Changing timing of increased flecainide dosage

[Reena09]

My EP has recommended I take an extra 50mg flec at night (currently on 50mg x2). Does anyone know if I can change the extra dosage from night to morning or can it not be changed once I start? Total dosage remains the same at 150mg. Thank you all

[CDreamer]

Something to ask the prescribing doctor.

Remember that needs to be taken on an empty stomach - no food 2 hours either side of taking it so that could be the reason?

[Reena09 in reply to CDreamer]

The reason he suggested it at night is because I can see that I go into afib in the early hours of the morning so hoping the extra dosage keeps me in sinus. But wondering whether this can be changed if it doesn’t work. I was hoping if the total dosage is the same, it can be changed. Wondering whether anyone has experience of this.

[Slim2018 in reply to Reena09]

Interesting my consultant reduced me from 100 mg twice daily down now to one 100 mg at 9.00 pm as all my episodes occurred in the hour or two after midnight and the four / five hour window after 9.00 pm gives me the best chance...so far absolutely fine as opposed to the old 8 am and 6 pm regime...

[Reena09 in reply to Slim2018]

How did you realise your episodes occurred at night? Could you feel the change from sinus to AF?

[Slim2018 in reply to Reena09]

Just woke up early hours with heart all over the place...apparently with normal slow heart beat when it gets even slower in deep sleep the irregular beats slip in

[Reena09 in reply to Slim2018]

Thank you. That’s the first time someone has explained a possibility why I may go into AF at night. As I can’t even tell, never understood why.

[rosyG in reply to Reena09]

Look up vagal af reena

[Reena09 in reply to Slim2018]

Are you also on a beta blocker?

[scorp1o in reply to Reena09]

OP shouldn't be with a slow heartbeat as it will depresse it even more. Hence the flecainide.

[Reena09 in reply to Slim2018]

Have you ever been told that the flecainide can also reduce heart rate? I guess my question is by taking the flec at night, although you are helping the rhythm, are you reducing heart rate slightly as well and therefore counter productive?

[Slim2018 in reply to Reena09]

My heart rate before flutter ablation and fibrillation cardioversion followed by the Flecainide for the last year has always been Swiss Digital Quartz accuracy of 60 bpm. It was in the deep sleep after a couple of hours that the Fibrillation slipped in apparently...so it appears ok

[Reena09 in reply to Slim2018]

Is that 60bpm when sleeping? Do you know how low it would go before the AF kicked in. The reason I ask is that my resting pulse in the day is between 55-60bpm but at night when I’m sleeping it can go down to 47bpm.

[Slim2018 in reply to Reena09]

Mines about the same

[Reena09 in reply to Slim2018]

Do you take a beta blocker as well? Thanks for all your help. Hope the extra 50mg at night works for me too.

[Slim2018 in reply to Reena09]

No beta blocker just Flecainide once a day at 9.00 pm 100 mg...so far so good!

[secondtry in reply to Slim2018]

Hello Slim, your circumstances are very similar to mine and you are the first person on here that I have seen who is taking just Flecainide like myself - I don't suppose your cardiologist is at Guildford UK? If I may, can I ask how you reduced to just 100mgs Flec was it cold turkey or did you do it slowly e.g. 25 mgs at a time?

[Slim2018 in reply to secondtry]

No Norwich...just stopped the morning dose...post cardioversion I had been on 200 mg a day and just stopped everything on his advice with no problem- and AF disappeared for a year then came back August 2019

[secondtry in reply to Slim2018]

Thanks Slim, I think we all as a whole need to make many more lifestyle changes in conjunction with the medical interventions. I have made too many to list!

[scorp1o in reply to Reena09]

Mine too and often night time episodes are a problem, so take flec in the evening.

[TheProf in reply to Reena09]

I started flec a year ago and I have records of bp and heart rate taken once a week for years. Flec reduce my hr by 10bpm to around 44bpm. Not as low as when I did triathlons but close.

[secondtry in reply to Reena09]

Tricky one, my cardiologist gives me the stock reply that Flecainide is just a rhythm drug and does not affect heart rate but it knocked mine down from 60 to 55 and can go below 50 when I am practising Mindfulness. I take 100mgs 6am & 4pm and nights have been OK since I started.

[rosyG in reply to Reena09]

Hi Reena. My AF is also at night and I find linked to my potassium levels so worth working out how much you are getting in diet

[Reena09 in reply to rosyG]

I just had my magnesium and potassium levels checked and both are fine.

[Reena09 in reply to rosyG]

Do you take a magnesium supplement? If yes, which one?

[Reena09 in reply to CDreamer]

Hi, I’ve spoken to various pharmacists and they have suggested that as long as the flec is taken within the 12 hour window not to get too hung up on empty stomach and no food 2 hours either side. It may have a very small effect on absorption levels but nothing significant. I have to take levothyroxine first thing and have to wait for 30 mins before food so the whole process for me would be too long. Did you notice the difference when taking on an empty stomach?

[CDreamer in reply to Reena09]

I was VERY ill when I on one occasion, took a PIP dose - 300mg - about an hour after eating. Not a feeling I ever wanted to repeat! It passed within about 4 hours .

[Hidden]

Most of us here are not medically trained so it would be wrong for us to comment on prescribed medication. As CD says, you need to ask your EP.

[Reena09 in reply to Hidden]

Appreciate that. Just wondering whether anyone has had a similar experience. I will still obviously double check with my EP

[jeanjeannie50]

I take 1 x100mg of Flec in the morning and 1 x 50mg at night. More Flecainide than 50mg at night gives me very vivid and scary dreams. This dosage was at the suggestion of my very experienced AF nurse.

Jean

[Reena09 in reply to jeanjeannie50]

Thanks jean. So presume you changed from night to morning after it gave you vivid dreams?

[jeanjeannie50 in reply to Reena09]

No, for a while I was taking 2 x 100mg daily, but reduced by 50mg at night when the vivid dreams started. I think it's a combination of taking low dose sleeping tablets Zopiclone, Metoprolol beta blockers and the Flec as all list nightmares/hallucinations as a side effect.

[Reena09 in reply to jeanjeannie50]

Do you take any magnesium supplements? Lots of mixed reviews on this but you seem to be very knowledgeable. People recommend starting off with magnesium citrate at 200mg. I’m just never sure as GP suggested not to as magnesium levels are fine at 0.88.

[jeanjeannie50 in reply to Reena09]

Magnesium citrate made the top of my stomach sore, so I now take 1 x 200mg magnesium glycinate daily, mid breakfast. I often put the powder in my bath too and also have a magnesium spray.

[Reena09]

Thanks John. Resting heart rate at night is around 50 bpm and only on 2.5mg bisoprolol. Don’t think this can be reduced any further as when I go into AF the Heart rate would be on the higher side.

[Reena09]

Interesting! Have you ever been told that the flecainide can also reduce heart rate? I guess my question is by taking extra flec at night, although you are helping the rhythm, are you reducing heart rate slightly as well and therefore counter productive?

[Reena09]

Sorry to hear that John. Hope you are feeling better. So you are new to flec as I am? I presume no one has said to you that the flec could take your heart rate too low? As yes, would otherwise agree that it’s a contradiction. I hope it works for you. The majority on this forum seem to be very happy with flec.

[Reena09]

Hi John - how are you getting on?

[Reena09]

Oh John. Hope you are better today. I’m okay - I went back into NSR 24 hours after Extra dosage of flec but reverted to AF Again 3 days later and again at night. So not sure whether the extra 50 mg in the evening will help but I guess need to give it some time. Hoping it kicks in and starts helping so the episodes are less frequent.

[doodle68]

Sorry to hear you are in hospital John, I hope you return home soon.

I am due to start taking Flecainide soon (Echo permitting) and feel a bit apprehensive .

[Reena09]

How are you today, John?