Switching from 100mg Flecainide twice daily, to Pill in the Pocket. Has anyone done this?

[Budken]

A few months ago, my Cardiologist here in Leipzig, suggested I reduce my dose of flecainide, due to a slow HR. I did so, and had no ill effects. My heart rate is now in the low seventies, it was only in the low fifties. Today I saw him again, and he suggested that I try using the Pill in the Pocket, as I have had not episodes of Afib in four years. He said he did not think it necessary to keep taking it daily, and suggested that I simply take two 100mg pills, if I have an episode. He said it was not necessary to wean off of it, but to simply stop. I mentioned that I was afraid to do that, because four years ago my Cardiologist had me stop taking Metoprolol. He thought it was causing my occasional episodes. When I did so, it was a roller coaster ride! I was having episodes of Tachycardia, and it terrified me. He said that the Flecainide was different. He said that Beta Blockers affect your adrenaline levels. He said the racing heart, was because when I stopped, my body thought something was wrong, and started producing extra adrenaline. I am going to follow his advice, but I would like to hear from anyone else who has switched to PIP method, after taking Flecainide for an extended period. ( eleven years ).

[meadfoot]

I switched from daily flecainide 2 x 100mg per day to Pill in the Pocket as instructed by my cardiologist who I trust implicitly. I had no issues whatsoever with the change. That was five plus years ago and I only take flecainide if I have a Afib or SVT event.

Its scary changing medication regimes but in my personal experience of flecainide it was absolutely fine. Best wishes hope all goes well for you.

[mjames1 in reply to meadfoot]

Just wanted to amend my previous reply a little. If you're planning on having an ablation in the near future, keep in the keep in mind that the more controlled your afib is, the better your results will probably be. At least according to an ep that I just got off the phone with. That doesn't mean you shouldn't do PIP, but if you start getting more frequent episodes, something to consider.

In my case, since I plan on having an afib ablation in the near future, I've decided not to stop the flecainide entirely. If the 25mg, twice a day, doesn't hold me in NSR, then I'll go back to 50mg and hopefully arrive for my ablation nice and stable like the ep wants.

Jim

[saulger in reply to mjames1]

Jim, Japan calling !

[Budken in reply to mjames1]

No have no intention of having an ablation. Has never been suggested by any of my Docs. My original Cardiologist said to me " Do you really want them burning holes in your heart? Because that is what they do, and half the time they fail, because it is all guesswork." I did at first see one EP and he said he saw no reason, since the Flec was working well.

[mjames1 in reply to Budken]

If you can manage without ablation, then a medical approach is reasonable. That was my approach and it worked well and then it didn't. Recently I had a typical flutter ablation and soon will have an afib ablation. Yes, there are risks, but there are also risks when the meds can't control your afib. Also, the earlier in life you have an ablation, the better you will tolerate the procedure. You're 74. Do you want to have an ablation at 80? I'm not saying you should have one now, but I'd keep all options open should things change. A new and safer ablation is now starting be offered in Europe called pulse field ablation (PFA). If interested, you can look it up. If it was available to me in the US, I'd be looking at it.

Jim

[mjames1]

I haven't switched from daily to PIP, but am about to. In my case, I was on 50mg, twice a day.

As your doctor said, no medical reason to wean, such as with beta blockers. That said, you might consider weaning to see if the lower dose of flecainide holds you in NSR. Might be useful in the future if the PIP burden is too great and you have to go back to daily flecainide.

That's what I am doing. Currently on 25mg, twice a day. From what my ep says, some people are succssful switching from daily to PIP and some are not. Good luck!

Jim

[Budken in reply to mjames1]

Yes, I have decided to slowly taper off. Tonight I only took half a 100mg pill. So I will be taking 50mg twice a day, I figure until next week. Not sure whether to simply stop at that point or to go to 25. I figured this way, I will see if I have any events on the lower dose. Four years ago, my cardiologist in North Carolina told me to stop taking Metoprolol with my Flec. I was having occasional breakouts. He said he was sure the Metoprolol was the reason. I think he was correct, as have not had one single episode since. Am simply hoping that cutting the Flec will not cause any problems. I read everywhere that you should gradually wean yourself off the stuff. I have read here, some people who said they took months to do so. So it all has me a bit confused. I do trust this Doctor, as he actually explains stuff, unlike my original Cardiologist, who simply said take it or you will instantly go back into afib. He was the one who upped my dosage to 100mg twice daily.

[mjames1 in reply to Budken]

Interesting about the Metoprolol. As I mentioned, nothing in the literature about needing to wean off of Flecainide. Weaning off beta blockers like bisoprolol or Metoprolol is another issue. That can take months. You'll see soon enough whether you need the flecainide or not. Like I mentioned, I was told by my ep's office that with some it works but with many it doesn't. If it doesn't, maybe you can find a lower dose of Flecainde that does. I did pretty well on 25mg, twice a day, but I'm pretty sensitive to drugs. Make sure you get a good pill cutter if you go that route. Also keep in mind that it takes 3 days to really get the effect of a dose change. So consider waiting 10 -14 day to give the dose change a chance to work.

Jim

[Budken in reply to mjames1]

I have been off the pill now for six days the last two days I have had some PAC's and last night had short bout of afib, but did not take any medication. It stopped within a half hour. So I am glad I did not resort to taking the PIP. I did not think to ask, should I wait these out, or immediately take the PIP. Depending on how many I have, I do not want to keep taking too many pills.

[secondtry]

Thank you for the post that is good to know.

Over the years the consensus reported here (if I remember correctly) is that most medics suggest you can just stop the Flecainide without any taper. Members here have said the effect can wear off over time and the dosage may need to be increased. My theory however is we don't know for sure how our individual body is affected by Flecainide, whether it is a lot or very little, therefore it would seem to be less risk, if you are coming off, to taper it slowly.

I am on 200mgs daily and would dearly like to reduce it having only had 2 very short episodes over 9 years. If I ever do so, at present my feeling is I will reduce the first 100mgs very slowly over several months minimum and if all well the last 100 over a similar period. My cardiologist plays safe by saying if all is OK keep taking it daily.

[Budken in reply to secondtry]

I have been taking 200mg daily also for the past five years. For the first year or so, I had a few episodes. Then a new Cardiologist told me to stop taking Metoprolol 25mg which he thought was what was causing my oubreaks. Although stopping the Metoprolol was a terrifying experience ( all kinds of ectopics ) once I had, I have not had a single episode. That is about four and a half years. Three years ago, when I was examined here, they said my Holter Monitor showed no ectopics. Than again several months ago, only one ectopic beat in 24 hours. That combined with a low HR, my doctor said I should try the pill in the pocket approach. Stopping Flecainide entirely, and only taking it if I have an episode. He said to keep a journal of any Episodes, and to see him again in three months. He said he saw no benefit in taking it every day, if I have no or few episodes. Right now I am down to 100mg a day, and I feel fine. I am still a bit nervous about stopping it entirely. However I will never know, if I don't. I certainly would rather take it only if needed, than every day.

[secondtry in reply to Budken]

My AF is certainly vagally mediated and that can be a problem as you can sort out the gastric issues but at the other end of the Vagus Nerve the mind can play tricks eg recently having had no AF episodes for years, I jumped on my bike at an unusual time in the evening (I've had episodes on the bike in the early days pre-diagnosis) and lo and behold before riding very far I got the pre-AF feelings, jumped off and walked home! Hence why I am scared to give the Flecainide up as in those situations I suspect it protects me.

[Cangelo629]

My Cardiologist had me discontinue Flecainide in December three months after my ablation and go to the pill in the pocket no withdrawal symptoms I was told and they were correct.

[doodle68]

Hello Budken , with regard to a PIP, my EP told me if your episodes are very close together and you are take Flecainide as a PIP, you may be taking a large dose almost continuously so a daily dose is advised .

If your episodes of AF are not so frequent a PIP may be suitable.

I am taking daily Flecainide again having ones stopped it . When I stopped last time I was told I didn't need to taper it off gradually but I did anyway because I had side effects .

[Tapanac]

I thought bisoprolol was a rate control and could lower heart rate and BP and flecainide regularised the heart best?!?!?

[Budken in reply to Tapanac]

I know nothing about Bisoprolol. So I can give you no opinion.

[Jmc43]

For three years, I took 50mg of Flecainide twice a day. That, plus a beta blocker taken for BP and perhaps my natural self, led to low H/R, especially at night…and an increasing amount of ectopics as my heart rate was around 40 bpm. Wearing a heart monitor, my cardiologist discovered pauses of 5-8 seconds…so he recommended a pacemaker, which I got 4 days later. I came off the Flecainide once the pauses were discovered, got the pacemaker implanted, and with my agreement, I am now not taking Flecainide, using it as a PIP. I had no trouble stopping, and have only had one short Afib episode, took the 50mg PIP in the pocket, and it reverted to sinus rythm within an hour. We will see what the future brings, but it is fine now. I still get ectopics but they are not dangerous and the pacemaker helps. My base heart rate is now 60 bpm and I sleep well at night.

[Budken in reply to Jmc43]

So your pill in the pocket, is the same as you were taking. I have been told to take 200mg as a PIP. I have worried about taking that much at one time.

[Jmc43 in reply to Budken]

Yes, mine is the same as I was taking. But reading through all these threads about PIP usage, I see lots of variation so I guess it differs from person to person and cardiologist to cardiologist. I see some are even taking one dose after a half an hour of an Afib episode, and then another in a couple of hours if the first one doesn't work. hmmmm....

[Budken in reply to Jmc43]

Yes, I see. Seems that many are doing their own thing. I also am considering just taking a normal dose and see what happens. So far though, I haven't needed to.