Coming off antiarrhythmic

[Cookie24]

Has anyone titrated down from Propafenone 425 mg SR and how? If not Propafenone, another antiarrhythmic SR?

[BobD Volunteer]

After my third successful ablation I stoppped propafanone over a period of about 6 weeks. Not sure how you get 425mg when the pills are 150mg but I cut down from four a day to three a day to two etc and then one every other day. Had a lot of ectopics to start with but eventually clear for many years. Now with a different arrhythmia so back on 150mg but nearly ten years free was great.

[Cookie24 in reply to BobD]

My dose is 425 mg sustained release twice a day.

[cuore]

Sorry, Cookie24. I am not one of your success stories. I was on 150mg x 2 Propafenone doing beautifully for four months, Then I tried to stop by taking only one Propafenone for twelve days, then alternating so the third day would be none. On that day I ate three fried donut like pastries and on the third one went immediately into persistent AF. In two days on Day 34 persistent I am booked to have a cardioversion, all because I tried to stop Propafenone. I wish you much better success.

I did email my local EP via his secretary. The response I got was a 30 tablet Propafenone prescription with the instructions "take as needed." If you get some enlightenment, do let me know.

[Cookie24 in reply to cuore]

Was your 150 dosage an extended release capsule? I have taken Propafenone successfully before and after my ablation. I also take Diltiazem 240 mg. I stopped propafenone for a while after my ablation but had resumed because of a 10 day flutter episode. For the past 7- 10 days my heart rate has been in the 50s and I feel lethargic.

[cuore in reply to Cookie24]

I don't know if the Propafenone I am taking is an extended release capsule. It is in tablet form. There is the "Apo" prior to the name, but I think that is the company. Propafenone also does have some beta blocker properties. So, if you are taking Propafenone plus Diltiazem 240mg, it is no wonder your heart is in the 50s and you feel lethargic.

I am curious as to how you stopped Propafenone since it is a twice daily drug?

[Cookie24 in reply to cuore]

Stopping Propafenone - I took one a day and went down to every other day, every three days, and then stopped. It used to be one could break open the capsule and count out 1/2 the mini balls inside.

I had an ECG and my rhythm was ok and I have an appointment for a 24 hour monitor May 17. I asked my EP what can be done in the meantime for slow rate and low energy. Today, he reduced my Diltiazem to 120mg so I hope that helps with the slow heart rate. These instructions were via a patient portal with the nurse as he was in the EP lab all day. I have been taking Diltiazem 240 mg for 4 years so I don't understand why it would be causing a slow heart rate now.

[cuore in reply to Cookie24]

I did notice that you were taking a high dosage of Diltiazem but felt it was not my place to question. I believe that route should help. I found that Dilitiazem 120mg was lowering my heart rate so , I asked to go off it.

The heart changes with time (in your case a four year period) but the pill doesn't. All I can think is that there is now a mismatch.

I was unaware that there was a capsule Propafenone containing mini balls. Both in France and in Canada, I have been prescribed only the tablet form. When you say you took one a day, does that mean that you took the 150 mg, broke that capsule, then took half the mini balls , and twelve hours later took the other mini balls. That way you were still taking 150 mg for the whole day?

Then when you say every other day, you did the same thing on the day you were taking Propafenone, i.e. 1/2 mini balls, then later 1/2 mini balls. Were you instructed that that was the way you were to wean off Propafenone. I tried the one a day tablet (no splitting) for 10 days, then started alternate days, but on third day alternate, I went into AF. Now I am scared to ever stop an anti-arrhythmic drug.

[Cookie24 in reply to cuore]

I found this information about Propafenone on a forum:

" In this case, I would hardly call it "breaking and entering" ;-). When I was first prescribed this, I was curious, and just pulled apart the two sides of the capsule ( no glue or stickiness involved).

Probably most pills that are "subdivided" this way would work the same. That being said, the micro-tablets that Rythmol SR contains are freakishly uniform (in a very good way :-). I understand the newly-released generic version contains particles of varying sizes, so this approach would not apply.

Obviously, not all time-release meds are configured this way. I have been weaning myself off of Aciphex over the last couple of months. It is a small tablet, but also of the time-release variety, so the "Divide and Conquer" method doesn't work. In this case, I started out taking a pill 4 of 5 days for a couple of weeks, then 3 of every 4, then 2 etc. Now, I take one only if I need it.

I guess the approach is different for every delivery method. In the case of non-time-release meds, deciding at what ratio you want to cut down, and cutting pills down accordingly makes sense to me. When you get to the last fractions, dissolving a pill in water (especially if it is a tiny one, and hard to split), and consuming as many fractions as you want. For example: One Ativan dissolved in 4 tsp. of water. Consume 3 tsp for whatever length of time, then 2 tsp. for whatever length of time, then 1 tsp. Obviously, this could go on forever."

[cuore in reply to Cookie24]

Thank you, Cookies 24, I shall keep your reply in mind.

[Cookie24 in reply to Cookie24]

I have lost 30 pounds since I started Diltiazem. Not sure if that makes a difference in dosage. Maybe this has made a difference?

[Dee5165]

It was interesting reading about Propafenone for Afib. I was on Sotalol and was going to switch but not anymore. After my Cardioversion I was fine for only 2 weeks and back into Afib. The Sotalol was worse than the Afib. Doctor kept increasing. I was not able to walk without being out of breath, palpitations, lightheadedness, fatigue, nausea, low Heart Rate and BP. I decided to do my own research. Doctor lowered my dose for preparation of med change but it appears all beta blockers have side effects for me so I am going natural for now. I am taking Magnesium, Hawthorn Berry, Vitamin D3, B12, and Wild Alaskan Fish Oil. This is day 5 and I am still in Afib but already feeling better. No side effects. I take supplements between 2 and 4 hours from any meds. I also take Amlodipine Calcium Channel blocker and Eliquis. I have only tapered off of 120 mgs. 2 X per day to now 80 mgs. 2X per day of Sotalol. May try to go to 60 mgs. soon if Supplements help my Afib back into rhythm. Long term tapering has not affected my BP to go higher so far.