Flecainide & eating timing

[MTBCyclist]

Hi All

I'm taking 100mg Flecainide twice a day and 1.25mg Bisoprolol once a day.

I have had 6months relatively AF free since starting this dosage 6 months ago, now have daily battles with AF/ low uneven rhythm as the Flec wears off and between meals.

Trying to stick with empty stomach guidelines (2 hours after food and not eating for 1 hour after).

The routine was 6.30 am /6 pm, but often had night time episodes so have switched to 7.30 am/ 8pm with an early evening meal before 6, same situation but better during the night.

Questions

Has anyone experienced a similar situation, and what did you do to get more stable?

What is the general consensus regarding taking Flec on an empty stomach?

Thanks for reading.

[CDreamer]

Hi - I’d just like to check out your expectations of Flecainide? Are you expecting your meds to prevent AF? It may do for some indefinitely but for many AF breakthroughs indicate progressive tendency towards persistent AF so maybe time for a treatment review if you are pursuing NSR?

My experience, which admittedly was a long time ago, was that if I had breakthrough episodes I took another 100mg as soon as the episode started, with direction of GP/EP. I sent frequent ECGs for monitoring purposes. That kept me stable for a while. Then my dose increased to 150mg x 2 daily so unless the episode was severe - which often was in which case - after 72hours it was a hospital visit. I found Flecainide worked to prevent AF for about 12 months. Then break through episodes became far too frequent so I was recommended Sotolol - refused so told nothing more they could do at which point I took a second (private) consult with an EP and went for ablation.

I’m sure you will get responses which will report Flec has worked for many years but a consensus opinion will not be a predictor of how you will react.

[MTBCyclist in reply to CDreamer]

Many thanks for the info. Yes I think it’s progressing to persistent AF which is why I am having breakthroughs. I am going to sort an appointment with my EP to discuss, meds and ablation. How was your ablation?

[CDreamer in reply to MTBCyclist]

Long story but I had other conditions to cope with which complicated matters but 1st made things a lot worse and second gave me 3 years free of AF. The ablation itself was easy but recovery varies. Some recover really quickly whilst others find it can take weeks/months. I would say it was 9 months before my resting HR was anything like back to normal but I couldn’t really say if that was just the ablation or coping with other stuff.

Pleased to say that I no longer have regular AF episodes, still a wobble if I have an infection but mine is now controlled by pacemaker - magic bullet for me.

[wilsond]

Hi I had same situation,esp night time episodes.

I wasnt given info on taking on empty stomach and was having lot of breakthroughs. Spoke to EP and was told,try 9am and 9pm. He.said absorption of the drug can be reduced by 3/4 by food!

Worked very well but eventually with having flutter and fib episodes broke through despite new regime over several years . Worth trying the timings above,but don't change dosage of course.

I had an ablation 15 weeks ago all good so far,another option xx

[MTBCyclist in reply to wilsond]

Thanks,how was you ablation?

[wilsond in reply to MTBCyclist]

Hi I did a detailed post if you search on my profile here. All mostly good except one section where I had to get more pain relief. Hope it helps x

[paulalex1313]

Hi, I have been taking Flecainide for 30 years, since my first symptoms of AF started. There was never an issue with conflict with food. I have always taken my 100mg doses after breakfast and before bed.

I was advised to take an additional 100mg Flecainide tablet at the onset of an attack, but no more than three tabs overall in one day.

I also have had two episodes when my heart rate went sky high, in one case to 220bpm. These episodes abated after arriving in A& E without further treatment, other than a single dose of Metoprolol.

Have you worked out if there are particular triggers for your AF episodes? We think mine was caffeinated coffee, on which I overdosed when I started my own business and was working from around 7.30am and midnight every day. I have only drunk decaf for the past 30 years.

I have had three ablation procedures and since 2016 I have been symptom free, but still take my two doses of 100mg Flecainide every day and I still carry one Flaecainide tab and one Metoprolol in my pocket, just in case. Thankfully, I have not had to use them.

I suggest you consult your consultant regarding dosages and their proximity to food. It is also worth asking if you are a suitable candidate for ablation.

Good luck!

[MTBCyclist in reply to paulalex1313]

Many thanks, yes Ian ablation was suggested so will be discussing that with my EP.

I am still working on triggers, have gone decaf since diagnosis, bread,sugar,hot drinks seem triggers especially as the Flec wears off.

[Drounding]

I've been taking Flecainide for quite a few years now, initially as pip, then as 50mg am/pm and now 100mg am/pm. The lastest dosage has been working well for at least three/four years now with very few AF episodes, and then they only last for an hour or so. I also take 5mg Bisoprolol am.

I take the Flecainide at 5h30 am (yes I'm early riser - out walking the dog before 6am) and the pm dose at about 9h30 pm. Most of my episodes ocurred at night and were linked to gerd and a hiatus hernia, so laying down can cause reflux.

I take a variety of other medications, including 30mg Lasoprozol am and pm which makes a significant diffence to the reflux and AF frequency.

Regarding taking Flecainide on an empty stomach, it's never really been something I've ever thought about, but I take mine before breakfast and sometime after evening meal anyway.

I've never needed to take any additional dose of Flecainide since being on 100mg but when I have the odd episode then I may take the next dose early of Flecainide and Bisoprolol depending on how long it's been since the previous dose.

Others probably know better than me but I think in some circumstances Flecainide can itself cause Atrial flutter, which i think is why the Bisoprolol is prescibed with it, at least for me. I can feel the difference between AFib and A Flutter, and my Kardia has confirmed it occasionally.

Touch wood I remain stable as is. Flecainide has changed my life for the better.

[wilsond in reply to Drounding]

That is true about flecanide on its own causing flutter ,happened to me,even though I was prescribed it as an in patient! Took just a week to arise. Huh!

[MTBCyclist in reply to wilsond]

Yes I am sure most unusual rhythms are flutter rather than AFib , they last a few seconds or minutes and often start with below 40bpm then go up to 110.

[wilsond in reply to MTBCyclist]

Yup ,same numbers as mine were x

[MTBCyclist in reply to Drounding]

Thanks, good to hear it’s working well for you.

[secondtry]

I have taken 100mgs Flec 6am & 100mgs 4pm for 8+ years with virtually no AF. I leave at least 3 hrs after my main meal of the day (lunch 12.30pm)and always wait an hour before an early 5pm light evening meal. Maybe worth a try.

I attribute my stability in part to many lifestyle changes. This approach is a journey rather than reaching a specific destination; having a lifelong sweet tooth I am currently 4 days into a no sugar trial!!

[MTBCyclist in reply to secondtry]

Thanks, yes I have been doing lots of lifestyle changes, cutting sugar was easy, cutting things with sugar in other than fruit is not so easy,

Hope it works well for you.

[Caradomben]

I been on the same dose as you for the past 2 years and only had 1 episode since. I take my Flecainide and bisoprolol just after breakfast and at night with a light snack . Take them around 9 am and again at 9pm . Seems to be working for me. Hope you get your regime sorted ..

[MTBCyclist in reply to Caradomben]

Many thanks, glad it’s working well for you.

[SuziElley]

I take 50mg Flecainide twice daily and no side effects. It’s controlling the rhythm nicely. I take the morning dose when I wake and have breakfast at least an hour later. The evening one I don’t take until I go to bed, so some time after eating my last meal of the day.

[MTBCyclist in reply to SuziElley]

Thanks glad it’s working well for you.

[Elsie1955]

According to the materials I've read, Flec can be taken with or without food. IDK about the other medication you're taking.

[MTBCyclist in reply to Elsie1955]

Many thanks

[Afibflipper]

I have similar issues - not when the heart is behaving but during its chest dancing I know when I’m due the next dose soon.

I’ve read it should not be taken with milk as can inhibit it’s absorption. I try when possible to take an hour or so before food (but that doesn’t always get remember so in that case I’ll try to leave at least a couple of hours before dose but when I’m having issues with palpitations they usually settle an hour or so after the dose whichever (I just try to avoid milk)

[Tapanac]

I've never been told about eating and flecainide. I take mine at 8.30 in the morning and 8.30 at night. We usually eat dinner about 7, but I have often taken it with food if we are with friends and couldn't stick to my usual routine.

[Cos56]

hi

Flecainide on an empty stomach? I take my cocktail of Flecainide, Eliquis and metoprolol with at least a bite of something in my stomach.I I didn’t know I shouldn’t.😳

[CDreamer]

Because I was warned by a consultant at AFA Patient’s Day Conference back in 2013 that it can cause life threatening arrythmias in some people and that particular consultant campaigned to have it removed as a recommended treatment for AF. That person had had very poor patient experiences with that drug.

This is the latest advice from our equal to the FDA - NICE - should only be prescribed by secondary care ie: specialist although Primary Care may be asked to monitor and continue prescriptions.

cks.nice.org.uk/topics/atri...