Can medication be reduced after a certain time with no problems?

[tunybgur]

In 2012 I had a heart attack which resulted in the insertion of a stent, fortunately prompt treatment meant there was no major damage to my heart, although I started getting AF attacks in 2016.

In 2017 I started taking 100mg of Flecainide and this was successful in stopping my AF attacks.

In 2020 I started getting the odd AF attack which became more frequent. My Flec was increased to 150mg and since then I have been completely AF free.

I take Flecainide, Bisoprolol, Amlodipine, Ramipril, Atorvastatin and Warfarin!!!!

It would be nice to try and wean myself off or reduce as many meds as I can, especially the more powerful ones if I no longer need them.

I stopped taking Ramipril for six months and found it had no effect on my BP, I understand it is less effective in the over 50's, I'm 75.

I have reduced Bisoprolol as my resting heart rate is only 42, nothing seemed to change much so do I need it? It was originally introduced to treat the odd tachycardia attack, I haven't had one of those for 9 years.

I would like to try reducing Flecainde back to 100mg, the theory being that AF is now a distant heart memory so perhaps sinus rhythm has become entrenched and AF will not return.

I will continue with the Statins as I have no side effects and I believe the long term benefits can be significant.

Has anybody discussed reducing meds with their cardiologists, especially Flec, and what is their experience? I ask because we only seem to hear about increases in medication, we don't keep taking aspirin once the headache has gone, I know it's a different scale, but does our heart get better and heal up so we no longer need medication?

[BobD Volunteer]

Sadly AF seldom just gets better and all treatament is for quality of life (QOL) .

Sorry to say but I am surprised that you are not taking aspirin as well since you have a stent. It is common for warfarin and aspirin to be prescribed together in such circumstances. Warfain is an anticoagulant to help prevent stroke whilst aspirin is an antiplatelet to stop the platelets clustering together on the foreign body (stent) you have fitted.

Pesonally I would not stop taking any drugs without clear indication to do so by your cardiologist.

[tunybgur in reply to BobD]

Yes, the problem is once prescribed it seems these meds are on continual renewal, my question is 'do we need to take them all for the forseeable future after we have stabilised for a number of years?'

[Ewloe]

I’m on ramipril after heart attack. It wasn’t started for blood pressure as mine very normal but I was told by rehab it’s for the damaged heart muscle after the heart attack. That it helps keep the muscle from getting any more stiff hence helping ejection fraction. I was told it’s life long as if you stop it the muscle is more likely to become stiff.

[tunybgur in reply to Ewloe]

That's interesting, didn't know that, I'll do some research.

I stopped Ramipril at the beginning of covid because it was supposed to increase the risk of severe infection.....laterly disproved, and found it made no difference to my BP.

Thanks

[CDreamer]

I stopped both Bisoprolol and Flecainide very suddenly without tapering down because I had to, I remained in NSR. However, I wouldn’t recommend just stopping either suddenly, it wasn’t pretty coming off the Biso and had a big affect on my moods and anxiety but it seems to affect women more than men.

Ask for a medication review and then talk and if need be negotiate with your doctor before doing anything by yourself, ask for reasoning behind continuing meds at current dosage. You may be surprised at some of the answers you receive.

I on the other hand have just asked my GP to write to my specialist about reducing my medication for another condition, when GP and I both agree it might not be in my best interests. There does seem to be a push to reduce medications, if at all possible. There was a consultant pharmacist present at my consult.

[tunybgur in reply to CDreamer]

Thanks for your reply, and in a perfect world this would be the right approach. Unfortunately my GP (if I can ever get a face to face rather than a telephone appointment) is not a consultant cardiologist and getting an appointment just to discuss medication when there are no other problems is very difficult, and the advice from my GP is always the same, just keep on with what you're doing, we're very busy here!

I feel that I need to create some ficticious problem to get an appointment, which of course I won't do.

[CDreamer in reply to tunybgur]

Do you have an annual MOT? That would be the time to request a medication review.

GP being busy is not an acceptable excuse for not discussing medication review. Is that your GP saying that to you directly or a receptionist?

My view is that a face to face appointment is not required, I’ve not had a face to face with my GP since we moved here in May but my husband and I have had really good telephone conversations. Most GPs are telephone triaging and only seeing patients face to face if your condition requires a physical exam, I know a lot of people don’t like that but I’m in favour.

[CDreamer in reply to tunybgur]

Just a thought, could you put your query in writing? That has 2 advantages - there is a clear record of your request and when in writing your request can’t be ignored.

[tunybgur in reply to CDreamer]

I don't have an annual checkup, the only communication I have is an occasional request for a BP reading which I supply but never get any feedback.

[secondtry]

A very good question. It is a real dilemma, when no episodes you quite naturally consider reducing medication and your cardiologist no doubt will say the opposite (well mine did), the medication is working don't change anything.

Aside from two very brief episodes, I have had no AF for over 8 years (diagnosed Lone PAF) and frequently think of reducing my medication of 200mgs Flecainide. I know my cardiologist, who I see annually before Covid, biennially now, will not risk his reputation by agreeing in case something goes wrong. Also there is a deafening silence on this Forum on successful reductions of this drug, so if I do, I have to act unilaterally. I then think about my excellent QOL and annual ECG/blood tests which show no side effects to date and think maybe I will leave it another year....coward I know 😂.

If I ever do start reducing, I will do so very slowly, especially the first 100mgs, say over a year 25mgs at a time using a pill cutter. Medics here have reportedly said going cold turkey is fine but that doesn't make sense to my cautious approach.

Do let us know your decision and if you do reduce what your experience was.

[tunybgur in reply to secondtry]

I also have a pill cutter, and have reduced my beta blocker a little at a time with no adverse reactions!

Like you, I'm thinking of doing the same with Flecainide.

You are very fortunate having a regular appointment with your cardiologist, I was signed off and no follow ups have been planned, I have to phone my GP just to get my cholesterol checked every few years.

This is one of the biggest failings of the NHS, regular health checks which can spot problems early are not the norm although everybody agrees they are very important, the resources are just not there.

[secondtry in reply to tunybgur]

My regular cardiologist appointment is a private one! I have to push for the annual GP surgery bloods/ECG but so far have got them.

[tunybgur in reply to secondtry]

Yes, the NHS requires a pro-active approach, but it shouldn't be that way.

[CDreamer in reply to tunybgur]

Maybe I’ve been lucky but I’ve always enjoyed regular, pro-active approaches from both of the GP surgeries I’ve been registered with - often have to wait to speak to a GP on routine matters though.

At the moment I am 6 months and waiting for a hand over to Sussex Cardiology from Devon and neither my husband nor I still do not have a named cardiologist and what’s more cannot even get a private appointment with a local cardiologist. On-going, consistent cardiology care does seem to becoming problematic.

[Raewynne]

You seem to be taking quite a few.I wonder if any are for the same problem. I Wouldn't go changing before talking to your specialist. If you're not happy see another Dr.When you've been on some meds for a while it can be dangerous to reduce suddenly.

[tunybgur in reply to Raewynne]

Agreed, getting an appointment is the problem.

[Raewynne in reply to tunybgur]

I see.I saw what someone said about not taking aspirin and wayfaring.I would be querying that too.

[tunybgur in reply to Raewynne]

Yes, I also thought that combination was no longer used, aspirin can cause bleeding in the stomach and of course warfarin will exacerbate the problem.

[Raewynne in reply to tunybgur]

Yes.Maybe check in with your chemist about that if it's impossible to see Dr.

[wilsond]

I am on flecanide,100mg x 2 bisoprolol1.25mg x1 ,apixaban ,losartan 50mg x1atorvastatin 25mg x1 and furesomide40 x1I was quite stable for a few years and it was being discussed about taking flec and biso as a pill in pocket .Then AF and Aflutter started to get the upper hand,out of the blue,so continued.

After what seems a successful ablation,almost 6 months nsr,I was advised by an.idiot GP to stop flec and biso so that my back pain could be releived by NSAIDs.

Within 2 days AF episode!

Back on,and will take consultants advice at review soon.

I assume I shall remain on these ,perhaps slightly lower flec to maintain status quo.

If it ain't broke don't fix it!

[tunybgur in reply to wilsond]

Sounds like between us we're keeping big pharma going!

[JOY2THEWORLD49]

Hi

You shouldn't be taking aspirin and warfarin.

When you are upgrading you will be offered a modern anti-co.agulant such as PRADAXA, RIV..., A....

I read that statins are not given at 75 and over. What is your cholesterol level with good fat.

I would talk to your Dr or better still a Cardiac Specialist about lowering other meds.

cheri JOY 73. (NZ)

[tunybgur in reply to JOY2THEWORLD49]

Hi Joy,

About 5 years ago I was advised to go on a modern anti coagulent at one of my INR checks and a note was sent to my GP, nothing ever happened....too busy I guess.

Lack of consultation is my underlying issue....not for want of trying though!

[CDreamer in reply to tunybgur]

Ever thought about changing your GP? It sounds as though you need to.

[tunybgur in reply to CDreamer]

Yes, but it's difficult to get a new GP because demand in this area is so high, one of my biggest gripes is trying to get past the receptionists.

When they question what I want to see the doctor about I ask them if they are qualified to discuss medical matters and they just say they are required to triage all patients.

Some years ago I had chest pains but they said there were no slots available and I should either go to A&E if it gets worse or try back later.....I think that was unacceptable....but what can you do?

[ozziebob in reply to tunybgur]

Yes, lack of consultation ... I know it well. And "informed consent" seems to have been lost as well. I realise this is the experience of some, not all.

[JOY2THEWORLD49 in reply to tunybgur]

Hi

I agree Drs tend to leave you on the med and put it up rather than discuss a change.

Warfarin needs checking monthly - is that done?

Whereas the new is checked early and then a check 6-12 monthly only. Science moves on.

I changed my Dr when he suggested Istop Metroprolol cold turkey but a discussion with chemist was aghast. She said a change would be better.

When I went back (My doctor was away 5 mths) he said "Justas well because another patient stopped and ended up in hospital. Only 1 year from stroke with AF.

I back ManagingMyOwnHealth.

Cheers JOY

[tunybgur in reply to JOY2THEWORLD49]

My cholesterol was last checked in 2020 and total was 4.5 mmol/l, it has slowly been creeping up over the years.

After my HA I started statins and the consultant said he was happy as long as it was kept comfortably under 4.

[JOY2THEWORLD49 in reply to tunybgur]

Hi

Excellent @ 4.5 but you can deduct the good fat total from it.

Scientifically my Medical Journal says one cannot measure cholesterol. Woman are higher than men and we need it in our diets.

So confusing. I can have a low-fat more so for a week prior to blood test and have a good reading. That suggests that

1. You do not need statins but a Heart Tick diet of healthy foods.

2. Your level will change day by day

No build up in my carotid arteries so I'm not convinced of treating a 4 plus to 7 reading.

cheri JOY

By the way Drs get paid for subscribing statins to patients. If also interacts with thyroxin tabs for Ca Cancer. Research now says keep low 10-20mg only.

[CDreamer in reply to JOY2THEWORLD49]

Joy you are wrong - although asprin is not recommended for Lone AF but for people with stents the UK recommendation is both anticoagulation + antiplatelet therapy.

nice.org.uk/guidance/ng185/...

[JOY2THEWORLD49 in reply to CDreamer]

Hi

Not into stents, I had no idea except research recommends the 1/2 aspirin a day be stopped because of stomach bleeding.

Thanx CDreamer.

cheri JOY

[Silvasava]

Joy2 - statins are still given at 75 and over, I'm still on mine at 76 and I know many others on here older. I have reduced my dosage only because before my stroke my cholesterol level wasn't an issue however statins also provide other benefits to heart patients apart from lowering cholesterol.