Changing timing of increased flecainide dosage - AF Association

AF Association

20,463 members25,028 posts

Changing timing of increased flecainide dosage

Reena09
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

48 Replies
oldestnewest

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
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
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
Reena09 in reply to Slim2018

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

Slim2018
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
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
rosyG in reply to Reena09

Look up vagal af reena

Reena09
Reena09 in reply to Slim2018

Are you also on a beta blocker?

scorp1o
scorp1o in reply to Reena09

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

Reena09
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
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
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
Slim2018 in reply to Reena09

Mines about the same

Reena09
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
Slim2018 in reply to Reena09

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

secondtry
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
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
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
scorp1o in reply to Reena09

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

TheProf
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
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
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
Reena09 in reply to rosyG

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

Reena09
Reena09 in reply to rosyG

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

Reena09
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
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 .

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
Reena09 in reply to FlapJack

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

john6
john6 in reply to Reena09

Bisoprolol 5 mg gave me a daytime resting HR of 42/44, unfortunately, at night I was having Afib episodes almost nightly until I realised that my HR was probably dropping into the 30s (much too low). I changed to Nebivolol 5mg which initially (gone a bit lower since) gave me a resting rate of 56/58 bpm, it cut my nighttime episodes by around 95%.

Reena09
Reena09 in reply to john6

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.

john6
john6 in reply to Reena09

Yes my HR when in Afib would also be very high. What started it off was the HR going too low, in many respects it caused it to fight back/protest, to then send it into crazy numbers.

Reena09
Reena09 in reply to john6

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?

john6
john6 in reply to Reena09

Although I started talking to my Cardio some months ago (pre C19) about having Flec as a Pip, it fell by the wayside due to appointments being stopped, well that was until I landed in hospital yesterday (out now). I will now will be seeing how I go with Flec doses of 50 mg a.m and another 50 mg p.m - hopefully I can then answer your question as to whether it reduces the HR or stabilises it.

I will be keeping an eye out to see if it drops my HR too low as I know it can start my Afib off, hopefully they know what they are doing on that one. The write up states that Flec extends the time that the heart is at rest "causing the heart to pump normally again". It seems of bit of a contradiction saying it could take it too low when in actual fact it will be my Nebivolol taking my HR lower and hopefully Flec with do its magic and give it some stability.

Reena09
Reena09 in reply to john6

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.

john6
john6 in reply to Reena09

It is [one] of the reasons that I value this forum, as you get to hear the different experiences of others who have used different medications. Through talking to others it was a reason as to why I landed up taking Nebivolol, it made a big difference from Bisoprolol, hopefully Flec will do as good a job for both of us as it has done for others.

Reena09
Reena09 in reply to john6

Hi John - how are you getting on?

john6
john6 in reply to Reena09

Hi Reena, At the moment not great. All sorts of problems with my Afib with the present dosage of Flec not helping. I'm writing from a hospital trolley (the 2nd time in 7 days). Hopefully they will sort it. How about you, has it helped you?

Reena09
Reena09 in reply to john6

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.

john6
john6 in reply to Reena09

I am still in the hospital but feeling much better. They are changing my medication back to Bisoprolol 2.5 and whatever the dosage is for Dronedarone, along with an echocardiogram

Athough I did not take Flec for very long it did not do a job when I badly needed it, in effect it did nothing as the Afib continued to override it, the cardiologist is of the opinion that this can happen.

On the other hand it appears that it is working for you and others, long may it continue.

doodle68
doodle68 in reply to john6

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 .

john6
john6 in reply to doodle68

Don't let my failure on it deter you, (apparently) it works well for others. Perhaps I have been unlucky with it not working, I would think that it is probably due to my episodes being more severe than what I normally have.

Reena09
Reena09 in reply to john6

How are you today, John?

john6
john6 in reply to Reena09

I came out today with a different medication program. The Cardiologist put me onto Bisoprolol 1 x 2.5 mg, Edoxaban 1 x 30 mg & Dronedarone 2 x 400 mg, with an Echocardiogram to come on the 14th.

Every other medication prior to this has just given me spasmodic relief, which has to a degree been alright - ish, basically because I have been able to manage it.

The past few months my Afib has gone to another level causing me numerous problems. In many respects, the plus side has been that they are at long last giving me a thorough check over and taking my condition a bit more seriously.

Thank you for asking. John.

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

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

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.

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.

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.

You may also like...