Hi, I am having a bit of a difficult time with ectopics and AF breakthroughs. For 2 years I`ve been stable and was discharged from the Heart and Lung hospital but lately every day I`m getting episodes lasting minutes or few hours. When I last saw the doctor at Broad Green Cardio he said it was ok to take an extra flecainide if AF happens as long as I don`t go over 300mg a day. I mentioned this to my GP this week on seeing him for a new appointment at Liverpool, he said DON`T take any extra; Has anyone else been told it`s ok to take the occasional extra flecainide when things are a bid haywire?
Thanks, Pat
Written by
ruskin10
To view profiles and participate in discussions please or .
Hi, I've been on flecainide for over 12yrs now and was told at the beginning I could take an extra dose if needed but definitely not to go over 300mg per day. Plenty of people on here also take it as pip ( pill in pocket) just to sort out an attack but keep under the 300mg.
I'm surprised that your GP overrode the specialist's advice regarding dosage. That seems very unusual. Did the doctor give a reason? He or she will have your specialist's report, after all, and will be reacting to that - or to other information they have about your specific situation. I'd be reluctant to go against my GP, myself, but would phone to check the advice.
Do you get a racing heart when you get the palpitations? If so, maybe an extra beta blocker would work? That's what I take. Again - your GP needs to give the go-ahead.
Thankyou for your reply. GPsaid it was because he didn't have it in writing that I could take an extra. I'm on the low dose 50mg twice a day, been in touch with hospital and have telephone appointment for 15th April...would have thought they'd want ecg etc but glad of that anyway. I'm age 70, keep well on the whole. Pat
I'm on my way to 70 (68). Your GP is being cautious and that's for the best, I think. I guess you haven't got an Apple Watch or similar, a Kardia for example? If you had, you could save a few ECG traces to take with you or email the consultant with.
Hi Pat, you don't say how much Flecainide you are taking or other details of comorbidities, age etc so it is a bit difficult to gauge where your GP is coming from. It may be he/she thinks you are too close to the max already, you have other issues that could be affected or as with my cardiologist favoured an increase in the regular daily dose to 200mgs over and above the 'roller coaster' of PIP, which could unsettle the heart further.
My reaction would be to make a prompt private appointment with you trusted cardiologist.
I got 9 episodes in a month on 100mgs and was then offered an ablation; instead I asked if I could go to 200mgs (medium level) and that stopped them completely.
I have also been on Flecainide for a long time (20 years plus) due to Atrial Tachycardia and take 200mg a day (one 100mg tablet morning and evening, twelve hours apart).
This is rather anecdotal but many times I have read that patients can take 100mg when they go into an abnormal rhythm as a PIP (pill in pocket). These patients are not usually on a regular maintenance dose, they take it as and when they experience problems
You don't say your daily maintenance dose but if it is 50 or 100mg twice a day, you should be safe to add one PIP additional dose in each 24-hour period .
Personally, I would consider ringing your Consultant's secretary at Broad Green and ask her to check with your Cardiologist that you heard correctly and that it is indeed safe for you to take an additional pill when your arrhythmia continues for a while.
Hope you sort this out but please let us know the result.
Before I had an ablation I was on 150 Flecainide twice a day with no problem BUT I do not know what other health problems you have or pills you take. I only had AF.
I was discharged from resus on flecainide (and apixiban) and told to take 100mg extra (pip) if AF started again by cardiologist.. he said back to hosp after an hour if no improvement in symptoms. My Gp had said follow advice by cardiologist as flecainide is initiated and reviewed in secondary care. That’s my experience, I’m under care in Essex/Suffolk hosp, regimes and care does vary it seems despite NICE guidelines. Take care ❤️
So hopefully one of the two is correct! Common wisdom is to go with the cardio as they presumably know more about these issues than your gp. However, not always. What is the REASON your gp said not to take more? Find out and weigh it against what your cardio said and maybe then discuss with cardio. Or better still, have a consult with an ep, who should know more than both.
Lots of factors go into decision making with Flecainide and its dosing, such as your age, heart structure and hopefully periodic ecgs to look for changes such as a prolonged QT interval which could suggest that you need to reduce your dose or stop taking it.
Related funny story although not so funny at the time. A week ago, my EP gave me the green light to increase my flec dose from 50 twice a day, but I was to have an ecg a week after starting the higher dose to make sure there were no abnormal ecg changes. This is pretty standard.
To save time, I had the ecg at a local doc in the box. Doctor comes in with the ecg report and suggests he suggests we call an AMBULANCE to take me to the ER based on what I assume was the machine's print out reading of the ecg. I declined and headed over to my ep's office for a second ecg. The second ecg had the same negative reading, but the ep said it looked great, not to worry and apologized for my experience at the doc in the box.
He also said he never bothers to look at the machine's interpretation because they are wrong much of the time. So, one doctor wanted to call an ambulance and another sent me home with a green light to stay on my new higher dose of flecainide.
Right now, I'm taking 50mg flec in the morning and 100 at night, along with 120 mg time release Diltiazem as an AV nodal blocker for safety. I am authorized to take another 50mg at the onset of afib and a second 50mg dose one hour later if I am still in afib. That would mean it I had afib at night I would have a maximum onboard load of flecainide around 200mg. But that's just me and what my ep thinks is reasonably safe. Your situation may be different.
But more pertinent to your case, I should add I also have the green light to take an extra dose of Flec if I start having ectopics. Ectopics don't really bother me at all, but once I get them afib tends to follow soon, so taking an extra flec makes sense.
Thanks for your reply. I`ve had ectopics from the diagnosis of AF but it`s only lately they have bothered me, seems to take my breath for a second and heart thumps in my chest lasting from minutes to a hour. It`s not pleasant. I have a phone consultation with Liverpool cardio in APRIL, in the meantime I`m going to take an extra flec when its lasting a while. I am only on 100 mg a day at the moment . Have a leaky valve which I have an ultrasound for each year, just had one. Asked the person doing the test, said it wasn`t their area I would need to talk to nurse when I get reults. Hey ho.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Flecainide
Flecainide as PIP
Any thoughts?
When to take PIP flecainide?
Stopping Flecainide 
