Flecanide and Bisoprol combined?

[Guitar335]

Last Xmas I ended up in hospital on Xmas day following an an AF episode.

Thank fully, through lots of life style changes I have not had another episode until last night.

I have been on Flecanide for the last few years (100mg twice per day). When I was discharged from hospital last Xmas I was prescribed some Bisoprol by the on duty consultant as a PiP. The dispensing nurse thought this combination so odd that she went and checked with him before dispensing to me.

Last night when my AF kicked off I was too scared to take a PiP Bisoprol and would like to understand if other people are using this drug combination or been told anything similar to allay my fears?

Thank you

[dommydops]

I'm on Flecainide as a 300mg PiP but 2.5mg Bisoprolol daily. I've had to take the Flecainide a few times with no issues; I'm in fact meant to take an additional 1.25mg Bisoprolol 30 minutes before taking the Flecainide, as I recall. That said, I've just Googled 'Flecainide and Bisoprolol' and come to a NICE page about drug interactions involving Bisoprolol that has brought me up short a bit... Be interested to read some other replies.

[docmar in reply to dommydops]

Well this could explain things... I've been told by my cardiologist/surgeon to take maximum flecainide (up to 300mg/day) and bisoprolol (10-15mg/day) to conttrol AF/flutter - when I get this it lasts for days/weeks and becomes more difficult to revert to sinus rhythm. I try to keep the bisoprolol at 5mg and double up on the flecainide (total 2x100mg/day) as a maximum. I've had a prolonged episode (5-odd weeks) and only managed to get pulse to about 100, so remembering consultant's advice, took an extra bisoprolol in the evening. I was rather concerned about 2 hours later to get a sensation in my chest pretty well identical to that which I had when administered a drug (adenosine?) to stop my heart, which passed after about 20 seconds (felt longer!) and pulse reverted to NSR and my usual rate of 50. Don't think I'll be doing that again in a hurry! So your reference to the NICE page was very timely - thank you!

[Hidden]

Hi Guitar335, I'm not on this combination but I know of several people who are. It's recommended that caution is used when prescribing these together as both are capable of causing bradycardia (slow heart beat of under 60bpm). It's not necessarily a problem to have a slightly lower heartbeat, but it's as well to be aware that the two medications together can enhance that effect if you are susceptible. Hence the caution. If your heart beat is slow but you experience no dizziness, faint feelings, or extra palpitations, then no need to worry. But if you do, you should consult a health professional to ask about the advisability of using bisoprolol as a PiP. And you'd probably be more likely to suffer regular or troublesome bradycardia if you are taking both drugs regularly, and probably less so, when taking bisoprolol as a PiP. Hope that helps.

[Palpman]

The MedScape App shows no interactions between Flecainide and Bisoprolol.

[Drounding]

I am on 100mg Flecainide twice a day and Bisoprolol 5mg once in the morning. My understanding (laymen only) is that Flecainide can ironically sometimes convert AFib into AFlutter and that if this does happen (which it did to me on occasions in the distant past) then the Bisoprolol can help in lowering the flutter HR.

On those grounds I guess it seems reasonable that your cardiologist might suggest taking Bisoprolol as a PIP if you get AF that might turn to AFlutter, especially if you have Afib with a high HR. In my case when I got AFib my heart rate was always high and of course the Bisoprolol limits that happening to some degree.

The only drawback I have with regular Bisoprolol is that excercising is harder. It's also very easy to put on weight, which in itself can excaserbate AFib occurance in some people.

[Drounding]

@Guitar335 What lifestyle changes did you make if you don't mnd me asking?

[Guitar335 in reply to Drounding]

Thank u for your reply. Very helpful

Lifestyle changes -

reduced weight from 14 stone to 13 to get my bmi to better levels

Quit a stressful finance career now earning less than ever and happier than ever

Making a dream come true by travelling a lot ie 2 months at a time. I do believe a more care free and happier lifestyle helps.

Limiting my alcohol intake to a pint of beer or glass of wine at most in a day. (This was the trigger…again…as I had 2 to 3 glasses & possibly dehydrated)

The odd coffee only

[Bazman29]

Hi, I am on Flecainide 50mg twice per day and Bisoprolol 1.25mg mornings. Similarly, I was advised the Bisoprolol was to counter potential side effects of Flecainide. The timing of this post is quite timely since I ran out of Bisoprolol and it took me the best part of a week to get more, but I carried on taking Flecainide on it's own, yesterday was my 1st Bisoprolol again and I had a terrible night last night with constant ectopics and low HR (40)

[secondtry in reply to Bazman29]

The common scrip is to take something to control HR with Flecainide just in case Flec trips you into a very rapid dangerous HR. So don't give anything up without talking to your specialist e.g. cardiologist.

That said mine specifically said in my circumstances (60yo with Lone PAF and no comorbidities) that he wouldn't suggest anything to accompany my Flec 'as it would make me feel unwell'; this may have been because I love sports with a resting HR in the 50's and low BP usually around 110/60.

[secondtry]

See reply to Bazman.

[wilsond]

Flecanide must be taken with a betablocker such as Bisoprolol as without it you can develop atrial flutter or other additional arrthymia. This actually happened to me after just one week on Flecanide alone as a daily dose.So immediately prescribed Bisoprolol in addition. Must have been an oversight there.

I am not sure if the requirements differ if you take Flecanide as a PIP. Suggest you ask your prescriber for exact answer .

[ILowe]

I asked a similar question to Dr Sanjay Gupta. This is what he said.

"So flecainide 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 Flecainide is often prescribed with an AV node slowing agent which reduces AV conduction and thereby reduces the risk of very fast ventricular 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 flecainide 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

[Singwell in reply to ILowe]

Great to see this so clearly set out. I take the Flecainide Diltiazem combo and most of the time it does the job.

[dawny1908]

Hi I was taking bisoprolol for svt and after the last hospital visit for the dreaded adenosine cardiology called me to say they were going to try me on flecainide and bisoprolol to try to help with my svt. I have had no problems touch wood

[docmar]

Just to let you know Guitar335 I'm on high dosage medication when I do have problems, but I took 5-10mg bisoprolol and 100mg flecainide for many years without problems.