Too much propafenone?

[Jfbould1]

My cardiologist and I were hoping to reduce propafenone from 150mg 3x daily to 100mg. But I’ve been having a lot of afib and tachycardia recently. Today after a bad morning and afternoon I had messaged w my doctor about instead increasing to 200mg thrice daily, Funny enough, things settled down just when I was supposed to take my mid-afternoon dose, So I delayed taking it since the morning dose had done jack all. Now I’m 2 hours overdue for another dosage and still in NSR.

So, maybe a pipe dream, but wondering if anyone has had better luck reducing rather than increasing anti arrhythmia meds, whether propafenone or flec or others?

[BobD Volunteer]

Sorry to say no. Not until after my third ablation. I was on 900 mg a day split three ways at one point 13 years ago.

[Jfbould1 in reply to BobD]

Thanks Bob, just some Christmas wishful thinking on my part. Hope you’re staying well.

[cuore]

After my third ablation (May 29, 2019) I was on 300 mg x 2 Propafenone which I took for about a year. Then the dosage was 150 mg in morning and 300 mg at night. Two months ago, I started 150 mg x2. I am one year and seven months post third ablation now and still hope to get off Propafenone completely. Do they make 100 mg tablets?

[Jfbould1 in reply to cuore]

Hi Cuore, thanks for your reply. I am in China since the start of the pandemic. I usually split my time between US and here, but that’s not an option now. Here they dispense propafenone in 50mg tablets, but not sure what neck of the woods you’re in. I think I saw in my US Medicaid formulary 100mg tablets but haven’t had the “opportunity” to use my US coverage as yet. So it seems they’re available in several dosages. Good luck for the New Year!

[cuore in reply to Jfbould1]

I live in Canada. In speaking with my internal medicine gal, she talked about just taking one dose and the missing the other dose for the day. But, she was neither a cardiologist nor an electrophysiologist so I don't think she knew what she was talking about.

Google stats" " the drug is rapidly and extensively metabolized with an elimination half-life from 2-10 hours." If I followed her suggestion, I think part of the day I would not be covered by Propafenone at all.

Sites such as drugs.com do not list 100mg tablets. Interesting that China starts at 50mg.

[Jfbould1 in reply to cuore]

The reason I asked my initial question was that I wasn’t stable on the 150mg x 3, but it seemed that things calmed down towards the end of each 8 hr period, just when I was due to take another dose. So last week I skipped the mid afternoon and evening dose and stayed in NSR until the next day. Now I’m playing around with the “pill in pocket” approach, taking @100mg when it flares up and doesn’t go away in a short while. I’m having as much or better results as when I was dosing regularly at 150x3.

You might be right about no 100mg in NA. I do remember seeing the 150mg and thinking that’s convenient given where I was. My Chinese cardiologist initially had me at 100mg and it worked fine. I should have left well enough alone, but I found a three month supply of flecainide in my closet. I had moved to propafenone because flec isn’t available in China and I thought I was out. I was very stable on the propafenone but I switched to use up the flec and I haven’t been stable since, even after I switched back to propafenone. It’s maddening.

[cuore in reply to Jfbould1]

I absolutely agree with you that drugs are very finicky. My understanding is that Propafenone is a step down from Amiodrone which I have also taken. Flecainide also has its drawbacks in terms of flutter issues.

I do hope PIP is succeeding for you.

[Henry716 in reply to cuore]

Hi, have you ever had any stomach issues whilst on this med? ie bloating, aching gassy stomach. I’ve been on 150 x 2 per day for 8 weeks and it seems to be playing havoc with my stomach, also getting dizzy. Thanks in advance

[cuore in reply to Henry716]

When I first started taking it (300mg x 2) which was 18 months ago, I had several issues with it including stomach. I remember feeling nauseous about 2 to 3 hours after taking it in the morning. I also got quite disoriented while driving, and it gave me substantial memory fog. I also think it's affecting my kidneys somewhat because now that my dose is recently reduced , 150mg x 2, my kidneys have gone up about 5 points. And, of course, there was the metallic taste.

Currently the side effects are very minor or I'm used to them. However, just a few days ago I did get a bout of dizziness and I have wondered if it was the Propafenone.

At eight months after ablation I did try stopping it, but I lasted 6 days sinus. At 18 months sinus, I am soon going to ask to come off of it again.

You are on the lower dose, and it took me a lot longer than eight weeks not to feel the side effects. Hope you don't have to stay on it for too long.

[Henry716 in reply to cuore]

Hi, thankyou for your reply. I have paroxysmal, probably 2 episodes per year but the reason I asked to get on the tab was just the fear when I was in afib. I get very anxious when I go out of sinus and scared that something bad is going to happen although my cardiologist says it’s not dangerous.

[cuore in reply to Henry716]

How long do your episodes last? Your frequency two a year is nothing. Atrial fibrillation is not life threatening. You will not die from it. When I first had a bad attack with my heart pounding out of my chest, I truly felt my heart was going to stop and I was going to immediately die. That is a normal reaction when one knows little if anything about AF or if one is in the very early stages. At that time I knew nothing about it.

The good thing is that you have chosen an anti-arrhythmic drug which is the currency rather than rate to be on according to recent trials that focus on getting back into rhythm rather than keeping the rate down which was the older treatment. The concerning thing is why would you want to be on any drugs at all if you are getting only two episodes a year? Side effects from these drugs do all sorts of things to your body as you are experiencing right now. How ironical. I am trying to get off the drug while you want to be on one.

I suggest you go back to your cardiologist and discuss with him whether you can take Propafenone as a pill in the pocket (PIP). You take it when an episode occurs, and in your case it would be two times a year until you get more frequency, and hopefully that doesn't happen. With more frequency, then daily pill taking comes into play.

Now, I've had three ablations, tried all sort of both rate and anti-arrhythmic pills and am still here. So are all the others on this forum -- still here. You will be just fine. And, when you do become fearful, write a post. You will get all sorts of encouraging feedback. Good luck -- again, you will be just fine.

[Henry716 in reply to cuore]

HI first episode lasted 7 days and pip didn't work so cardioversion was done, stayed in sinus for 3 months and it happened again, this time pip worked, lasted for 6 months, this time pip didn't work and i waited 3 days and went for another cardioversion in early december. In sinus ever since and taking 150mg propafenone twice daily ever since just as a precaution

[cuore in reply to Henry716]

Were you on an anti-coagulant or did they do a TEE when you had your first cardioversion? Are you on anti-coagulants now?

[Henry716 in reply to cuore]

Yeah I was on warfarin and still am now with an INR of 2.6 - 3

[Jfbould1 in reply to cuore]

Just as a follow-up, after particularly bad afib a week ago, I’ve reverted to regular dosing @ 100mg 3x daily, with a 50mg flecainide chaser 2x per day. Been in NSR for a whole week. Will soon start cutting out the flec and see how it goes. Feel a little washed out at times, find it harder to finish calisthenics but happy with the NSR!

[cuore in reply to Jfbould1]

Wonderful that you're going back to the previous regime and it's working for you.