Hoping you are all having a good day.
I’ve just had the news that my three month post ablation ambulatory ECG has given good results - ‘very reassuring’ and ‘no sign of AF’. So far, so good. I was told that I can stop Flecainide today and Bisoprolol after a further two months.
I’d welcome your comments/advice about doing so - I’ve been told to just stop them - no weaning required.
Thank you! X
That's great news! Flecainide you can stop cold. From everything I've been told and read, you should gradually wean off of beta blockers such as bisoprolol. Definitely get another medical opinion on that.
Jim
Nurse said as it was such a low dose - 1.25mg, that weaning not necessary ….
Yep
You mean 125 I guess? No-one takes 1.25 Flecainide. Or did you mean the Bisoprolol here? I know Jim says you can come off Flecainide cold. I don't know if he's tried it. If you're already on the lowest dose it should be OK. I was on 25mg a day X2 and in the UK you can get smaller than that. But I titrated DOWN to that dose. Personally if you're on more than 100mg a day overall I'd titrate. Bodies need adjusting time. I wish medics would realise this...
1.25 daily is Bisoprolol. Flecainide was 25mg daily - half the lowest dose available. Thanks for your advice.
No, but I haven't weaned off it either. Flecainide does not require gradually withdrawal. There will be no withdrawal symptoms, like with beta blockers. Check the literature.
Now, can you go back into afib or aflutter, etc, if you suddenly stop flecainide. Absolutely! But that is not a withdrawal symptom, it just means you don't have it in your system any more to do its thing. The same would happen if you gradually withdrew from Flecainide, i.e. as soon as you reached a blood serum level that was not therapeutic you could potentially go back into afib.
Jim
So while not as familiar with bisoprolol (in the US, Metoprolol is favored) 1.25mg once a day, seems to be a low dose. So it's very possible that stopping it cold is Ok. However, in general, it is not recommended because abrupt withdrawal of beta blockers can cause withdrawal symptons. As far as Flecainide goes, no withdrawal symptons at all if you stop it cold. Don't take my word, check the literature. Now that doesn't mean you won't go back into afib when you stop the flecainide, but that has nothing to do whether you stop it cold or withdraw gradually.
Jim
You don't say how much Flecainide you are on. I am on 200mgs and have been for 9+ years. I understand most medics say you can just stop it but I haven't heard any reasoning why weaning off slowly (particularly from 200 to 100) is a bad thing. For a strong drug that your body has adjusted to over a long time surely that requires a slow weaning or at the very least that would not cause a problem, so a better bet.
If ever I am lucky enough to be able to stop the Flec I will be challenging my cardio for his reasoning if he says just go cold turkey.
Realise I didn’t give enough info in my post - obviously a little over excited at the time! I’ve been taking 0.25 flecainide once daily, in the evening. Was put on it immediately after ablation. It’s half the normal smallest dose available - rather threw the pharmacist who initially thought there had been an error!
25mgs is very small so I guess cold turkey wouldn't be an issue. Good luck.
Hi,
I can only comment on Bisoprolol .............. wean off it ........... do read the paper in the packet !!! If in doubt consult your Pharmacist, maybe best to do that anyway.
Thank you!
My advice is to titrate down. I was on 50mg X 2 and cut my pills in half. Prior to that I took 50mg am and 25mg pm. Depends when you're most likely to get your Arrythmia if there's previously a pattern. I rarely got mine at night.
I think it's good to titrate separately, which they're suggesting. Sounds like they want to find out if NSR will hold on its own but keeping you on the BB for rate control. EPs have different views on the timeline for coming off meds. Mine was quite happy to wait till the 9 month mark post ablation when I'd been in NSR for 7 months. See what others say. And of course, you can always keep the Flecainide as PiP. I still have mine.
Thank you. I take 1.25 mg daily, in the morning. I shall take on board the advice here, and talk further with the AF team before I decide, but I like the sound of dose reduction.
Did you get any advice from your EP re keeping flecainide as a PIP? Would you take what was your usual dose?
You should be fine I'd think to come off fhe Flecainide in that case But you need to ask about PiP use. Wouldn't be appropriate fir me to advise.
Thank you. Fair enough. Was curiosity - will be asking AF team for advice. I’m not someone who is gung ho about meds!
Am the same. My Dad was a professor of pharmacy! I can.share what I used to do if AF broke through my maintenance dose. I'd wait 20 minutes to see I'd it would calm.down, then take 50mg. I'd wait a further 40 minutes and if it didn't look like going off, I'd take another I never needed more than 150mg to see off even a very determined episode but tbh is feel rubbish the next day. And sometimes it felt off when it reverted to NSR. I'm glad I don't have to do this anymore.. At least for now.
The NICE guidelines for Flecainide is 300mg within 24 hours. But I'm.small and also 66 so I think my.dosage and response to meds is different than so called norms.
I see, thank you Singwell. So was 150mg your usual daily dose?
definitely need titration down from Bisoprolol . At least that is the protocol here in Canada and what I was advised by the pharmacist. Not sure about the flecanide. My thought is to be as gentle with the body as you can. Good luck!
Thank you!
I pretty much just stopped flecainide. I was on 2 x 50mg and the first day I missed morning dose, then took the evening and that was it. I also stopped diltiazem rste control immediately from 1 x 200mg per day mod release capsules.
Hmm all I can say is I was advised to simply stop Flec and Biso ,so that I could take NSAIDS for back pain,by my GP.This was 4 months after ablation,was still waiting for follow up.
Went into AF within hours ,for 24 hours or so.
Put myself back on!
Few weeks later follow up with EP,told they much prefer a slow weaning,6 months on full meds ,then 6 months on half,then stop.
It seems they have different thoughts on this!
Xx
Reduce gradually in my opinion. I dropped Sotalol as per my EP. Episodes increased dramatically. This was prior to my ablation. I had horrible side effects from the meds.
Congrats on the milestone! That's a big time...I was taken off diltiazem and flec at three months also cold turkey...that had always been the plan, but within a couple weeks I started having AFib showing up again, so they put me back on. That helped pretty quickly though I continued to have little bouts of palpitations but much more stable. Obviously I wasn't ready. The weaning sounds like a good idea. I've been on diltiazem 240 per day and Flec 100 2x...
Well, if you are on 1.25mg once a day, then you have little choice but to just stop it (bisoprolol). However, I do own a pill cutter (£2 on eBay?) and that would actually halve even the 1.25mg pill, as they tend to be filled out to a larger size than they need to be (varies by brand). Also, if you are on them twice a day, then just dropping to once a day for a couple of weeks would do no harm, and better safe than sorry. Having said all this, I'm just a user and have no medical expertise. Yeah, just stop the evil Flec!
I came off 1.25mg Bisoprolol and suffered side effects for at least a couple of months; racing heart, fight or flight feeling, I was convinced that I really needed this drug to keep my heart calm. However, when I went online, I found accounts of people suffering exactly the same symptoms as me when trying to cut out Bisoprolol, and how they titrated down, even to dividing the tiny tablet, then alternate days etc. That said, you may be one of the lucky ones with no symptoms, some on the forum haven't been affected at all.
Thank you!
You should wean off the Bisoproplol despite the low dose. I took weaning advice from a poster online ( not this site) and he said in his experience weaning off from higher to lower doses was ok but it was going below 1.25 mg that he experienced withdrawal symptoms. If you can, cut the tablets in half and stay on this dose of ,65 mg for 3/4 weeks. If you get any adverse symptoms - palps, jitteriness try 3/4 of the pill . The trick is to deceive the body . Once you are down to a quarter of the 1.25mg pill with no problems go to taking it every otherday for a couple of weeks before stopping completely. Some people are very sensitive and have to wean down to literal crumbs!
Thank you!
I was advised to come off bisiprolol 3 months post ablation , it was a bit too soon . Personally I’d have some in reserve ready just in case the symptoms return . So pleased for you that all seems well !
Thank you!
I've come off both meds at various points in my a-fib history, "cold turkey," without any side effects.
Thanks for that! Reassuring!
Hi, I had a phone consultation with my EP last week (had ablation and cardioversion last August and in NSR since ). Was told to just stop Bisoprolol, it was the same dose as you 1.25. I did ask about weaning off them but he said it wasn’t necessary at that low dose. My resting heart rate has increased very slightly but so far so good and I’m less breathless. Good luck.
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