I’m on 100mg of Flecainide, 50mg twice a day, no beta blockers. My afib is of a paroxysmal nature and each episode lasts usually no more than an hour or so, sometimes minutes. It is however very intense and uncomfortable!
I can usually self terminate by exercise or various vagal manoeuvres. I have been advised to also take a further 100mg of Flecainide as a pill in pocket if I can’t self terminate any afib break throughs. The most I seem to go afib free is one week and in between I get nightly afib, always during the rest and digest stage when sleeping, anytime between midnight and seven or so in the morning. I know we can’t ask for specific dosing or medical advice on here but I’m interested in knowing the timings that others take Flecainide? As my episodes are all of a vagal nature and occur at night, I’m wondering if I should take my second 50mg closer to bedtime in the hope of staving of a nighttime episode?
Currently I take it at 7.00 in the morning and 7.00 in the evening but I still get Afib break throughs? I’m also questioning if 100mg a day is simply not enough to have and effect at keeping an episode at bay? Thoughts please?
Thanks in advance
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Motov
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Keeping current dosage, you could ask your doctor about trying 25 morning and 75 evening. Or up the dosage to 50 morning and 100 evening. Either should offer you more night time protection. Pull cutter needed for first scenario.
I don't know your medical history, however beta blockers or calcium channel blockers off and taken with Flecainide as a safety measure to help prevent 1:1 flutter.
Especially if you're planning on increasing your dose of flecainide, you might want to have a conversation with your doctor.
Absolutely understand the 1:1 thing but as beta blockers lower the heart rate at rest, this often predisposes vagally mediated Afib to kick in! I’ve seen lots of post on here if people on straight Flecainide with no beta blockers and at a higher dose to me. My heart is structurally sound and I’ve had no issues with 100mg daily without a beta blocker? The 75mg/25mg split sounds worth investigating further!
I took diltiazem with my flecainide, which I tolerated better than a beta blocker. 75/25 is worth trying before 100/50, as is 100/25. I had a similar issue as yours, night time/early morning afib and loading up more at night helped. Got to experiment a bit till something clicks. In my case, my nighttime afib was due to digestion issues. Once I got that sorted out, I didn't need to load the night time dose any more. Now I'm on a very low dose of 25/25 which is working surprisingly well. If I could only find a decent pill cutter!
Pill cutter was also on my mind. Like mjames I take Diltiazem with my Flecainide but I will say that my EP has stated for some it's OK to take Flecainide solo. And it's what I shall be doing with his permission as a cut down in due course. (Am post ablation currently.)
I'm on 100mg twice a day, no beta blocker. My only long episodes have been just as I was dropping off to sleep. I haven't had an overt episode since 2013 but 2020-21 all sorts of weirdy goings on, runs of tachy lots of ectopics, feeling grim. At this point had been on 50mg flec twice a day reduced 6 yrs back by GP as having runs of tachy.Saw great cardiologist who increased flec to 100 twice a day which has stopped majority of probs.
Re uneven dosage, some EPs won't entertain it, others do.
A lot of instructions say take flec on an empty stomach and I do in the morning but in the evening I have it at six pm with my evening meal. My theory ( totally not researched) is that food will slow down absorption of evening dose making it be released more slowly and cover me into the night. I'm sure this is akin to not treading on the cracks though!!!! as I know flecs half life etc will see me through anyway.
As I said I've been on 100mg twice a day with no betablocker since 2011 with 5 yrs at a lower dose which worked for most of that time oh and I'm 78.
That's so interesting! My EP is not against Flecainide without AV node blocker- says it depends. He's also open to uneven dosage. It's odd too isn't it the food thing? For my first year or so with AF I followed others' advice to not eat or eat light during an AF episode. I discovered my mistake that having a hospital tuna sandwich and cuppa usually made the AF disappear. So in this case, rest and digest calms it all down... I now eat as needed during an episode.
Before Flecainide, when I used to have longer afib episodes, I always ate, at least after getting my HR down. Like yourself, I converted more than once during or right after a meal.
I can’t help with your Flecainide query I’m afraid but just wanted to ask if you’ve been tested for sleep apnoea? My AF episodes were always nightly, in the same time window as yours. I wanted to know what was going on, so purchased a ring device that measures O2 and heart rate overnight and, from that, discovered I was having regular O2 drops during the night. An NHS sleep study revealed I have sleep apnoea. Only mildly but enough to trigger episodes in me. I’m not overweight, I don’t snore loudly, or at all apparently, so not a typical candidate for sleep apnoea but nonetheless still had it. Since being on CPAP therapy my nighttime episodes have stopped. I’m not saying that’s the cause for you, of course but thought it worth mentioning.
Also, check out your supplements, if you take any, as some were causing me problems - magnesium Taurate in particular, which I know a lot on here swear by. Just goes to show how different we all are!
I've used Flecainide successfully for a while as a maintenance dose and extra PiP as needed. What's the timing of your evening meal in relation to the 2nd dose? That's likely to be important. Flecainide needs water to absorb into the body and doesn't work well on a full stomach. I always take mine a full hour before eating. Occasionally I've kicked off after my evening meal in a vagal event, in which case I wait a minimum of 1.5 hours before taking PiP. Might be worth experimenting with different timings to suit you before increasing dose, especially as you're on Flecainide as a solo drug.
I was similar. I had 9 AF episodes in 5 weeks on 100mgs Flecainide, the only drug. I then went onto 200mgs (a medium dose) with cardiologist's approval and I have been fine for 8+ yrs. I take it 6am & 4pm, making sure I haven't eaten for 3+hrs before and 1 hr after.
I started on 100mg flecainide about 5 years ago after cardioversion failed and the effect was immediate. AF was stopped an hour or so after the first dose! I took 50mg morning and evening for 2 years.
After about 18 months the odd AF attack became more frequent, I had regular weekly short AF attacks which were lasting a few hours.
My GP increased the dosage to 150mg and we decided I should take 100mg in the morning and 50mg at night always on an empty stomach.
My routine now is 100mg when I get up around 6am with a cup of green tea, and breakfast an hour later.
My evening 50mg is taken at around 9pm a few hours after my dinner with a cup of fruit or green tea.
This routine has kept me completely AF free for the last 3 years so I guess the average blood serum level must be stable enough to prevent AF reoccurring.
We are all different, but this routine has worked very well for me.
Since the empty stomach thing has been brought up several times, I'll just say I take it with or without food and have not noticed a difference. That is also the instructions on my label. I do understand that some UK brands specify empty stomach, but I would question on what basis. A pharmacist might be a good person to speak to on this.
Mayo Clinic says "with or without food". My package insert says "Food or antacid do not affect absorption". I do understand some UK brands say take on an empty stomach. I would like to see the science behind that. My guess is that they only tested it without food therefore they are being overly cautious. Just a guess.
This is a very useful thread. I had exactly the same issue as you do. Had an ablation over two years ago, was put on 50 mg Flecainide 2x/day plus a beta blocker to moderate my high blood pressure. Everything was fine until about 6 months ago when I started having night time episodes that came at 1:30am. Odd. They were ectopic beats of different sorts, which sometimes morphed into Afib episodes which I handled by deep breathing and/or taking another 50mg dose of Flecainide. I consulted my EP and he suggested taking 100 mg at night (plus the 50mg in the morning). That took care of the problem, and he had no problem with the uneven dosage.
Hi motov I'm.on 50mg flec morning and night plus betablocker as well...I take mine at 5.30 am with the beta blocker.and then between 5pm.and 5.30pm for the second dose of flec...my ep told me if I start to get breakthrough episodes regularly then to up the dose to 100mg twice daily...thankfully so far this hasn't happened but maybe that could be a way forward for you ..obviously ask your doctor/ cardiologist first though before you take any higher doses...regards andy
You mentioned in an earlier post that you thought perhaps your Afib had something to do with your digestive system. I am of this belief also as the Vagus nerve does travel all the way to the digestive system.
I have very similar Vagal Afib to you and can switch it off with a vagal maneuver also. In bed I hold my breath, created pressure within and tense up from my sphincter all the way up to my head and I switch the Afib off. Sometimes for the rest of the night, sometimes for an hour and sometimes for only 10 minutes.
I only take 100mg of Flec on demand, always when I get exhausted at night in bed turning off the Afib constantly. I am happy doing this for the time being whilst I study this little monster within me.
Last night was interesting in that I was lying there after switching off the Afib and I thought of my digestive system (at 1am in the morning), my afib returned after 1 hour so I tried a Vagal maneuver where I did not hold my breath and I would not involve my upper body. All I did was tense up my sphincter and my stomach. It switched off the Afib, so I wonder if the pressure put on the Vagus Nerve around the stomach caused it.
If you are still able to turn your afib off as you mentioned previously can you try what I did? Would be interested if that works for other Vagal Afibbers.
interesting! I’ll definitely give that a go. My afib episodes have settled somewhat since I’ve switched to 50mg Flecainide in the morning and 100mg in the evening. The one thing that has definitely made a big difference to me has been taken 1000mg of vitamin C! It’s reduced the episodes for sure!
it’s just what me and my cardiologist agreed on, he said it didn’t make a massive difference either way, ie 100mg in the morning and 50 at night or 50 in the morning and a 100 in the evening. So far 150mg a day is working good for me with just a few mins of afib in the last month and finally some sleep, I’ll take that for now over the nightly episodes I was previously enduring! To answer your other question, yes, I had episodes in the day but like you probably three or four only in the last two years?
The last 3 or 4 nights have not been good. I usually lie down and fall asleep in 2 minutes, the last few nights I have been awake for hours. Last night I had zero afib for the first 2 hours of being awake, so I took a sleeping pill assuming I was not having an Afib night.
It was only this morning when I downloaded from my ecg recording device to discover that I had Afib for almost 3 hours straight! That is the longest afib period I have had ever.
Tonight I plan to take a preventative 100mg of Flecainide and take a sleeping pill if I don't sleep immediately.
I have an appointment with my cardiologist in 2 weeks time and I will mention your regime to see if it is something I should try.
I feel your pain! Unfortunately everyone is different and there doesn’t seem to be a fix or a one size magic bullet for all! My afib is definitely vagal in nature and came out of the blue! I accept it’s unlikely to ever go away completely but for now it’s 100% better than before. I’m not totally convinced it’s the reworked Flecainide regime but I swear by magnesium, vitamin C and vitamin D daily. The addition of vitamin C for me was a game changer, I’m convinced, my afib improved within just a few days and before I increased my Flecainide dose! Vitamin C is anti inflammatory and it’s use after heart surgery is well documented in reducing post surgery episodes of afib in heart patients.
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