I’ve been pretty lucky that I only get AF every one or two months, I take 300mg Flec as a pip and this normally puts me back in NSR within 45 mins. It says on my tablet box to take 300mg as required but not to repeat in 48hrs. Up until today that hasn’t been a problem, but I’ve had this evil cough/flu thats doing the rounds. During this my heart beat was banging about but avoided AF until just after midnight yesterday - I took my PIP and it reverted as normal - I got to see a nurse at my Docs surgery yesterday who prescribed Doxycylone which seems to be getting on top of my chest infection. I expressed my concern that I might get another AF episode before the antibiotics fully work, I explained that the max daily dose of Flec is 400mg I couldn’t understand why I shouldnt be able to take it every 24 hours. Does anyone else have a 48hr restriction on their Flec Pip and do you know why? As you might have guessed I have just started another AF episode - I’m waiting on hold with 111 at the moment - my other option is go to A and E but by the Time I get there and get seen I’ll be able to my PIP anyway! Why does this always happen on a holiday weekend 😳
Dan
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I was always told that the maxmum in any 24 hours was 300mg. This is the poison level! No idea where you got 400mg from but it is not right. ! If you took the flec at 2 pm today you can't take any more till 2 pm tomorrow. Simples.
The NICE website says 400mg - admittedly for ventricular arythmias, but like you its the toxicity levels that interests me! - but thats not really the key issue . My problem is that my last episode was about 43 hours ago, my Flecinaide packet says dont repeat within 48 hours. My call to 111 suggested I went to A and E. so not really a great help, esp I’m not a medical emergency and am unlikely to be seen before midnight when i can take my pip. I don’t understand why I can’t take 300mg again after 24 hours. I was wonder if there is a know reason?
So here comes my last disclaimer of 2022. I'm not a doctor so the following is only advice to discuss with your medic and not intended as medical advice.
There are a few questions I would ask.
1 - Would I be better to take just 100 mg at the start of afib. Take another 100 mg 20 minutes later and the final 100 mg another 20 minutes later if the first 200 mg hasn't 'kicked in'. It's spead over an hour this way.
2 - Is it possible taking 300 mg in one go could lead to flutter? (it could IMO). If so would it be an idea to take a small amount of a beta blocker to reduce the risk of this? Say 1.5 mg of Bisoprolol when you take the flec.
3 - Flec has a fairly long half life. This could be why you have been told to wait 48 hours if you're on 400 mg. As far as I'm aware 300 mg is the MAX you should take daily. However I can't second guess your EP or cardio. Take to much and flutter maybe coming your way my friend in 2023. It's no big deal and can be dealt with - best avoided though.
One more thing - always take a flec PIP on an empty stomach. If you feel an attack is likely (I could always tell) don't eat anything before you take it. Far more effective.
Many thanks - I’m due a check up and they are some good questions, but I’ve had PAF for about 12 years and seen 3 consultants the last was an EP. None have questioned my dose (300mg as pip) - note I am 6’4 and nearly 14 stone , I am on 3.75 bisoprolol daily and have about 12 episodes a year, I was recommended to go on a daily dose of flec when i had a spell of episodes a few days apart but on my suggestion we agreed to wait a couple more weeks, which we did and I didn’t have another for 2-3 months but anyway that doesn’t change my dilemma or why the Nice guidance says a max daily dose of 400mg in 24 hours when my drug packet says 48. Here I am 45 hours into my 48 period with probably zero flecainide in my system. Surely the idea is keep the dose in your system below 300mg at any time
Im pretty sure my recent episodes have been triggered by this flu/cough thing doing the rounds and don’t require a daily dose yet. However 111 automatically assumes I’m an emergency and wants me to go to A and E which will take 3 hours to get there and be seen, by which time I can take my tablet.
>>>>>Im pretty sure my recent episodes have been triggered by this flu/cough thing doing the rounds and don’t require a daily dose yet<<<<<
Any infection can kick start afib. It could be a stomach bug or a gum infection. I wonder if your flu/cough infection is causing this. Maybe this should be your first port of call to see if it solves the problem. You'll find a chemist will be open tomorrow even though it's New Year's day. Perhaps it's worth calling them to explain the situation and see what they say.
I understand that Bob, but the point I was trying to make (probably badly) was that 300mg a day is ok so why do I need to wait 48 hrs to take a 300mg PIP (it’s not mentioned anyware on the official Flecainide docs - anyway we’re now at 47 hours and I’ve taken a dose - no call back from 111 Doctor and I wasn’t going to go and sit in an NHS waiting room risking picking up covid and giving everyone else my bugs! -
Does anyone on here take a 300mg pip for PAF and does their flec tablet box say anything similar?
I used to and always with EP strict instructions - no more than 300mg in 24 hours. Your doctor is obviously being cautious in stipulating 48 hours. My AF responded to Flec within 3 hours - when it stopped responding then I stopped using it as the increased risk of toxicity v benefit unnerved me.
My point would be if the Flec has not stopped the AF then any further dose is unlikely to either but the potential to make things more complicated will rise ie: risk:benefit.
The reason - because of it’s toxicity it has potential to not only stop arrythmias but cause them and unless you are in a clinical setting where you can be constantly monitored and treated you would be risking undesirable affects.
When similar happened to me I would email my ECG from my Kardia over and my EP would advise. On one occasion only did they suggest it was ok to take a further 100mg about 20 hours after the full PIP dose of 300mg = 400 mg in 24 hours - but only after ECG.
This is not a drug to mess around with so do take care.
You don't have to wait 48 hours if you only take 300. You wait 24 hours. I've never seen this 48 hour thing on my Flecainide box. Not on any of the brands. Is it something the pharmacist has printed up? I'd be questioning it if so.
look up the half life. If it’s 24 hours you theoretically have half the dose in your system at a full day later (24 hours).. taking another full dose after 24 hours could put you past the safe levels. Maybe this is why they directed you not to take another for 48 hours. I took flecainide as a PIP for several years. Worst side effects of any drug I’ve ever taken
I'm going to tell you what my GP and EP told me. 300mg max within 24 hours. Possibly there's a difference for age and BMI. Check the NICE guidelines on this. It'll be what your GP does. It's not safe to take high doses unsupervised so please do take care
Hi Folks, thanks for all your input, I finally got a phone call from Devon Doctors at 7.30 this morning. After about a 20 minute consultation he promised to call me back after speaking to Cardiology registrar on call at the RD and E. This was because I’m concerned that my heart may slip back into AF as is still jumping about a bit despite 300mg of Flec last night.
The hospital agrees that is probably my flu/chest infection causing the issue, and has suggested increasing my Bisoprolol to 4mg (after I have my BP checked this morning) and said I should keep super hydrated and relaxed.
They say do NOT take a 300mg PIP less than 48 hrs after the last one, (To be honest I dont think I’d want to, although I’m a child of the 70’s the visual disturbances were weird.
If I do go into AF they say to come straight in to the RDand E where they have details of these discussions. So while it took some time I have at least got a short term answer. Ill book a review with my EP next week.
Thanks again, its good to know fellow AFibbers care!
With the caveat that we are not medically qualified on this forum I can offer you my experience, but you must bear in mind that we are all different.
I have been taking Flecainide regularly at 100mg x 2 for a very long time. All the same AF managed to get through from time to time
Obviously with a daily dose PIP was much more difficult to manage and I had to look at the last time I took my daily dose if I were to use more Flecainide as a PIP.
When I was first told to take 300mg PIP like you suggest I used to feel quite awful for about 24 hours although I found it normally worked.
I had to change EPs due to retirement and then was told by the new man not to take more than 200mg as PIP he said that more was dangerous. The lower dose still worked
Since then I have adhered strictly to max 300mg in any 24 hour period only really taking an extra 200mg at one time due to my regular dose.
If this didn’t work, which was rare I would not repeat the PIP in the second 24 hours as I was told to go to A & E. I had a note on my file at the hospital to recognise my diagnosis and they would give me a cardioversion as long as my INR was within limits 2-3 as cardioversion is not carried out without effective anticoagulation.
Cardioversion always got me back into NSR what a wonderful feeling every time.
Mind you that was all “BC” (before Covid) not sure it would be so easy at the hospital now with the NHS under such pressure.
hi Pete. Read your experience with flecainide with interest. I’m also on 100mg x 2 a day. It was increased from 50mg x2 when I last went to A&E 2 years ago because the frequency of my episodes had increased. During the time since I’ve had occasion to still take a PIP of 100mg on top which took me to my max 300mg in 24hrs. The extra 100 seems to do the trick fairly quickly but I’m wondering what will happen when even that is not enough to get me back to NSR. Do I sit it out till I can take another 100 or go to A&E ? As your previous contributors have said., I too was advised not to exceed 300mg in any 24 hours
I have had decades of this issue. Trouble is we are all different. I too have taken extra Flecainide to return to NSR and in the main it has worked.
However as I have had 7 ablations and I am well known at the hospital I have been told that if I cannot get my rhythm back with Flecainide to go to hospital for a cardioversion. The caveat is that I am pleased to say that since my last ablation 5 years ago I have not had a problem and with Covid and the NHS situation I am not sure how welcome I would now be. I have a direct line the arrhythmia nurses and what I would do is contact them first if heaven forbid it does happen again.
Not a lot of help I know as we are all so different but best thing to do is to discuss this subject the next time you speak to your EP. If you do not have an appointment planned a letter by snail mail works for me with my EP and he always responds.
Hi. I take 150mg at start of AF and 150mg. 90 minutes later. Normally revert within 4 hours but my heart rate is normally still 80-90 for about 8 hours following return to sinus My normal is 55. I am 78 yrs old and have been with AF for about 4 years.My Cardiologist suffers with PAF so I get good first hand from an experienced sufferer He always has said take the required doses to suit you as we r all different but never exceed 300mg in 24hr. Also works more effectively on an empty stomach and you need plenty of water to stay hydrated Hope it helps
After going back into Sinus how did you confirm AF was back… via Kardia or Apple or was it just the heart pounding and jumping around. I remember Bob telling me to relax and breath…… it ended up being anxiety and palpitations thinking I was back into AF when it was me working my self up worrying.
I can also add my experience. In the past have taken 300mg Flecainide daily over 3 days on EP advice and it did eventually cardiovert me. The EP was very precise- I had to take it as 100mg 3xdaily - so every 8 hours. A month later AF came back and I repeated the higher dose again for 3 days. Anyway long story but in a nutshell 5 yrs later I am still here!
To put it in context I was waiting for my second ablation and had gone into persistent AF (again). I am 5'1", 8 stone and at the time was 65. So a 6'4" guy weighing 14 stone like you should be ok. But I don't know how my heart or test results compare to yours obviously.
I felt pretty odd though. Very fatigued and tired. I still take Flecainide 100 x2 a day but AF is hopefully under control.
Ideally, this is a question for your doctor who knows your medical history. But if but if you're allowed 400mg in 48 hours, then you still have another 100mg you could take. No one size fits all with Flecainide. Some can take 300mg a day, some 400mg, some none. In my case, I'm only allowed 200mg in 24 hours.
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