informed people here who may have firm views and we don’t always agree, however, that too can be useful as I found it helps to think things through and make up my own mind.
Also irresponsible of the pharmacist as this medicine is a Black Box one,indicating high risk for some people.
You do usually need to take betablockers with it if you take as daily dose to avoid going into Atrial Flutter ( which they didn't do for me a.d subsequently developed flutter too)
Hi Wilsond, What does Atrial Flutter feel like> I'm on Flecanide for the past 7yrs now but not taking a Betablocker as they don't agree with me. I take Flecanide 100mgs twice a day. I get episodes of AFibb and take extra 100mgs of Flecanide as pill in the pocket which thankfully works to bring me back to NSR. I've never had any supervision while taking the extra one to get me out of AFibb. I'm careful not to take more than 300mgs in 24hrs....
I agree with others that this drug should only be prescribed initially by a consultant level cardiologist although once instructed by such your GP can continue to prescribe. Please check with your Cardiologist.
I have paf. I took 50mgx2 a day just at home and luckily had no side effects whatsoever other than it seemed to increase the number of episodes. So then my electro physicist suggested pip. Two when an episode comes on. It doesn’t stop it but I think it reduces the length of attack. I am due to speak to him soon and wonder if I need a higher dose. The lack of side effects makes me want to stick to it. However I will see what he says
I also have a very naturally low heart rate so lots of medication cannot be prescribed. I am on Apixaban and that’s all. Bisoprol was lowering the heart too much and was giving me severe leg cramps. My heart is healthy and my blood pressure normal. It’s difficult for them to prescribe much. They don’t want to risk the heart health with an ablation so Flecainide is maybe a good choice for me
Flecainide leaflet can be downloaded from the internet. It is a old drug people on this forum have been taking it for 20 years I believe. I took it first as as an infusion in hospital (as a cardioversion from afib which would not stop) and had an ECG and blood tests after this BEFORE I WAS released from hospital. I had a follow up ecg after 3 months. I always used it as a maintenance dose 50mg twice a day. I had extra doses on two occasions. I used it as maintenance as I had high rate in afib , 130 to 195 resting , and the cardiologist said it was easier to keep me in sinus rhythm than to get me back to it from AFIB.
MAXIMUM DOSE IS 300MG PER 24 HOUR DAY.
After my ablation I was told to use my remaining pills as PIP if necessary, initial dose 200mg, and another 100mg 4 hours later if I had not gone back to afib.
"I would ask for a referral to a specialist to discuss all your options regarding treatment plan which would normally be drugs or ablation. AF is often progressive so the sooner it is halted, the better"
Great advice.
As for flec - it's really works for me and many others. It might not be the same for everyone of course. I can only speak from my personal experience - for me it really works and no bad side effects. I doubt very much my HR would be in sinus without it.
You can have it as a PIP or be on a daily dose (or both but 300mg in 24 hours max). I'm a complete fan of the medication - but please note it might not suit everyone.
These med's are serious stuff. They are not sweets. However from a personal take there's no way I would not want to stop taking it.
Paul
It has always been my understanding that the first dose of Flecainide has to be given under medical supervison. I got mine while an inpatient in the telemetry unit. It worked quickly and they monitored me for 24 hours before sending me home with a prescription.
Also, I have strict instructions not to take any NSAIDs as they are known to have cardiac effects, including arrhythmias. Remember Vioxx, Bextra and the others that caused people to die from cardiac events before they were pulled?
I am only allowed to take Tylenol, which I guess you call Paracetemol (sp?).
Thank you to everyone for their comments.
I did see a consultant, previously, I went privately because there was such a wait for an NHS appointment. At that point I had only had the first two repeated episodes, he recommended a beta blocker, one or two tablets, and if this didn't work, flecainide 100mg. The prescription that the GP issued was for the Bisoprolol only. When I emailed my GP after the prolonged episode she simply replied that she was sending me a prescription for flecainide. When it arrived, it was a strip of tablets with no information leaflet or dosage, just "Use as directed". I found the consultant letter, saw the dosage and then I googled to check any other information, and discovered NHS Trusts websites saying that the first time you use flecainide it should be under medical supervision, and this concerned me.
I live in Bristol and was prescribed Flecainide at my Arrythmia check up as I had been having more frequent and longer lasting AF episodes. I was just sent home to take the tablets the pharmacist telephoned after a week to check I was ok - that Was the extent of my medical supervision. I have now had an ablation and am gradually weaning myself off the Flecainide down to 25 mg per day from 200mg and am feeling less dizzy and shaky. Hope to be off completely by September providing the AF doesn’t return.
I’ve had great success with flec. Doesn’t appear to warrant too much worry about taking it. Just my experience and reading about the different drugs out there.
Well as of Tuesday this week I am now experimenting with 100 mg of Flecainide at 9.00 pm at night and stopping the morning one. Nothing to lose says my cardiologist and worth a try as all my AFlutter and AFib events all happened between midnight and 3.00 am when my heart naturally goes slower. Bit twitchy as have got used to the Flecainide twice a day but if I can manage on less meds, worth doing. We shall see....my cardiologist says it is an excellent, well proven drug with minimal side effects...so that was reassuring...
Interesting, I also focus my dosage in the evening. I still spread it across the day, but take a little more before bed. In all 175mg per day, w 75mg at night, 50 in the morning and another 50 mid-afternoon. My cardiologist says 3 times a day is too complicated but it eems to work.
Hi Maddiegran a timely question for me.I should have been attending the arrhythmia clinic earlier this year to discuss being prescribed Flecainide for increased frequency of P-AF episodes but then came lockdown and the clinic was cancelled.
The next available clinic is in October at the county hospital by which time C19 may be on the rise and the clinic cancelled yet again so I have booked to see my consultant privately in 2 weeks time , I am hoping if he prescribes Flecainide I will then be able to get it on NHS prescription and not have to pay for it , is that your experience.
I would not be able to get to a hospital or a GP during an episode of P-AF in order to take the Flecainide ithe first time under supervision , I am not safe to drive when in P-AF so plan to ask someone to be with me while I take it in case of an adverse reaction.
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a timely question for me.I should have been attending the arrhythmia clinic earlier this year to discuss being prescribed Flecainide for increased frequency of P-AF episodes but then came lockdown and the clinic was cancelled.
Flecainide
More episodes in first week of daily Flecainide?
After 3 months of symptoms have finally been diagnosed with PAF and started bisoprolol 2.5 mgs today. 
Switching from 100mg Flecainide twice daily, to Pill in the Pocket. Has anyone done this?
Flecainide without Beta-Blocker
