Flecainide and beta blockers: Is it... - AF Association

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Flecainide and beta blockers


Is it absolutely necessary to take beta blockers with flecainide? I took atenolol with flecainide and ended up with excruciating backaches. Dr. changed my meds to carvedilol/coreg to take with the flecainide. That combo made me so dizzy that I spent two days laying in bed unable to walk. I am one of those people who are sensitive to drugs and have had a hard time with BP meds also. Flecainide by itself actually does agree with me and works but my Dr. told me that is was a necessity to take it with a beta blocker. I have taken atenolol for years and it agrees with me too but the combo did not. I do not know if I took the carvedilol alone if it would be enough to help with my arrhythmia and occasional afib events. Any advice would be Welcome. Thanks in advance!

31 Replies

Cindy - we are not qualified to advise on drugs but I can give you my experience and what my EP told me.

I take 200mg Flecainide and wanted to use Bisoprolol only as a pill in the pocket to take only if an episode started - Bisoprolol gave me bad side effects and I now take Nebivolol. My EP said it was too dangerous (in my case) as Flecainide can induce Atrial Flutter and in the absence of a beta blocker - or similar - there is the possibility of one to one conduction of flutter signals with a dangerously high heart rate.

Having said that, there are people who take Flecainide on its own and some who take Propafenone which has a beta blocker 'built in'.

cindyrella in reply to Finvola

Thanks Finvola! I will look into those medications.

foxglove1 in reply to Finvola

HiIve just been prescribed 2.5 Bisopropolol as pill in pocket today after my second emergency department visit in 4 days. I am not keen to take and wonder what side effects you had? Interestingly my intravenous magnesium and saline reduced the rate (150) and returned me to SR within 3/4 of an hour. was this coincidence or the magnesium. My bloods showed a magnesium of low side of normal.


Finvola in reply to foxglove1

Bisoprolol, even at only 1.25mg made me very breathless and tired - I couldn't do several tasks one after the other and couldn't walk uphill easily. Hence my question about taking it only if and when an episode started.

Desanthony in reply to Finvola

Bisoprolol made me breathless walking downstairs! My cardio tried several beta blockers and calcium channel blockers and varying doses and I would be fine for 2 or 3 weeks and then back to being breathless again. Usually it works the other way round. In the end just before my first successful cardioversion I was on lowest dose digoxin and that worked - they started me on a higher dose and the same thing had started to happen and then when we were due to visit a friend who was head of training for Boots Pharmacists I said I had to wait for a prescription before we could come and visit and she asked me what I was on as she could get it for me and that her Dad was on digoxin too and the dose I thought I was on the lower dose but she said no and so asked for the lower dose and that worked really well. However, since having 3 cardioversions - all successful for at the longest 11 months and my third one last February is still keeping me in NSR I have only been on Eliquis (apixaban) and I am fine and functioning as well as an old grump can. LOL

I would ask about a different medication or dosage and see what happens.

Finvola in reply to Desanthony

Great that you've got sorted Desanthony. My post above was only pointing out my side effects on Bisoprolol and since it was changed to Nebivolol two years ago, the symptoms have gone . Sorry for the confusion.

dmac4646 in reply to Finvola

Not medically qualified - but have been on flec for 12 years no beta blocker - reason pulse rate sleeping circa 45 .. and as low as 40 cant tolerate blocker for obvious reasons

Again Cindy I can only talk from my own experience - as Finvola says we are all different. I'm on 100mg flec twice daily but no beta blocker. My cardio stopped the beta blocker as soon as I started on flec. Maybe it was because my HR tends to be fairly low at rest. Your doctor will know the best combination for your personal needs.


docmar in reply to Paulbounce

Well you saying your cardio stopped the betablocker when you went on flec made me smile (somewhat wryly). I've been on flec + bisoprolol for over 10 years and in that time can't recall a single time any cardio has reviewed dosage or effectiveness. Frankly I'm not convinced at the moment either of them do any good at all - I've been in AF for over 2 weeks and no change. The chances of getting anything done at the moment are I suspect close to zero.

wilsond in reply to docmar

I'd check that,my hospital have been doing telephone appointments for me since March.Open for business for ablations etc and also general hospital work ,even Physio ( my son injured his hand)

Medication review is important and I'd suggest you might need something tweeking !

Best wishes x

Hi Cindy, no advice but my good QOL experience over 7 yrs is 200mgs Flecainide per day with nothing else. My cardiologist confirmed this would be best as I was then 60 with Lone PAF and HR just under 60 with BP 110/65. I see my cardio annually and so far he hasn't changes anything. I am very active nordic walking and in my smallholding, which may make a difference. I accept there is a risk of Flutter developing or worse so I am looking to decrease the Flecainide post Covid.

I’m on Flec only

I used to take flecainide on its own but then about8 years ago I was told to take verapamil with it. I have taken them both together for about 5 years now with no problem. I was given a beta blocker when I first had AF but it made me feel awful.

Yes I would say so in MY opinion but not a medic

I was put on Flecanide for AFib without any betablockers and a week later went into AFlutter too which I did not have before.

The beta blockers do their job


You may not have to take a large dose. As little as 1.25 mg a day seems quite usual.

My cardiologist said I must take a beta blocker with Flecainide to get optimal benefits. My heart rate dropped to 42 so the bb was changed to amlodipine which is a calcium channel blocker.

This dropped my blood pressure too low so I had to stop that too.

Now only on Flecainide but doing well and no tachycardia.

Hi Cindyrella, my experience is that I took Flecainide alone for over 12 years, starting at 50mgx2 a day and then 1000mg x 2 a day, and for the last 10 of those 12+ years 150mg x 2 a day. After 12+ years I was found to be in persistent asymptomatic AF, so on doctor's orders stopped taking Flecainide.Three years later one Friday afternoon I had a grumbling pain below my right ribs. It was still there on the Saturday so I contacted the out of hours service. A couple of hours later I was diagnosed as likely to be having appendicitis.

During the subsequent operation to remove my appendix my heart rate went over 190bpm.

The next day a hospital doctor asked why I didn't take a beta blocker. I said that no AF specialist had thought it necessary. That answer wasn't good enough for him, and so he put me on 2.5mg of Bisoprolol.

7 weeks later, on Christmas Eve 2017, I started having painful rashes. I was taken off Bisoprolol after two months, during which time I had an exacerbation of asthma which landed me in hospital for 2 nights.

My GPs did research and they found that if you have those side effects from one beta blocker, you're likely to get the same side effects from all beta blockers, so I no longer take them. For, now permanent AF I take only an anticoagulant, Warfarin being my choice.

cindyrella in reply to Thomas45

Thanks Thomas. I am on Eliquis in addition to the others. The mixture of all these meds is just a risky business. There's no guarantee. Sometimes I am tempted just to stop them all!

Dr Sanjay Gupta, in 2017, kindly answered a similar question I had in which I also asked about diltiazem:

"So flecanide slows atrial activity down and therefore sometimes there is a risk that it can slow fibrillation to flutter. Because it has no effect on the AV node there is a risk that flutter waves in the atria can conduct through the AV node in a 1:1 pattern and can cause the ventricular rate to go very high i.e 200-250/min which can be very uncomfortable for the patient and potentially dangerous. This is why Flecanide is often prescribed with an AV node slowing agent which reduces AV conduction and thereby reduces the risk of very fast ventrcular rate.

Both beta blockers and diltiazem are AV slowing agents and therefore either would work in terms of reducing the likelihood of flutter transmitting to the ventricles at a fast rate. However beta blockers have antidysrythmIc effect as well i.e. they can help convert AF to sinus rhythm whereas diltiazem doesn't and this is why beta blockers are preferred and if the flecanide dose is proving ineffective, the beta blocker dose is increased. If you used diltiazem instead of a beta blocker, you'd get the AV node slowing effect but you wouldn't get the antiarrythmic properties of the beta blocker.

Hope this helps:-)

cindyrella in reply to ILowe

Thank you! I love Dr. Gupta! You're fortunate to have him!

I take Flecainide and nothing else as per my EP. It's worked wonderfully with NO side effects. Never took anything else, just the Flec.

cindyrella in reply to sdweller

Thanks. I think it's the beta blockers that are bothering me. No problems with the flec.

I was on flecainide with diltiazem 200mg rate control, for AFIB. I don't tolerate beta blockers. (tried atenolol and bisoprolol)

I was not good on Diltiazem either but thats another story.

However I had an ablation which stopped the AFIB.

9 days later I developed re-entrant rate controlled ATRIAL FLUTTER! No trace of flutter on previous ECGs. EP advised it was probably promoted by the flecainide.

Even with the Diltiazem I was in 140BPM. I struggled to walk to the kitchen and back - major breathlessness. This would have been much worse without the rate control!

The flutter would not stop.

I had an ablation for flutter 3 weeks later.

Some people appear to manage flec. without rate control drugs.

I am not medically trained but I suspect this is to do with how AFIB presents itself to that individual.

I was always high rate - on average I would say 165bpm resting, sometimes as high as 195 bpm resting. It was very very difficult to get me out of AFIB (the last time before I was on flec was 8 days and 5 days of that were in hospital, eventually being cardioverted in the local hospital CCU by flecainide infusion).

Consequently a PIP approach of rate control was not possible. (and CCBs are relatively slow acting anyway).

IF your AFIB does not present as particularly high rate then perhaps this is not as much as an issue??

A discussion with your medics on the individual risk for you with your afib symptoms may give a way forward.

By the way apart from the flutter Flec was very good - it kept me out of AFIb. The only time I got AFib was when I missed an evening dose - I woke up in the morning and as I went downstairs AFIB kicked off!!

Best wishes.

cindyrella in reply to KMRobbo

Thank you for responding. My HR has never been that high. I wish you good results in the future!

I am fine - I had an ablation 2 years 11 months ago which sorted me out!

Hi...Thought I'd share my experience. I had my first episodes of afib in mid-April of this year. They tried me on bisoprolol first (5mg, then 10mg), but I still had afib episdodes. Flecainide was then added (50mg 2x/day). That combination worked and continues to work with respect to the afib. I also take 60mg edoxaban. I've had maybe 2 short afib episodes since the end of April. My EP insists that I must take a beta-blocker with the flecainide. I can say that I'm not a fan of the beta-blocker though. I felt awful for the first while....could barely get up off the couch! They ended up reducing my dosage of bisoprolol to 2.5 mg/day. By mid-May, I was able to get off the couch and very, very gradually started to feel better. Although I do function relatively well on a daily basis now, from comments I've seen I think it's the bisoprolol that is giving me weak-feeling legs. Also, I used to go for brisk walks, but my walks are no longer considered brisk. A bit of a struggle to get up hills too. I've asked my EP to switch me to nebivolol as per the feedback I've read on these forums, but he will only give me the choice of bisoprolol (his favourite) or metropolol. I've opted to stay on the bisoprolol for now, although I'm still not entirely sure why the nebivolol couldn't be an option. Does anyone else know why my EP wouldn't be in favour of it? I asked but the answer wasn't clear to me and of course you're not given much time to ask questions :) I am pondering having an ablation since I am only 55 and my heart is healthy otherwise.

cuore in reply to blue_reader

EPs as well as other medics are in their comfort zone prescribing meds they are comfortable with and by extension not necessarily the patient. You might want to print out statements from members on the forum whereby nebivolol worked for them to show to your EP. Then, present the argument that you feel you have the same body type as they do so you would like to give Nebivolol a shot. Insist that at least it is your right.

cindyrella in reply to cuore

Thank you! That's a great idea. My EP thinks he knows everything.

Hidden in reply to blue_reader

If you were in my hospital catchment area, and fit, you probably would be offered an expedited ablation. And probably asked what the triggers to the episodes, if detectable? If excitement (anxiety, exercise, when awake) given beta blocker as PIPocket, if depressive (alcohol, heavy food, usually at night) flecainide

When I switched to Flecainide, I did ask the EP whether a beta blocker was needed. The answer was not at that dose. But, I then did get atrial flutter in the right atrium. I have wondered whether it was not taking a beta blocker with it.

Hey cindeyrella, your post resonates so much with me. Also suffering excruciating back pain for past 3 months having been on Flec and Bispopropol since April. I have very low HR (40 sitting at desk sometimes) but not getting any traction with GP so see Cardio for review so have stopped both as of Friday to see how I fair.

I would be most interested to see if your backache improves. I sure hope so. I can no longer do my cardio exercises. I wish you well. I have considered quitting my meds also!

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