I take Flecainide 150mg, Bisoprolol 1.25 and Xarelto 20mg every morning and this regime usually keeps me free from Afib episodes and able to lead an active life.
However, about once a month my heartbeat becomes irregular and is often over 100, at these times my BP plummets
My Cardiologist says when this happens I should replace the Flecainide and Bisoprolol with Amiodarone
I just wondered if anyone else has tried this and did it work, or should I just sit out these episodes?
Thank you for any experiences of this you can share.
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Summerlily
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I think I might change cardiologists to be honest. Amiodarone is not a drug to be taken lightly and with the max flecainide daily dose at 300mg far easier to take an extra one if so prescribed.
Like most folk here, I’m not medically trained therefore cannot really comment on what your Doctor is suggesting but a couple of thoughts spring to mind which might be worth discussing with your Doctor. Flecainide is a serious drug which needs to be treated with respect and Amiodarone is, we understand, even more potent and certainly is not encouraged for long term use. If you regularly take 150mg of Flecainide, that means you could double the dose on occasions when your AF kicks in, PROVIDED you never exceed 300mg in any one 24 hour period. This is also a drug which you seem to tolerate. I think I would want to know what the risks and consequences might be of mixing these two drug. We know AF is generally a progressive condition so the chances are, at your age, you could be faced with mixing these drugs for a long time as well as having to increase doses.
I know France is a big country but in Bordeaux, I believe there is the world’s leading experts in Electrophysiology and if I were you, I would be seriously looking at all forms of therapy available for managing AF. Take a look at the link below.
Thank you both for your repliesI live very near Bordeaux but so many people I hear of have had an ablation and are still on the same meds as I am and still have episodes of A F
Yes I agree, although personally I am pro ablation therapy, I agree it’s not a step to be taken lightly. About two years or so ago, I produced a post on this forum designed to gauge forum members views and opinions on having an ablation and I’ve added a link so that you can if you want, take a peek. The general thrust is that here in the UK, over 8000 ablations are performed annually. Generally, forums are noted for attracting folk who experience problems and the evidence suggests that very few experience problems once the so called blanking period (6 months to a year) has passed and even those who still have bouts of AF say the effects are significantly less than they were before their ablation(s). Lots of things to try first such as lifestyle improvements etc etc but it’s worth considering before accepting a lifetime of quite potent medication ……..
Very strange advice. Amiodarone is a drug that only starts acting after many days and it has a half life of something like four months in the body as it builds up very slowly and is not excreted in the normal manner by kidneys, liver and so on. It is also a very potent drug with unpleasant side effects for many and requires regular blood checks etc to ensure it is not causing other health problems.
To do justice to your cardiologist, perhaps he was suggesting it as an alternative, not something to be taken on just a day or two when you have problems. When I was given Amiodarone nearly two years ago (which was terrible for me!) I was also prescribed Bisoprolol at the same time, initially. But normally you don't take both.
Okay, this approach does not seem to get the thumbs up from this forum!I have always had confidence in my cardiologist but I would be very interested in what advice other people have been given when usually okay but experiencing an Afib attack that has lasted three days.
Do you just keep taking your same meds and sit tight?
Reference your latest post, I see you live in France. As you may have seen in my reply to Summerlily here, I mentioned the famous AF clinic in Bordeaux together with a link. Just thought I’d mention it to you………
When you say you have AF for around 3 days, have you had a Holter (24 hour) test to see what is happening between attacks? 3 days is a long time for paroxysmal AF attacks, but it is possible with rate control (usually beta blocker types) you can carry on with permanent AF but not feel too much from the effect. I had my first bad attack in 1995 and I took Sotalol for around 30 years (still taking it in fact, but about to change to Nebivolol if it works for me) leading a mostly normal life. (After a stroke almost two years ago I am now told I am in permanent AF though and finding life very difficult with tiredness and breathlessness.) Amiodarone is however a very powerful drug which blocks not just rate receptors in the heart but also others in its role as anti arrhythmic and I would be very surprised if it was given for paroxysmal AF as it is a very strong drug with many side effects including long term ones. How often are your 3 day attacks of AF?
I attempted Amiodarone as a pip; it wasn’t effective and my cardiologist advised against it. Only good for long term as it takes time to build up to an effective dose. Also the toxicity to lungs and thyroid have to be checked. My guess is that your cardiologist was suggesting switching.
Very interesting thread! I am 76 and in the US. I would love to know the dosage of amiodarone your cardiologist prescribed. I take amiodarone 50 mg daily and metoprolol 25 mg daily. I am asymptomatic so have only known to have atrial fibrillation when a doctor has told me I had an irregular heartbeat. I have been prescribed 400 mg amiodarone (200 mg twice a day) and 100 mg once a day in the past but could not tolerate either. Since cutting back I feel fine and my electrophysiologist seems to like my electrocardiogram. He said to have my liver function and thyroid function tested and I plan to do this every 6 months. No follow up visit requested for a year. Thanks for all the sharing. Chris
Sorry to hear that Oscarfox49, I hope the new meds help.The cardiologist was definitely suggesting Amiodarone 200 as a pill in the pocket
This will really shock you all.
Last time I had an Afib attack that lasted 4 days I was told to take 2 Amiodarone pills in the morning and evening for 3 days then 1 in the morning for 10 days! then revert to Sotalol which at the time was my daily medication.
In answer to your question Oscar fox, I have not had a halter observation.
I had a cardioversion November 2020 and since then seen the cardiologist every four months when I have an electrocardiogram
The only other test I have had is an echography and last month the nurse came out to take BP every morning for a week.
The attacks usually only last a couple of hours and I have onle had two longer ones since the cardioversion
I do a lot of walking, perhaps 3 hours a day, field trials with my Springers, gardening and looking after the other animals
This is all very interesting, thank you all for your views
This is France where I think the attitude to drugs might be different
I'm curious Lily, during that regimen of amiodarone for 13 days, when did you go back into Normal Sinus Rythym? I was on amiodarone for over a year in NSR but my new doctor doesn't like amiodarone and switched me over Sotalol 120mg twice a day. Problem is 3 months into the new regimen I had a 72 hour Afib episode which reverted on it's own but now I had another lasted over 24 hours. I guess I'm asking, did that amiodarone regimen work? I'll ask about it to my Cardiologist since I was going to ask for a PIP anyway.
Hello riggjackI would not recommend taking Amiodarone, I have since changed my cardiologist and it has never been suggested again.
I think the replies you can see I had were very informative
I did go back into normal sinus rhythm during the course but I don't think that was due to the Amiodarone, see Oscarfox49 reply, it is a drug with a long lead in period.
I did take Sotalol for a while then switched to Flecinide which I am very happy with It is the slow release version so I cannot take a PIP at the same time I am told
Hi, To be honest i don't get that many episodes of AF, I have PAF and when i do get a sign i usually do something to stop it naturally .Sometimes i have a cold drink or do something to make myself puff which isn't difficult because i have COPD.
I’m not a doc but really surprised that Amiodarone is being used as a pill in the pocket. It is used as an IV method in hospital for very serious cases of afib but that would be a higher dose and needs medical supervision as it is a serious drug.
I’m currently taking Amiodarone for a short while before and after a mini maze (ablation done from outside the heart). It takes time to build up (it clings to the protein in your body and then releases from there when your protein cells renew) so is either loaded or a dose built up over time. It therefore has a long half life as it leaves the body as the protein cells renew and can take 120 days.
It is a drug with serious side effects if taken for a long time, thyroid, liver and kidney damage and even for the few months I am taking it I am having blood tests. These risks are for using more than a pill in the pocket.
I’d be asking your cardiologist to explain why he is using Amiodarone, it’s the opposite of quick acting!
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