I know many of us begrudge the daily tablet taking to stave off the evil AF beasty!
The one thing that I do, that is not following my Doctors or cardiologist guidance, is that the 150mg of Flecanide that I take daily I break into 3 doses not the usual 2. I have a 100mg tablet I break in half and a 50mg tablet. So I take 3 tablets of 50mg, 1 every 8 hours(roughly).
Ive been quite some time now without an AF episode and FEEL that approach is working for me.
Just interested if other people do anything similar?
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Guitar335
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I agree - none of us want to be on med's. However I try and follow my doc's advise. The flec will still be in your system doing it the way you do - you won't get the 'hit' though of 100mg which can make the difference.
Personally I would take it as your cardio has suggested. That's just my opinion of course.
If it works for you, I'd stick to it. I'm much the same and to a certain extent, at times, do what I feel is best for me.
Last week I was advised to take 5 daily doses of 3mg Warfarin and 2 of 4 mg. I think the more even the doses, the better, so am actually taking 4 days of 3.5mg and 3 of 3mg, so taking the same weekly dose but spread over the days more evenly. I must add that I've been on Warfarin for more years than I care to remember and would have to know a drug very well before I did anything like this.
I agree you really have to know where you are with a drug and have some long term experience to do this. Thank you for your reply, that is exactly the sort of thing I was wondering about.
As Paul said above is the 'hit' enough versus a smoother intake.
Actually when I was once given a higher dose of Flecainide (300g per day for a short period ) the EP actually told me to take it in 3 100g doses. So EPs differ.
(Footnote. This was before my ablation and the high dose cardioverted me from persistent AF, but I felt awful - really spaced out and went back to 200g per day)
Doesn't it have to do something with the half life of the meds as they are metabolized in your body? A couple of weeks ago, my EP started me on 300mg/day of Flecainide, broken into 150 mg in the morning, and 150 mg 12-hours later. I think this is the maximum dose I can take, so I am hoping and praying this will be successful at staving off the beast. Thankfully, I don't seem to have any issues with it -- crossing my fingers it continues to work!
Fingers crossed for you. Yes it is about the half life. It seems to work best taken 12 hrs apart, so I was puzzled about being told to take 3 doses 8 hrs apart for a brief period. But maybe it was because I have a very slow heartrate when not in AF.
Anyway Flecainide is a very useful drug. From being a bit worried about it at first, I am now grateful for it. But it does slow me down.
Hi Guitar 😉 I always try to stick to a Doctors instructions with regard to dosage , I also check the manufactures instructions too.
Many drugs have a specific time period when they are effective in the body and a half life, by altering the dosage instructions of a drug it is possible to under or overdose or to reduce the effectiveness of a drug.
It is easy to find out the half life of a drug. One also has to remember that dosing protocols are a " one size fits all" and take no notice of genetic differences in rate of metabolisation. What is suitable for a large man might not be for an average size woman but the same dose will be given. Indeed it has been discovered that women are being overdosed with certain drugs as they were never included in the clinical trials and it has been shown that they metabolise the drugs differently.
I'm on the same dose of flec as you and have thought about splitting it into three to get more even coverage and I'm interested as to why you decided to change to three times a day? Did you perhaps find the 100mg dose affected you too strongly?
Hi Afbiff , Thank you for your question that has really got me thinking and I really like having to check-in with my own assumptions
The reason I decided to medicate my self three times was based on lots of factors.
Originally I was PiP and that did not work very well for me at all.
My (General Practitioner) doctor then said I should take 2 x 50mg per day, which I did for a few months and had an AF episode approx every 30 days. i.e. A big improvement but with break through every now and then. This proved to me that Flec being constantly in my blood stream was doing something positive and a build up of the drug was much better than a PiP approach.
My GP then looked back at some notes I had from a previous Cardiologist from about 4 to 5 years earlier and noted back then the dosage could be 150mg. She then prescribed on the basis of that old cardiologist recommendation a 100mg (morning) and a 50mg (evening) as I appeared to be getting more issues in the day. (I did not thunk that was the most robust of medical decisions given the age of the original notes)
AF on 150mg per day improved further than 100mg per day but I still had the odd issue over night.
I researched the Flec half life to be around 12 to 16 hours and my thinking was that after 12 hours the drug was therefore wearing off (Happy to be challenged on my understanding of half lives!) and given I was having the odd issue in the evening, not just the day, there was no logic to the large dose being in the morning.
So I judged that taking 3 x 50mg (every 8 hours) would even out the strength and give me a more even absorption than a half life of 100mg 12 hours later.
I have to add I seem to have a very laissez faire Cardiologist behind this that pretty much since I said I didn't want a Cardioversion seems to accept that what I say is OK or shrugs. (Perhaps I need a new cardiologist that I trust a bit more!)
Because of your great question....Ive just reviewed my log of my AFib and when I started to do the 3 doses thing and it was on 24th January which is when things have started to be consistently AF free. I had not realised that my correlation of AF free and my 3 doses was so clear cut (Thank you again for your question which got me to revisit that)
I have to clarify I have had 1 AF episode for about 12 hours (horrible) on 4th June that I can explain because I took several doses of a decongestant not realising the impact that would have on my AF. The lovely people on this forum responded making it very clear that the decongestant drug I took had previously had an impact on them and their cardiologist said to avoid phenlylephrine, so I am 99% confident that episode can be explained by that decongestant. (I had followed the decongestant dosage to the letter).
Having reviewed my AF daily log the other aspect I noticed was back in December 2019 when I tried to reduce my dosage to 2 x 50mg (I know I shouldn't... I hate taking medication) I had an AF episode on 2 occasions. One was due to my planned reduction and another unplanned was when I forgot a tablet. So I take from that my medication needs to be 150mg and not 100mg.
For me switching to 3 times has brought my AF under control consistently. The downside is that I do forget the middle of the day tablet for a few hours sometime but Ive been Ok so far.
My only other point I would add is that in 2019 I removed caffeine, minimised alcohol massively and took magnesium. None of that seems to have made a difference as now I have pretty much disregarded all that. I drink coffee, I drink alcohol and I hardly take magnesium. To be clear though I respect alcohol more and am totally convinced alcohol does affect my heart.
I hope that reading this may help someone somewhere and equally we are all different so please don't follow my lead as we all have different lives, bodies and circumstance.
So good to hear your thoughts, thank you for the detailed reply which I read with much interest, as there are similarities with my situation. I'm happy with my 100mg of flecainide am and 50mg pm as it's working for me. So far no events for 12 months, which seemed like a very good milestone to celebrate. But thinking ahead, should things change - when I chatted to my cardio, who rang me while I was in the garden, up to my neck in weeding, he has given me the ok to re-arrange my dosage of flecainide to three times a day. It's strange chatting to a cardio in your garden, quite relaxing but I couldn't think of all the questions I had prepared for our cancelled face to face appointment and the phone call was completely out of the blue, but it was good to talk and reassuring. I keep an Afib log too, I wonder how many of us do this? Thanks again for your reply and best wishes to you too.
Nice to hear your thoughts . with all the " selling " in our society , from Hamburgers, Political Kool-Aid propaganda in the news media , One feels everything is about the Benjamin ! One size does NOT fit all . Eating right does help that brain of ours in the Stomach !!!
My cardiologist advised taking Flecainide daily rather than PIP. Also, when daily the same level am & pm. That said once you have years of experience, one tends to self prescribe a bit as jeanjeannie50 mentions.
Secondtry, my EP advised the same thing, as he said I'd have better control if I took it twice a day, the same level in the a.m. and p.m. When I took 100 mg twice a day, it didn't control things, so the EP upped it to 150 mg twice a day.
I tried the same but it didn't work for me, still got the odd AF episode....but what I think is more important is to take flec without food otherwise I don't think it is properly absorbed into your system.
The instructions do say you should be food free for at least an hour before or after taking a dose, whether that includes a cup of tea I'm not sure...maybe somebody could enlighten us as I do like a cuppa first thing.
I am now taking 50 mg twice a day, was on 100 mg twice a day for 5 or 6 years. No other intervention apart from apixaban. I have always taken 7 am with morning tea and 6 pm as I start eating my evening meal. Have asked hospital pharmacist and two others who say with or without food. Some brands say half an hour before meals others don't. I haven't had an overt episode since 2013 so I guess it works for me like that!!
I've had several different Flec suppliers but the instructions in the box have always been the same....quote: ....'on an empty stomach or at least one hour before meals'....unquote.
That's from my current box of pills from Milpharm Ltd....it's there in the small print but perhaps it's not so important to some people.
I'm only just kept in sinus rhythm with flec so anything which reduces absorption can cause me to go into AF, but whatever works for you.
Flecainide works for many AF sufferes. Either as PIP or rhythm control. I took 100mg twice a day for 3 years as well as a 1.25 mg dose of Bisopropol. Neither did me any good. In fact it made things worse. I ended up with at least two episodes of AF every week lasting 24 hours. Not fast AF just abnormal rhythm(maybe that was the problem). Offered ablation and gladly accepted. Free of AF for 2 years . Quality of life improved beyond belief but I am not taking anything for granted. Take each day as it comes.
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PPI’s and atrial fibrillation 
Flecainide PIP
Can we have more than one attack of AF in the same day.
