Flecanide PIP dose

[Racquet]

This has probably been asked before, but, if you've been directed to use Flecainide PIP at the onset of an AFib episode, what dose of it do you take to get back to NSR and how long does it take for that to happen for you. I was recently told to take 200 mg. Admittedly, 100 mg never did work in the past. Just getting some reassurance that it's not too big a dose.

[BobD Volunteer]

The maximum you may take in any 24 hour period is 300mg. Any more is poison level. I've not taken this drug outside of hospital so can't make any other comments.

[GrannySmithgs5]

I take 200mgs as a PIP , hope this reassures you x

[Paulbounce]

I've used flec as a PIP in the past - I found it very effective. I'll add this - best on an empty stomach. If you feel afib coming on don't have a big meal.

That was my take. l also found it would take about an hour to work. Try the breathing exercises until it kicks in. A slow walk can help as well - just to stay claim.

Paul

[minchern in reply to Paulbounce]

Totally agree with Paulbounce the second time I took as PIP was after food so maybe why it took 2 hours to get back to NSR

[Racquet in reply to Paulbounce]

If one had a crystal ball to know when an episode is going to happen, then you could eat or not eat. Got to be lucky. What do you feel when an afib is coming on? I'd be curious to know from you and others what you experience before you have a full blown "attack". AND, do you find doing anything in particular nips it in the bud. I think I might know one but I'll share it when I'm more convinced that it works.

[Paulbounce in reply to Racquet]

For me it was always 'silly hours' flying. Kicked in most times when I went to bed at 4am and was up at 6am. That was my bullet point and I ate little during the day 'just in case'.

Paul

[minchern in reply to Racquet]

I found the trigger for me was wine or Spirits, I stopped drinking them and had no episodes for 5 years until I caught Pneumonia which put me into permanent AF and have my cardioversion on 25th

[CDreamer in reply to Racquet]

If I had eaten and AF resulted after I’d eaten then I’d wait about 3 hours before taking the Flec. I forgot once and felt very ill for the next 24 hours so never made that mistake again.

[Racquet in reply to CDreamer]

Thank you for that piece of advice, CDreamer!

[Suesouth in reply to Racquet]

I get a few 3-4 hours of palpitations and ectopic beats, then usually go into Afib early hours!

[minchern]

Hello Racquet, My PIP is 300mg I've taken it twice so far first time took 20 minutes to go back to NSR and the second time over 2 hours. Hope this helps but don't take more than 300mg in 24hr period

[CDreamer]

Past tense as no longer use it but I was prescribed 300mg as a PIP in one shot and occasionally was told by EP to take another 100mg about 12 hours later if I didn’t revert BUT that NEVER happened without him eyeballing my ECG prior to me taking it which I would email to him. That was in the good old days when I could contact him directly which was about 10 years ago now/

As BobD said 300mg is the highest dose for a 24hour period.

If it was going to work it normally took 2-3 hours to be effective for me but everyone will respond differently.

[Stayfocussed]

I take flecainide 50mg as PIP and that has worked for the 10 years that I've had it. I was originally taking 100mg but have cut that down to 50mg, if it doesn't go back in within 2hrs I take another 50mg and that usually works

[Redmakesmehappy in reply to Stayfocussed]

When I tried Flecainide as a PIP my EP said to take one Flecainide at the beginning of the episode, I am on 50 mg, and if it didn’t work after a hour to call. Did it a couple time before I went back on it daily for so many odd heart beats that we’re driving me crazy, but when I did try the PIP it put me back in sinus rhythm in about 30-45 minutes. EP didn’t specify how much to take so I just took regular amount, maybe that’s why he said to call.

[daveygravey]

The maximum dose of flecainide is 300 mg per 24 hours. Two years ago I read a published report that said the following (as I remember it). A can’t give you the link. A large group of AFIB patients in the ER were administered 300 mg of flecainide and a large percentage, about 70 percent were back in NSR within 90 minutes.

After reading that, since my cardi. had not been specific about the dose for PIP I decided to try it.

In addition, I take the max dose of Metroprol 150 mg. This has returned me to NSR within an hour 100% of the time, involving about 8-9 events over the last two years.

I am not giving medical advice, just reporting anecdotal information.

[secondtry]

200mgs is considered a medium dose. I (68yo) have taken that level every day for nearly 8 years with no problems. Although Flec is a relatively old tried and tested drug it can cause problems with some especially I understand if you have comorbidities. However, if you have been told by your cardiologist it should be OK and you have confidence in him/her then I would go for it.

As has been said it should be taken on an empty stomach and no eating for an hour after taking. Admittedly, one doesn't know when an episode might start, so I would delay taking it for a minimum of 2 hours after a medium sized meal even if AF starts sooner. Best wishes.

[LouBrig]

I have infrequent episodes of Afrib, generally starting in sleep. My EP prescribed 300mg of Flecanide and as others have said, never take more than 300mg in 24hours. I was told to take 100mg first and wait 15-20 mins but 100mg never resolves the AFrib. So I take 100mg wait 15 mins and take a second 100mg. Generally 20-30 mins later I’m back in rhythm. I have never yet had to take the final tablet.

[Sportfix]

Hi Racquet, Yes, I was given this as a PIP after I’d had 2 ablations. The dose of 100mgs, along with 2.5mgs of Bisoprolol taken when I go into AF. Normally this works within a few hours. Just a few weeks ago , days after having the booster anti- Covid jab I went into AF. I took Flecainide and Bisoprolol & it didn’t work. I e-mailed him my ECG on my Apple Watch app which showed AF. I managed to get an appointment to see him and he prescribed 100 mgsFlecainide twice a day. If needed take 1.25 mgs Bisoprolol twice a day too. After nearly a week this kicked in. It’s never taken that long before. I’m still on that dose but I’m going to cut that down gradually. My consultant sent me for an Eco-Cardiogram 10 days ago and I’ve yet to hear from him what was the result. Hope you come out of AF really soon.

[ThinLizzy1]

I was prescribed 50mg and was directed to take up to 3. At my worst stage I’d take two to cut down on the drugs I was taking and also so I had a higher dose to go to if 2 x 50 was no longer doing the trick. At that stage without flecinaide I was having an attack for 24 hours or so and then ok for a day then back to another 24 hours.

I’ve had an ablation three years ago that has reduced the frequency of attacks by 95%. Now I pop one 50mg on my once a month or so attacks and it works every time with just 50mg.

Triggers for AF for me have included (in order how likely to trigger)

Alcohol

Stress

Caffeine

Crunching of my upper body when moving

Ice cold drinks

Hope you are feeling better soon.

Good advice is try and be relaxed during attacks - EASIER SAID THAN DONE

[Jajarunner]

I was told 100 then 100 half hour later if unresolved. It never works for me though, sadly, but it calms it a bit so I can get to hospital.I was recently also told max dose of 300 in 24 hours when my my useless local hospital gave me 350 and the cardiologist went mad the next day. That and the amiadarone was why my heart was "slow to get going" later that day after the DCCV! 😳

[Lucymoo]

I’ve been advised like you to use it as a PIP without any real advice following an ablation in May. Recently my heart rate was 180 so I took 50 mgs and waited thinking I could increase it say 30 mins if it had not slowed. Luckily after about 25 mins I could feel it slowing and back to normal around an hour later……we are all different so maybe trial and error to see what works for you

[TracyAdmin Partner]

Hi Racquet, please do not hesitate to contact the Patient Services Team if you need any supportive advice, you may also find it helpful to download the 'Flecainide' Patient Information Sheet' from the website heartrhythmalliance.org/afa...

[Dave0]

I was given a dose of 400 on a couple of occasions whilst under close supervision on cardiology ward in attempt to cardiovert. Unfortunately for me, this doesn’t work and only DC cardioversion gets me back to NSR.

[bikergurl]

I use Flecanide as a PIP for paroxysmal afib. My prescribed dose is 300mg, but only once in 24 hours. Thankfully, I revert within an hour. My afib is vagally mediated, rearing it’s ugly head at 3:00 am. Hope this helps.

[croesio]

I was told originally to take 150 mg flecainide as pip.but I now take Bisoporil 2.5 then 1 hour later I take Flecainide 100 mg. so far it works. funnily enough I tried taking them both together at one time but it didn’t, work?????

[Nugger]

300 mg plus 10mg bisoprolol, worked for me twice a few months back

[seasicksurf]

My PIP routine was 50 mg metoprolol tartrate at onset followed 30 minutes later by 300 mg flecainide. I’m in US at popular Mayo Clinic. A flecainide study I found on internet indicated average time for participants to revert to NSR (after 300mg) was about two hours—which was consistent with my experience. Note that I would be a mess for a couple days after from the medicine. Terrible effects for me, but it always worked. I had ablation 6 months ago that is so far good.

[Racquet in reply to seasicksurf]

I hesitate to ask but what were your terrible effects after taking the flec?

[seasicksurf in reply to Racquet]

Fatigue, nausea, headache, tightness in chest. I am otherwise fairly active (daily), but didn't feel like doing much of anything for a couple days. I called it my PIP hangover--which would be a good general description for how it felt. Imagine a very bad hangover...

[Cos56 in reply to seasicksurf]

I am trying metoprolol succinate tonight as a way to come out of a fib. I have taken it before going to the emergency room in the past so that by the time I got myself there I was in nsr. I’m hoping it works tonight. I wish someone could tell me the best way to get through the episodes. I see my doc again 11/3.

[seasicksurf in reply to Cos56]

Metoprolol succinate is the extended release, which isn’t as fast to act as metoprolol tartrate, but does last longer. That’s why tartrate version is used in PIP (faster acting). As for getting through the episodes, I get it, and you have my sympathies. I am totally empathetic. My way of getting through was to recline and just distract myself with my computer or listening to guided relaxation meditation or relaxation music (YouTube). I would always have plenty of water as well to take my pills and to hydrate as much as possible. If the episode occurred later at night, I’d take my PIP pills and go to bed—and typically be in NSR when I awoke.

I dealt with PAF for 5 years and had about 50 episodes during that time. ALL resolved at home after 50 mg metoprolol tartrate followed 30 minutes later by 300 mg flecainide. It was home self care that worked for me—every time! Getting back to NSR usually took 2-3 hours. It was however, a tough cross to bear for several years. I wish I’d have opted for an ablation earlier. If you get the chance, do the ablation.

Good wishes to you Cos56. I’ll send some positive thoughts your way. I sense the anxiety that I always had. Find your favorite YouTube relaxation meditation voice, sit back and let the time pass.

[Cos56 in reply to seasicksurf]

I know it’s the extended release but it’s all I had . The episode lasted one hour and 20 minutes. Ended as abruptly as it started. I’m hoping my doc will give me the tartrate since that seems to do the trick. Your reply has helped me greatly. Thank you so much.

I prayed during it and imagined it stopping and how great I feel when it’s over.

It’s beyond me.

Again, you’ve helped me so much❤️

[Racquet in reply to Cos56]

Last had an episode starting again at the bewitching hour of 12:30am. First time using flecainide PIP. Was told to take 200mg. Being the first time, I took 100 then an hour later another 50 and another hour after that the final 50 along with a 5mg of diazepam snapped in half. That calmed me down ALOT and even made me sleepy this being 3am. I fell asleep and woke up around 7:45 in NSR. That's how I got through. Sleeping away a bunch of hours is great. When the afib stopped, i'll never know. As long as I woke up in the first place and then in NSR was even better.

[Cos56 in reply to Racquet]

Yes, it’s always good to wake up. LolI do have some old Xanax in the house but I was afraid to take it!!! That would have been VERY helpful.

Thank you for your reply. It helped me to know that the anti-anxiety med helps.

[Racquet in reply to Cos56]

I only asked about diazepam (valium) with my drs and the chemist. No problem. Check yourself about the Zanax.

[Cos56 in reply to Racquet]

I definitely will. I am so sure it would ha e helped since I was almost jumping out of my skin.

[Cos56 in reply to Racquet]

Why does this happen at night?

[Boiler62]

I’m in the US, but my PIP routine is three 100 mg tabs whenever an episode starts. I take them as soon as possible and they have always ended the episodes. It may take anywhere from 30 minutes to 4 hours. I have noticeable symptoms (shortness of breath, heart palpitations) so I try to rest (sit or lay down) while I’m waiting for them to stop the episode. Virtually all of my episodes start while I’m exercising (jogging, bike riding, yard work) or while I’m sleeping after exercising the previous evening. Due to that fact, I don’t think I’ve ever had an episode within 1-2 hours after a meal.

When I was first prescribed them, my cardiologist made it a point to only take one tablet the first time and to call his office to confirm no adverse effects. He instructed me to go to an emergency room if there were any unusual side-effects especially related to my heart rhythm. Apparently, there is a relatively small group of folks for which flecainide makes arrhythmias worse.

[Cos56 in reply to Boiler62]

“Any unusual side effects”. How would we know if the rhythm is so crazy as it is? My rhythm is all over the place during an episode. My poor heart acts like it doesn’t know what to do🙁

[Boiler62 in reply to Cos56]

There are more serious arrhythmias than atrial fibrillation. I think the concern was that you'd lose consciousness or perhaps have chest pain or more severe difficulty breathing or moving.

[Davg7]

When I was taking flecanide as pip it 200mg then 300mg on onset of afib. I got out of Afib in 4 hours like clockwork, until it stopped working reliably. It is critically important not to take more than 400mg in any 24hr period.

I eventually got an ablation which had held well for now 18months.

[Racquet in reply to Davg7]

I have from reliable sources, the max in 24 hrs is 300.

[Dollcollector]

I was told to take 300mg as a pip , which l did the 1st time . It stopped my heart after 20 minutes and put me back in N.S.R. I thought maybe l was too sensitive to the drug and took 100mg the next time and 150mg the 3rd time but they didn't work. It seems that you need 300mg to work effectively.