Flecainide PIP

[PAP48]

Advice please. For a pip I take 2 x 50mg Flecainide tablets which usually take effect between 1 and 3 hours. If at any time they do not take effect, is it possible to repeat the dose of pip and how long after the first one? My daily usual dose is 1 x 50mg taken at night. My Afib episodes are generally in the night although I have had a few during the evening, rarely during the day. Thanks so much for your thoughts. Keep safe and well everyone.

[mjames1]

No pun intended, but Flecainide is not to be taken lightly. It's a powerful drug. Only your ep can safely advise you regarding dosage, be it daily or PIP. They have your medical records, including the structural integrity of your heart, your ekg's on and off flecainide, hopefully a stress test, echo, etc, and how you have responded in the past.

Personally, I now take 50mg twice a day. If I go into afib, I was told to take an additional 50mg and if I didn't convert within an hour, to take another 50mg. That would be a total of 150mg on board, including the daily dose. That was my 24 hour maximum. I was allowed to repeat the next day if I did not convert with the 150mg. Others, are given the green light to take more. Some may take less and some are not allowed to take flecainide at all. I believe the manfufacture's info says a max of 300mg in 24 hours for afib. But again, that is not a dosage everyone can take.

Lastly, many of us are given a beta blocker or calcium channel blocker to take with the flecainide. It's for safety reasons to prevent 1:1 flutter and other dangerous arrhythmia's that

flecainide is associated with. Not all ep's prescribe it but many do.

Jim

[PAP48 in reply to mjames1]

Thank you for your reply Jim, useful info. I do take Rivaroxaban one tablet at night. I've been signed off by my Cardiologist but think I may have to have another appointment!

[mjames1 in reply to PAP48]

Rivroxaban is an anti-coagulant, not a nodal blocker. But as mentioned, not everyone takes one. Definitely ask your cardiologist for PIP instructions. Better still, ask an ep, if you can.

Jim

[secondtry in reply to mjames1]

Just had my cardiologist annual checkup and I queried again the fact that I was on Flecainide without a BB or CB for 9+ yrs now. I was concerned as I get older (passing 70 this year) there might be more chance of a rapid HR breakout on just Flec. He advised the opposite saying if it has been OK so far the risk decreases as you get older ....Phew!!

I should add I have no comorbidities, active, low BP & HR.

[Whitechinchilla in reply to mjames1]

thanks Jim for your reply to PAP48. That was just what I needed.

I had an episode which lasted just under 48 hours this week but only peaked at 105. So I was nervous to even take a Flecanide.Eventually I did as I could not get my heart rate below 100.

I ended up having to take 4 in a 24 hour period.

Boy did I know it next day! My BP dropped through the floor but eventually stabilized. But the AF continued.

So I took 150 mg the second day.

I did not know what to do as it was not high enough to go to A and E so I thought I would sit it out. Today I woke as if nothing had happened, SATS completely normal!!

Anyone else experienced anything similar please?

Do I need to contact my gp?

I’ve had PAF for 2 years and was signed off by the Cardio department as no structural damage to my ticker so when the episodes started coming regularly my gp told me to increase the Bisoprolol. After reading I deduced that was not the usual practice so I phoned the nurse in the Cardio Dept who said my gp was wrong and told me to take Flecanide which was my PIP at the time and she wrote to my gp accordingly.

I am so grateful to have found this site having been on the COPD site for years.

Thanks on advance of anyone has any advice please.

Jill

[mjames1 in reply to Whitechinchilla]

Glad things worked out well!

It sounded like you took 200mg the first day, but 50mg at a time, spread it out? That would have worked for me, however most take at least 100mg at one time as PIP, some even more. But very important, do not take more than your doctor prescribes, so if not sure, speak to them and carefully go over different PIP scenarios. Like how long to wait to take the flecainide. How much to take initially. How long to wait before taking more. Maximum allowable in 24 hours, etc.

Did you take your blood pressure in afib, before you took the flecainide? It's possible the bp drop was more related to the afib than the flecainide and also most bp monitors are not very accurate when you're in afib.

[Whitechinchilla in reply to mjames1]

Thankyou again Jim. I think it very likely that I was not thinking straight as it did not occur to me to take 100 mg at once.

I will remember that.

Yes the doses were spread out and I need to find another gp at the surgery for advice. (My own gp looks beyond exhausted and when I asked to speak to him when the episodes became frequent I was told he was too busy and I must email him. Then he took 3 weeks to reply!!!!!)

Thanks for the tip about the BP. That sounds more plausible than my knee jerk conclusion.

I am very grateful for your kindness in replying.

Despite being a feisty, self sufficient OAP, I find that sitting here on my own in the middle of the night and not having a clue what to do is the worst thing about this illness.

So yes, your suggestion is good. I definitely need some guidelines from a gp.

Thankyou again most sincerely.

Jill

[mjames1 in reply to Whitechinchilla]

Sorry about your doctor communication problems. They seem more prevalent in the UK than here in the US. That said, I am still waiting 4 weeks to hear back from my ep about a date for my ablation

Is there any way you can get referred to an ep, or possible go private for a single consult. A one time consult might help with clearer guidelines for PIP.

Meanwhile, not qualified to say whether taking 100mg or more Flecainide at once is a good idea, however the fact that your heart is structurally sound stands in your favor.

Some of us have had to pass stress tests in order to take/monitor flecainide. If you haven't already, something to put on your list, which I'm sure is ever growing. Mine certainly is.

But all said, your back in normal rhythm, which is always a good thing!

Jim

[Whitechinchilla in reply to mjames1]

Thankyou. I am now making a List of ?s and will certainly think a about a referral as you suggest.

Kind regards and many thanks again.

Jill

[PAP48]

Thank you again Jim, how does one find an EP? Penny

[mjames1 in reply to PAP48]

I'm from the US, so someone from your health system may be of better assistance, however from what I've read here, either ask for a referral from your GP or Cardiologist, or directly go private if you want a faster appointment. EP stands for electrophysiologist.

Jim

[Paulbounce]

Hi Pap.

My answer to this is simple. However, it is not intended as medical advice and only something to discuss with your medic.

300mg a day is your max to take. If you only take 50mg at night you are on a low dose. 100mg as a PIP stands a reasonable chance of working - only on an empty stomach though. It kicks in roughly an hour later if you have not had a big meal before taking it. If it doesn't return you to sinus ask your medic about taking another 100mg about another hour or so later.

You'll still be under the 300mg level in 24 hours. However, DON'T do this without talking to your medic first. It could lead to flutter and more problems.

If your afib only happens only at night get checked out for sleep apnea.

Paul

[PAP48 in reply to Paulbounce]

Thank you Paul, very interesting and definitely something for me to discuss with my Cardiologist, although at the moment he has signed me off but I can get back to him I'm sure. I will also mention sleep apnea, he has not mentioned this aspect. Penny

[secondtry]

You don't say how frequent your episodes are. I would ask your cardiologist if you should increase your Flec dose to 50mgs twice a day to stop them all. As Paul says also get checked for Sleep apnoea and in the meantime eat your last meal at 5pm, make it light, no caffeine after 1pm and use a Breatheright (worked for me, no commercial interest) nasal strip at night. Check out breathing - see YouTube James Nestor & Patrick McEown. No late night crime dramas or these days any news!

As you might gather from the above I believe the best way to combat AF is to change your lifestyle habits on a number of fronts with the intention of the accumulative effect keeping you below the trigger threshold; this is in contrast to believing there is a silver bullet either with drugs alone or one changed aspect of your life.

[PAP48 in reply to secondtry]

Thank you secondtry, my episodes up until recently were only every few months but I went on holiday at the end of January for 2 weeks and had 3 episodes in that time and 2 since I've been home. I'm sure my trigger is eating later at night (which you tend to do on holiday) and possibly alcohol. Stress as well. I'd be interested to know what changes you have made as I tend to agree with you.

[secondtry in reply to PAP48]

Sounds like it could be vagally mediated AF. Stress getting ready to go away, travel hassle, then big relax once there and possibly over indulging in the evening and into bed before it has all digested.

The changes I have made are based on the shot gun approach as I have no idea which individual one has the most impact so I back as many as I can. I suppose the main ones are reducing stress on all fronts, reducing exercise to moderate (largely daily x2 brisk walks of one mile).Eating light and early in the evening, reducing gluten & sugar by around 75%, mostly no processed food. No alcohol or fizzy drinks, caffeine minimal before 1pm. then advance dental hygiene. Don't forget spiritual has a great calming effect, for me prayer and Nature; as an academic said Nature has its own pulse.

[Tarikor]

Hi there mate. What two top Cardiologists in London told me was to take 200mg of Flecainide in the event of an arrhythmia. This was when I was already taking 100mg twice daily.

So you should be good for that amount as PIP. Just ensure that you actually are indeed in full Atrial Fibrillation or SVT if you decide to take the 200mg of Flecainide.

In addition, I would suggest that you take Dioralyte (available in the UK), the plain version only (you do NOT want those nasty artificial sweeteners as they cause arrhythmias in people like us). Dioralyte (and if not in the UK any non flavoured non sweetened electrolyte solution) will help you tremendously, to the point that I have cardio-verted quite a few AFs that were beginning just by drinking a full glass of water with a sachet of Dioralyte.

In addition, drink water with some Magnesium Citrate or Magnesium Chloride solution. I have had great results with both types of Magnesium.

Ensure you sleep well and avoid all stress. I found that many times, my AFs came from arguments and fights with my family and my very own beloved Spouse LOL. Seriously, avoid drama from people that stress you out. I even considered divorce, it was that bad at one point.

Other than that, hope you avoid all those pesky AFs and associated arrhythmias our hearts like to entertain us with

Take care!

[PAP48 in reply to Tarikor]

Very useful info Tarikor. I totally agree with stress and arguments and, sometimes, I find social situations stressful which can 'set me off'! Diarolyte is v difficult to find in my area, apart from blackcurrant flavour, I do drink coconut water but not convinced whether that helps or not. Keep safe.

[Singwell]

Hi, I will share my experience of using Flecainide. I used to take 50mg X 2 plus an AV node blocker, Diltiazem. When I needed an extra PiP I would take an extra 50, wait 40 minutes to see if it kicked in, then another 50. As Paul bounce says - ideally away from food - or it takes longer. If I needed to eat, I'd eat and wait 1.5 hours after food before taking an additional pill. Altogether I never took more than 150 to calm an individual episode. I see you're an older woman, so the amounts a larger man might be able to tolerate will not be the same for you. I'm 66 and my body mass index is around 21 I think (I weigh 8.4). Recommended doses tend to be reduced as we get older. I don't think my body would've tolerated a dose of 200mg.

What I am wondering is if you might do better taking 50mg X 2 - so a morning and an evening dose. This is because of the half life of the Flecainide. If you take it twice a day, the half life keeps topped up. And you might find it's that that makes the difference. Even taking a half dose of 25mg in the morning using a pill cutter might make the difference to keep AF at bay. (I did this for over a year post ablation - taking 50mg in the morning and 25 at night because luckily my AF didn't visit at night.)

Have a chat with your GP and ask them what they think and if you should be referred again to cardiology.

[PAP48 in reply to Singwell]

Thank you Singwell, I'm really thinking it's time for another appointment with my cardiologist. Makes sense to take med am and pm. My time for an episode is usually about 12/12.30 at night, so disruptive and makes me feel quite unwell the next day.

[Singwell in reply to PAP48]

Yeah, I hear you! Even after it's stopped you feel knocked out for 24 hours afterwards. I'm just thinking of the half life business being helpful for stability

[PAP48 in reply to Singwell]

I think you may be right, will keep you posted!

[Ppiman]

Only a cardiologist, who knows your heart's structure and electrical activity can decide on anti-arrhythmic dosage since the drugs can be pro-arrhythmic and dangerous. For example, I was told that flecainide would be too risky for me. The safer drugs which can be taken are beta-blockers and similar, and I have been told to take up to 5mg bisoprolol as needed.

Steve

[ChadL]

I was diagnosed with SVT 2 years ago, currently I'm on 100mg Flecainide and 12.5mg Metoprolol (any more and I see stars...literally!) 2x a day. I supplement with Magnesium with each dose. I was having palpitations almost every night and horrible side effects of the meds before taking the Magnesium. All was well until about 3 months ago when the palps came back almost every night... cardiologist in the ER asked if I was having any acid reflux issues... interesting enough I was! apparently acid reflux can cause arrhythmia, palpitations (who knew)... I take a PPI in the am, eat smaller meals at night and lotta water.. fingers crossed all stays well!

[PAP48 in reply to ChadL]

I, too, take a PPI daily. I need to take advise on Magnesium supplements due to other medication I take and I read that Magnesium affected the efficiency of a particular drug I take.

[Ozette]

I think that is a question for your doctor. While on a regular dose of Flecinide if I had an AFib break through I immediately called my doctor's clinical assistant, who had me take one extra dose right away and if I didn't return to a normal rhythm that day they scheduled me for cardio version right away. I didn't feel it safe for me decide when or how much extra to take. Flecinide is a powerful medication.

[PAP48 in reply to Ozette]

My problem is Ozette that my episodes are usually in the middle of the night so unless I attend A&E (not for me I'm afraid), I'm a bit stuck until the morning by which time everything has reverted to normal!

[Ozette in reply to PAP48]

I understand. Mine usually started in the middle of the night too, but didn't return to normal rhythm, thus the call to the doctor as soon as I could in the morning. Hope you find what works for you.

[healingharpist]

Hi PAP, When my paroxysmal AF episodes increased, my GP prescribed metoprolol (similar to your bisoprolol, dosing is different), 25 mg twice/day, and it is helping dramatically. Also, for 4 yrs. I've used flecainide as PIP. I take 150 mg when an episode begins and it stops it within 2-4 hrs. Rarely, I need to take an additional 100 mg after 5 or 6 hrs, and that stops it within an hour. (I do have a structurally sound heart, low BP & HR.) Unlike some here, though, I haven't had good luck dividing up the dose to 50 mg etc. My heart seems to need at least 100 mg at a time to stop the AF.

However--At first, I was prescribed 300 mg by my first cardio!! (fired him :-)) That is generally considered the maximum for 24 hrs. It gave me ectopic beats/PAC's etc. So I lowered it myself to 150 mg at start of AF episode, and found it worked great w/ no side effects ever. I'm in the medical field so I felt comfortable adjusting my own dose, but I do keep in close touch w/ my GP or my cardio. or EP through MyChart (online messaging here in the US, & my GP usu. gets back to me the same day--it is a godsend).

Flecainide is clearly NOT a "one size fits all" drug. We each have to learn our tolerance and effective levels. But it has been a miracle drug for me and I haven't needed to increase the dose in 4 yrs. The daily metoprolol has also improved life immensely. Just thought you might like to hear another person's story about dosages, etc. Warm wishes for constant NSR!! Diane S.

[PAP48 in reply to healingharpist]

Hi Diane, I too have a structurally sound heart, thank goodness! Always useful to hear others' experiences and thoughts. I'll investigate metoprolol, at the moment it's only Flecainide and Rivaroxaban I'm on. I feel an appointment with my cardiologist coming on as I prefer his views to my GP's. Fingers crossed for you too for constant NSR. x