Look forward to comments. Seems my cardiologist wants to cover all the bases (more medications = better protection). GP agreed I should try coming off flecainide. Taking Xarelto blood thinner to be safe. Use Apple Watch and take ECG readings at every opportunity.
Five days ago I went off flecainide (50 mg twice daily). I have had no adverse effects, probably feel better. Just don't know what to use as pill in pocket, if needed. I am still on Verapamil/Cordilox/isoptin (180mg once a day). Long term hope to stop using Verapamil/Cordilox also. My afib episodes were never at high heart rate (average was around 90 BPM). My preferences are (in order):
1. Can Verapamil/Cordilox (calcium channel blocker) be used as PIP for Afib (what dose)? Don't understand whether Calcium channel blockers control rate, rhythm or both.
2. Sotalol as PIP? Used it successfully in the past to control supraventricular tachycardia (around 170 BPM). Even 30 mg did the job.
3. Flecainide as PIP (200 mg) and maybe combine this with Sotalol (beta blocker).
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Fabfibber
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I would also like to come off or reduce Flecainide (200mgs) but my cardiologist is not keen to discuss this. He works on the basis you try things until you find something that works and then you stick with it for life or until it doesn't work any more. He doesn't seem to have or mention any experience of patients doing anything else. I hope you get some replies from people who have weaned themselves off, how & why. That said I don't think it is prudent to rock the boat with Covid around and doctors/NHS/hospitals under so much pressure. I am going to be 🙏 for some courage once things return to normal and very slowly reduce my dose to 100mgs!
I had persistent afib last fall 3 cardio versions in 3 months put on flecainide 75 twice daily and am down to about 40 twice -shave some off -a day. I have done many lifestyle changes no alcohol no caffeine add veggies fruits hydrate 1/2 body weight in oz in water added mag tartate 200 mg daily at noon so it doesn’t bind with my evening flecainide. Discovered I have vagal mediated a fib from the blog of richard bogle-excellent. Learned about pip triggers and sing/hum for breakthrough a fib see a chiropractor monthly to correct t4posture -cardiac accelerator fibers r at this area. The heart is irritable for 6 months so I didn’t cut back too fast. Also eat foods high in magnesium and not late at night. Don’t sleep on my left side walk everyday pray and believe it can be controlled. It’s work but worth it you can do it if u want. Keep reading on this site and it will help
I am also on flecainide (25 mg 2x/day) and digoxin. Can't tolerate calcium channel blockers or beta blockers. I still get the occasional Afib breakthrough, and use extra flecainide as a PIP. Usually works within an hour or two. Take 100-200mg for the PIP. I have also on occasion taken a beta blocker only, as a PIP, which slowed my heart rate but did not stop the Afib. I also tried to wean totally off the 25 mg of flecainide and rely totally on PIP, but increased episodes of Afib. So I'll stick with the 25mg 2x/day for now.
I have been told that Sotalol is a combination of anti-arrythmic and beta-blocker. I would not take both flecainide and sotalol.
Also, as I understand it, calcium channel blockers control rate, not rhythm, and are sometimes used instead of a beta-blocker.
I would suggest you discuss with your cardiologist.
I can't advise on what medicine to take, I can only tell you what worked for me as a PiP. At the first sign of an episode I took 200mg flecainide and 1.25mg bisoprolol and that combination always stopped AF in its tracks (maybe about three times a year) and worked for years. I am normally on daily Apixaban and Amlodipine for high blood pressure too.
You definitely need more guidance from the people looking after you who have your whole medical picture, the experts! Although your cardiologist has prescribed quite a few meds, it seems your GP is supportive in lessening your medication burden. Mine was too, and always spent time with me discussing the pros and cons of each route. It would be worthwhile talking again to him as he will know (or should know) why each drug was prescribed, the ramifications of stopping and the best combination to take as a PiP.
Best of luck, let us know what you decide.
Never understood the desire to come off flecainide. I've been on it for 35 years with no adverse effects an no AF for the last 6. Prior to that I only got a brief episode if I forgot to take the flecainide and it would revert once I started it. I wouldn't trust a GP to have any idea about effectiveness of drugs use to treat paroxysmal AF and I wouldn't routinely take blood thinners unless I was in AF.My own personal experience of verapamil, which my cardiologist tried first, was dreadful and, is digoxin really still used for AF?
Yes, digoxin is still used in Afib. IF beta-blockers and calcium channel blockers can't be tolerated, and if you're on an anti-arrythmic. My electrophysiologist insists on it. Says it protects the ventricular function.
35 years, I think thats a record on this Forum! Do you have any regular bloods to check for any side effects, although after that length of time I guess it is no longer necessary ?
Yes, it is a good record. Professor Pentecost at Birmingham General, as it was then, tried it after two other drugs failed. As soon as I came round from cardioversion, I knew it was working. Had some blood pressure and other blood tests for 3 years and then discharged. Since I know how miserable AF can make you feel, I have religiously taken 200mg a day for 35 years (now 69). Now I get an annual check up from my GP.
I'm not really sure what the adverse effects of flecainide are supposed to be, but it works very well for me. This might be because my heart has no underlying structural defects and my diagnosis was of familial paroxysmal atrial fibrillation.
Hi there..Wouldnt like to advise you re sotalol as a PIP considering all the other drugs you are taking.Sotalol is my only antiarrythmic medication and I only take 160 mg per day with an option to go up to 320 per day if it kicks off.Good luck with your situation.
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