Amlodipine and Flecainide

[Dulcimer]

I have been prescribed by GP to take Amlodipine for high blood pressure whilst taking Fleacainide for AF. I have read this can be dangerous, is this the case?

[jeanjeannie50]

Looking at the NICE guidelines for drug interactions I cannot see one for the drugs you mention.

Here's the link:

bnf.nice.org.uk/interactions/

[Dulcimer in reply to jeanjeannie50]

thank you!

[CDreamer]

Something to discuss with your cardiologist and/or pharmacist. It’s always a trade off when looking at risk of harm and balancing that against the benefits with a lot of these drugs and interactions.

Flecainide on it’s own is a toxic drug but a very effective one for many people. Amlodipine is a calcium channel blocker and theoretically could increase the affect of Flecainide so you need to be very careful you take them exactly as prescribed. Beta Blockers are more usually prescribed along side Flecainide.

Unfortunately there are no ‘safe’ drugs, they all have affects be it helpful or not and it really is a matter of taking them and see how you get on as no one is able to predict how you as an individual will tolerate them. It is important to be regularly monitored - regular blood tests and occasional ECG’s and report back to your doctor if you have any strange symptoms.

Just know that the timings of when you take these drugs can be a significant factor - Flecainide should always be taken on an empty stomach for example, I don’t think it matters for Amlodipine.

Amlodipine isn’t on the NICE list for interactions with Flecainide. bnf.nice.org.uk/interaction...

Priviso - above based purely on my own experience - no medical training so do go talk to your doctor about any concerns.

[2219overtimego in reply to CDreamer]

thanks for info Jan

[Hidden]

Hi,

Best query it with GP or Pharmacist. I had read on this forum over a year or so that Bisoprolol was prescribed for blood pressure control - my enquiries show this is not so. The Cardiologist prescribed it for me for Heart Rate control.

My surgery employs a Pharmacist who my GP passes me over to when I present her with too many challenging questions. So in my case I asked her about this ......... I take Ramipril and Felodopine ( BP control) AND Bisoprolol (HR control). When I queried it she said that the Bisoprolol has some properties which make it desirable to be taken alongside Ramipril so what happens is that the Bisoprolol when used with other drugs ( Ramipril) joins forces with the other drug to enhance the total effectiveness on BOTH BP and HR.

I cannot comment on your two drugs obviously but it would seem to me that these two drugs are working hand in hand together much as my two drugs are. So it is possible rather than be dangerous it is the opposite ..... most desirable.

As I said at the beginning consult GP or Pharmacist and ask them the question ..... " HOW DO THESE TWO DRUGS WORK TOGETHER PLEASE". Of the two I'd consult a Pharmacist.

John

[JOY2THEWORLD49 in reply to Hidden]

HI

my DR SAYS OF MY specialists choice both DILTIAZEM 120MG a.m and 2.5 BISOPROLOL PM. BOTH THE CCB and BB will regulate H/R and Rhythmn.

Bisoprolol on its own did not CONTROL.

Together they did control my BP as well.

Bisoprolol is ideal for those with AF.

cheri JOY 73 (NZ)

[Sylviep7 in reply to JOY2THEWORLD49]

I had awful side effects from Bisoprolol - it doesn't suit everyone.

[Speed]

I too am taking both Amlodipine and Flecainide and have had the dose of Amlodipine increased recently by my GP. I’m not aware of any issues but would like to follow up now the possibility has been raised. You said you read it somewhere. Where was this article and what was its providence - if I’m to talk to a pharmacist, I’d like to be able to refer to specific research?

Thx

[Dulcimer in reply to Speed]

I am going to contact my EP tomorrow and get professional advice, as my GP prescribed it and my pharmacist was happy to give it to me. I am being extra careful as I am due to have a knee replacement in 3 weeks time and don't want any complications. If he says I shouldn't take it I will let you know.

Regards Dulcimer

[Hidden in reply to Dulcimer]

Hi,

I had a right knee replacement carried out a few years ago and the only part of my party bag of drugs that changed was Warfarin ( my anticoagulant of choice). I was told to stop Warfarin for 6 days prior to surgery. No sweat. So long as you declare to knee surgeon and his anethetist what drugs you are on in advance.

Once knee was done and I was back in my room and conscious I was given two injections of Fragmin ( a bridging anticoagulant) then just resumed my normal Warfarin dose that evening at normal time.

One tip though, do persist with exercises after surgery, there are some pretty good videos on youTube regarding exercises, makes all the difference between success and otherwise. Most important that scar tissue doesn't form.

After my dressings were removed and I was cleared of any infection along the incision site I got a sports injury massage therapist to massage the area weekly, particularly the incision line. Must keep the area supple to cope with exercises. I was back driving my manual car in 8 weeks and back at work driving a bus in 11 weeks. Good luck.

John

[Dulcimer in reply to Hidden]

Thanks for all your advice, I am having the right knee replaced as well, hope it is as successful as yours!

[JOY2THEWORLD49 in reply to Dulcimer]

Hi

You need to have CONTROLLED H/R 100 or under. The Anaesthetist won't go ahead.

I had an op in early March and I was warned.

Lucky that in Dec 2021 a new but private specialist introduced a CCB Diltiazem 1/2 dose 180mg but too much and it was quickly reduced to 120mg am with reduced 2.5 Bisoprolol at night.

BINGO.

My H/R at 186 on Metroprolol was reduced down to 156 on Bisoprolol but introduced to add CCB am new it controlled.

But a CCB and BB needs to be separated.

I have remained @47 H/R night throughout.

cheri JOY. (73). NZ

now 123/72. and 77-88 H/R Day and 47 H/R Night

Diagnosed with Rapid now controlled Persistent H/R with AF. The latter heard a soft Systolic Heart Murmur.

[etheral]

Amlopidine is a dihydropyridine calcium channel blocker. According to drug information gleened from online Merck Manuel, combination with Flecinide increases the chances of Ventricular Arythmia. A beta blocker may be more appropriate. Please discuss this with your EP...Best,etheral

[Dulcimer in reply to etheral]

Thank you for your reply. I am going to contact my EP tomorrow and get help from the best source possible.

Kind Regards Dulcimer

[secondtry in reply to Dulcimer]

Good move!!

[TheProf]

Amlodipine had a lot of side effects for me - Mostly swollen legs, ankles and feet - I couldn't get my shoes on - I was changed to irbesartan - Problems gone. I take Flec and there is no problem with taking it with irbesartan - I would avoid amlodipine myself - but everyone is different ( there is a a drug called amiodorone which is similar to flec but not good for the thyroid)

[DKBX]

For several years now, I’m on amlodipine, flecainide, and metoprolol wo ill effect … so far.

[Bagrat]

Just looked them up on drugs.com and no interaction noted. This site usually more detailed than the BNF( British National Formulary) and highlighted interaction possible with flecainide and tamoxifen which pharmacist did not find ( it was very technical!) But nothing mentioned for your two

[dmack4646]

We are all different but I was put on Amlopodine along with Flec ( been on for 12 years) and immediately started collapsing - had to discontinue

[Singwell]

if you are on a calcium channel blocker together with the Flecainide it ought to help counteract the tendency for Flecainide to mape the heart race a bit. Quite commonly a beta blocker is used for this purpose but other drugs may also be used. I too am on a calcium channel blocker- called Diltiazem- this helps control the heart rate by acting as an AV node blocker. It also helps my BP, which tends to be high. Look up your Amlopidne on the NICE site and see if that is correct i.e. it helps with Rate Control, whereas Flecainide helps with rhythm control.

[Singwell]

just done a bit of digging. The Amlopidine is a vasodilator, so that helps with your BP. It looks like it also assists with rate control 'What is the mechanism of action of amlodipine?

Mechanism of Action

Amlodipine is a dihydropyridine calcium antagonist (calcium ion antagonist or slow-channel blocker) that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle.' BobD might explain more about that bit, which is rather mechanical.

[ozziebob]

I don't have experience of either drug yet, but I see others have shared very valuable information with you.

I just want to mention a website which was previously given on the Forum for drug side effects and interactions viz.

drugs.com/

There is mention of a minor food related issue with one of these drugs.

Bob

[Dulcimer in reply to ozziebob]

Thanks for everyone's advice, I am hoping to get a reply from a cardiologist at my local Heart Rhythm Clinic. Most of them are still on holiday but I'm keeping my fingers crossed!

[Morzine]

I think they are safe as I was prescribed the two together but just a word about amlopodine, it’s well known in some folk to cause feet and ankle swelling, I was that person, it was quite apparent and my lower legs too….so

You may be fine but keep an eye we are all affected differently eh, this was just my experience

Sue

[Speed]

The reply from my specialist cardiology nurse (first point of contact for advice / query to consultant), is that Amlodipine can interact with Flecainide resulting in an elongated QRT (I thought she said QRT but can find no reference to this on the interweb and maybe should be QRS) complex but as I’m taking a low dose (50mg twice daily of Flecainide), it should not be a concern. Further, my cardiologist should be reviewing this complex from the ECG on each consultation and so would pick up.I will mention the Amlodipine on my next review to make sure he is aware but intend to carry on as is in the meantime.

[Dulcimer in reply to Speed]

I had a message from my EP cardiologist to say that increasing my bisoprolol to 2.5mg was better than taking Amlodipine, but if that didn’t lower my BP enough I could take the Amlodipine. I have done that for 7 days now and my BP is down to 144/70. I am very pleased. Thanks everyone for your replies.

[Speed in reply to Dulcimer]

A good result - always worth that call to the consultant if unsure and adds to our knowledge bank here for this group. Unfortunately, I find Beta Blockers (Bisoprolol) severely depress by heart rate whilst exercising and to such an extent that I really struggle to enjoy running or cycling. As not only are these a big part of my QOL, but they are also big long term health benefit, on balance, my agreed and preferred option is to continue to take the Amlodipine instead of a switch to Bisoprolol. With keeping a close eye on any impact on my QRS, I hope this proves to be the best compromise for me. We are all slightly different but the more informed we are, the more relevant our conversations with our consultants are and the more likely we get treatment tailored to our needs / desires.

I have found this forum excellent at bringing relevant matters to my attention and have just recommended this site to a colleague with different issues so she can find a relevant group.

A big thanks to all those that contribute. Keep posting team…