Pill in Pocket?

[Stressbaker]

What exactly does “Pill in Pocket” mean? Is it a drug that you take when you go in to Afib? Is it one particular drug or can it be different ones? That has never been recommended for me but it sounds like a great plan!

[Jalia]

It means that you take a particular drug when you go into AF , tachycardia or similar arrhythmia. This is very often a beta blocker but can be a drug such as flecainide, both of which would need to be sanctioned by your doctor .

[BobD Volunteer]

Pill in Pocket or PIL is generally used to describe anti- arrhythmic drugs like flecainide which can be taken at onset of an AF event. Very occasionally it may be used for a beta blocker such as bisoprolol but not generally thought to be good idea where anticoagulants are concerned.

The protocol would generally be for people with paroxysmal AF who have long periods between events.

[Frances123 in reply to BobD]

As a ball park figure Bob, what would you call long, as in long periods in between episodes please? Thanks.

[BobD Volunteer in reply to Frances123]

I think that depends a lot on individuals and their ability to cope. If you are having events daily then obviously permanent rhythm control is best (if that works at all it --often doesn't). Once or twice a month would be appropriate for sure . It needs to be an agreement between patient and EP.

[Kennyb1968 in reply to Frances123]

I was told it was appropriate for a frequency if no more than weekly

[Buddy00 in reply to BobD]

Bob I’m currently taking Bisoprolol along with 20 mg of Rivaroxiban, where did you get the information that it’s not a good idea to mix the two.

[BobD Volunteer in reply to Buddy00]

I never said that. What I said is that PIP is not a good idea for anticoagulants.

[Buddy00 in reply to BobD]

I wasn’t having a go bob just concerned as I am taking both meds. What you actually said was ( Very occasionally it may be used for a beta blocker such as bisoprolol but not generally thought to be good idea where anticoagulants are concerned )

[BobD Volunteer in reply to Buddy00]

Exactly.

[Suesouth in reply to Buddy00]

I am taking Bisoprolol 7.5 mg and rivaroxoban for paf, just been given flecanaide as a PIP - haven’t needed to take any yet!

[mjames1]

It's a generic term but with afib generally means taking an anti-arrhythmic drug like Flecanide at the onset of an afib episode. Conversion can be within 1-3 hours.

It can also mean take rate lowering drugs like beta blockers and/or calcium channel blockers to lower the rate until either you convert naturally or if not, go to the hospital for an electro cardioversion. Both strategies help you avoid trips to the A& E.

For twenty years I used the PIP rate control strategy, but recently as my episodes became longer and more frequent, I started using the anti-arrhythmic strategy. One isn't any better than the other, just different approaches. If you go with an anti-arrhythmic like flecainide, you may require some testing to make sure it's safe for you.

Jim

[pusillanimous in reply to mjames1]

My BP for years was controlled by 120mg verapamil and 10mg of what is is called Zetomax here in SA but it is a common drug Liso something or other, for years . I have symptomless AF which was diagnosed by chance, but not surprisingly as it is familial , I have four sisters and they all have it, but are in the UK and all on different regimens! I was sent to a cardiologist who kept me in the private heart hospital for two nights and stopped the verapamil and prescribed 2.5mg of Biso only because he thought my BP was too low. I have Asthma and Chronic Bronchitis (Acos) and he stopped everything but Symbicort for that! The Biso made me tired but I thought I could manager, I am retired. My GPs are also qualified cosmetologists and have a 'beauty' section to their practice, and I went for an appointment for a spot of panel beating and told my GP that my BP monitor (I can only use a wrist version as my arms are thin and wrapping the cuff around properly is impossible, and they are not accurate.) showed very high BP. She took me through to her consulting room and lo and behold, my BP was way up. She phoned the Cardio and the verapamil was reinstated. To cut a long story short, I changed my Cardio (we only have one EP in my province) because the original one moved to another location, and have an arrangement with my new one that I take 1,25 mg of Biso if my HR goes above 105 - I take Xarelto of course. I'm pleased to say this seldom happens , and the HR that suits me best is in the 70s. So PIP means different things to different people!

[pottypete1]

I have had Paroxysmal Atrial Fibrillation for many years. I take Flecainide daily.

I have been given permission to take an extra dose if I get an episode of AF. For many years I had never heard the term “pill in a pocket “ but this is how the extra dose is regularly described.

Having had PAF for decades I have lost count of how many times I have taken the extra dose but my best guess is that it has been probably 80% successful.

When not successful I have often had to have had to go to the hospital and have a cardioversion to regain normal sinus rhythm.

So in summary it can be a very real option but not one to be taken without medical supervision and always remembering that the maximum dose including that days normal dose MUST NOT exceed 300mg.

Speak to your cardiologist/EP. Your GP probably may not understand this procedure.

Pete

[Ppiman]

It depends on the individual and their arrhythmia, I was told. I take 1.25mg bisoprolol in this way when I get mild tachycardia. The problem is that the pill takes about an hour to start working, so it is only useful if the condition goes on longer than this.

Steve

[DevonHubby1]

Had the conversation with wife's consultant over PIP. It is not suitable for everyone. Her form of PAF does not respond to cardio version, either byvshocknor throwing heap loads of drugs at it when she was in hospital. She will self revert as and when her heart feels like it. She's on Bisoprolol which does reduce occurance in first place.

[irene75359]

Pill in pocket (PiP) has worked really well for me. It was my GP who guided me through coming off a daily dose of flecainide to using it as and when I had an episode, about 3-4 times a year, alongside 1.25mg of bisoprolol. He advised monitoring the number of episodes I have as if they became frequent then obviously having a daily dose would be better. But I have been most fortunate as my AF has not progressed, in fact my last episode was November 2021. The same GP called me and asked me to check the use-by-date on my boxes of flecainide as I use it so infrequently, they were all out-of-date and he prescribed a fresh batch.

[seasicksurf]

Pill in Pocket. I chose PIP regimen when I was diagnosed with paroxysmal AF. My AF episodes were about once every 3 months. My doctors at the Mayo Clinic here in the US offered me three options for treatment of PAF including daily maintenance drugs, PIP, or ablation. I chose PIP option which seemed least intrusive and consisted of taking 50 mg metoprolol tartrate at onset of episode and then 300 mg of flecainide 30 minutes later. It worked every time getting me back to NSR within about 2-3 hours. Flecainide has a well documented clinical history of being a very effective anti-ayrthmic drug. I stayed with this PIP for about 4-5 years. The drawback was the awful hangover from the flecainide, which has a long half-life. It took 2-3 days to feel better after an episode and medication self-treatment (PIP). My condition progressed over the years until I was getting AF nearly every week. I went for the ablation over a year ago and have been AF free since.

Looking back, I wish I would have chosen the ablation straight away. Besides the medication hangover, one of the worst parts of PAF is living with the anxiety associated with “the next one.” My recommendation is to get in line for an ablation if you have that choice. Best wishes.

[Stressbaker in reply to seasicksurf]

I also go to the Mayo Clinic. Do you go in Arizona or Minnesota? I see Dr. Valverde in Az.

[seasicksurf in reply to Stressbaker]

TMI…

[kamkat1013]

I carry a pillow in my pocket: I take diltiazem as needed if an afib attack happens. I swallow one pill and wait for it to work. If it doesn’t work by 30 minutes I’m instructed to take another pill. My blood pressure is normal so I don’t need to take this medication daily. Now I’m trying to get off Eliquis. my doctor says I can just stop taking it but everything I’ve read on the Internet says never stop suddenly. So I don’t know what to do except to wean myself off slowly.

[Stressbaker in reply to kamkat1013]

Just curious why you want to get off Eliquis if you have Afib? I take that too and was told it would reduce the chance of stroke from the Afib.