Cutting down flecainide dosage

[Budken]

Can I safely do this, with 50mg less on a morning dose?

[mjames1]

Short answer is "yes", as long as your cardiologist is onboard and according to your bio they are.

Like yourself, I was also on 100mg flecainide twice a day. Reduced it to 50 in the morning and 100 in the evening. Then further reduced to 50mg twice a day. Now on 25mg twice a day and I have the green light to go off of it entirely and only use it when necessary (called pill in pocket). Since you've been afib free for so long, the only way you will know how much flecainide you really need -- or if you even need it at all -- is to try different dosages under your doctor's supervision. No need to take more than you need and no need in fact to take any Flecainde if you don't need it.

That said, you mentioned they took you off of Metroprolol. In most cases, a beta blocker like Metoprolol or a calcium blocker like Diltiazem, is added to Flecainide for safety reasons. I don't take daily diltiazem anymore because of my very low flecainide dose (25/25), but at 100/100 or even 50/50 you might want to be on it. Same thing with a pill in the pocket dose, I was instructed to take the Diltiazem along with the Flecainide. Did they give you instructions to take extra Flecainide if you go into afib.

And as long as you're thinking of going down this road, you might want to get a Kardia device or Apple Watch. both which can take ekgs, to let you know if you're in afib or not. The halter you mention in your bio is only good for a limited amount of time.

Jim

[Budken in reply to mjames1]

Here in Germany, they do not monitor you constantly like in the US. You see your cardiologist only every few years, unless there is something serious. In my case I had worn a holter now, three times. In each case, not a single episode of Afib was recorded. I do have occasional PVC's however. I was worried because my first Cardiologist back in Florida, insisted I could never come off of it. Then the Cardiologist in NC was the one who took me off of Metroprolol. He said it was causing my problems, said it should not be taken with flecainide. Here in Germany, they simply kept me on the same medication regimen. This last visit, my Doctor said she thought my BPM were a bit too slow. Said she thought it might be the flecainide, and therefore we should try reducing the dosage by one half, every morning. I was worried because I had always been told, you must take the same exact dosage, twice daily. Thanks for the info.

[mjames1 in reply to Budken]

No hard rules with some drugs, just guidelines that a good doctor will modify based on patient response. Sounds like your last doctor may be a good one.

Jim

[wilsond]

Can't really advise on medication changes. Why do you want to cut down? I'd ask your presciber for advice.

[Budken in reply to wilsond]

It is my presciber, who suggested it!

[secondtry]

That is a tough question and I wish there was a definitive answer! The bottom line is that you have to make that individual decision yourself after talking to a medic you trust. I doubt medics know either as I have been on this Forum for many years and not much in the way of studies on the subject has come up.

My experience: 100mgs Flec didn't stop AF, 200mgs did. I promised myself I would just stay on the drug for 6 months at the most and am still on the same dose now some 8 yrs later.

My reasoning: My quality of life is excellent. My cardio takes the safe route for his professional reputation and doesn't recommend reducing it. I have read here others have been on it for over 30 yrs without any significant side effects. I believe my heart is prone to instability so the best way to deal with this (provided annual blood tests on kidney/liver etc remain positive) is to stick religiously to the same dose am & pm. Reducing the dose particularly going cold turkey (I would favour a very very slow reduction) could trigger an unstable period with hospital visits at this very difficult time nationally in the UK.

[Budken in reply to secondtry]

Yes, I have been taking flec for eleven years now. It was only four years ago though, that my original Cardiologist doubled my dosage from 50mg twice daily to 100mg daily. I had been having small outbreaks of afib every now and then. Originally he suggested I do the "pill in the pocket" method by taking an extra 200mg when I had an outbreak. That idea scared me, so he simply upped my dosage. The problem now is that I have weak spells, and my BPM is only around 55 most of the time. The new Cardiologist, said it could be the flec that is causing this. So suggested we reduce the dosage.

[secondtry in reply to Budken]

Flec îs a rhythm not rate drug although I think it reduced my resting HR a couple of points from 58 to 56. Sounds to me like you need to double down on lifestyle changes.

[Budken in reply to secondtry]

Not quite sure, what you mean by double down on lifestyle changes.

[secondtry in reply to Budken]

Sorry, look at making even more lifestyle changes than you have probably done already.