This was the first time I would take Flecainide PIP, and the EP wanted me to take it at the ER. He prescribed me 50 mg. I am on 180 mg of Extended Release Diltiazem.
The attending ER doctor did not think 50 mg would make a difference (he said it should be 200-300mg) The ER doctor gave me 2 doses of Diltiazem, and then the 50 mg Flecainide. I converted on the way home after 5 hours in the ER.
My question is should my PIP be 50mg or 200/300 mg. The response I just got back from the EP was incomplete and vague.
I am kind of pissed at the EP, and there is no emergency contact for him.
Thanks for your help.
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AustinElliot
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It should be the lowest dose that converts you. Plain and simple. For me, that would usually be 100mg (50 in my system and 50 as a PIP dose). Sometimes, if that doesn't work, I take another 50mg in 30-60 minutes. That would be 150 total. But that's me, others need more (not recommended more than 300mg in 24 hours) and in your case, apparently 50mg is all you needed.
I am not sure if I converted naturally, my episodes are 8-12 hours, and I am not exactly sure if I was in AFIB at 2 am or 7am. (most likely 7 am) So 7 hours or 12 hours.
So you can't know for sure if the Flec converted you or not, but you were able to take it without incident, so you accomplished that. If it were me, I'd follow your ep's suggestion of taking only 50mg at the onset of an episode, but would try and get his permission to take another 50 after 30 minutes if not converted and another 50 thirty minutes later if still not converted. That will give you a feel for how it works. If the 50 converts you in 1-4 hours, then that's all you need. If you find you need the extra doses, then that tells you maybe you should take more than 50mg going forward. Have to experiment a bit with these drugs as we all react differently, but of course get your doctor onboard.
I was started on the full 300mg for my first dose BUT it was under medical supervision for 4 hours. We all react differently so I think wise to start at the lowest dose and work upwards if that doesn’t work for you. Taken on an empty stomach and within one hour of an episode starting I used to convert within about 2-3 hours.
Thanks Dreamer, that is why I was in the ER, told that the first dose should be supervised, according to the attending I tolerated the drug with no changes, so that's good. I agree with you about trying the lowest dose. Thanks Elliot
First time i took 50mg every hr pluss 2.5mg bisop to a max of 300mg flec & 10mg bisop,took 10hrs to convert,day after i saw the cardiologists & he told me,next time take them all together.This i did 2 weeks later & i converted after an hr,thats 2 years ago & be in sinus since 👍
Hi mate, from one of the best cardiologists (now retired) from Harley Street, London, and concurred by every other cardio I have seen, it is 200mg of Flecainide as PIP approach.
It takes about 90 minutes for it to cardiovert you after taking this amount. There will be time when it will NOT cardiovert you though, depending on what type of AF you have and if you have any other issues.
To help cardiovert, try taking sodium, potassium and magnesium in water right when you feel the AF starting. It has helped me TREMENDOUSLY, especially if your AF comes along due to dehydration and especially potassium depletion (many, MANY medicines out there deplete potassium, and many supplements as well, even certain foods like LICORICE, deplete potassium a lot).
My cardiologist said that the PIP should be 150mg of Flecainide and 5gms of bisopherol .Take this as soon as the palpitations start. The only downside is that it leaves you a bit washed out. Its always worked fir me .
I take Flecanide as pip. I've only used twice at home but I take 50mg x 4 so 200mg. It usually takes about 4hrs to kick in and cardiovert me. Hope all goes well for you.
hi I have Flecanide as a PIP 200mg , works in anything from 30 mins to 3 hours. Never monitored but was given lots of warnings of potential side effects. Am on no other medication.
I have been given flecainide as a pip . 50mg . If I haven’t converted in 2 hours take another 50 mg . If I haven’t converted in a total of 24 hours to go to the hospital. Personally I would think if you are being given a drug that has known potential side effects going in at the lowest dose to see how it is tolerated is the sensible course of action
Coincidentally I also have ongoing afib episode since Sunday. First since cardioversion 3 years ago. Gratefully received many responses on this forum.
Afraid to take extra meds as PIP. Never given any medical advice re this. Also have been on 2x50mg flecanide and 1.25mg bisoprolol per day since initial diagnosis 3 years ago.
I will consult my GP today and if necessary go to A&E. Maybe they’ll advise on PIP protocol before considering any other treatment.
As always, this forum is an amazing wealth of experience and knowledge.
Hi gtkelly, Yes this forum is amazing. My EP not so much, hard to get straight answers in a timely manner. I guess no one keeps emergency contacts anymore.
Sitting in A&E just had bloods taken and ECG. Will ask medic about extra dosage of flec. My current episode of afib is now 4 days. Maybe too late for PIP? 🤞
When I was prescribed Flecainide I was told to take 100mg of it as a PIP and it always works in a couple of hours. Had an episode yesterday and that’s what I did! I shall now go back to taking it in the morning and evening as I should be doing rather than cutting out the morning one which I decided to try to cut down the side effects of more fatigue and tummy trouble! I can always tell when my heart goes a bit crazy and then check with my Kardia where I can record how things go!
I have been on Flecainide as a PIP for about 4 years, I was tried and tested in hospital ( East Sussex ) and they said I needed to try an approach from a Cardiologist in Dorset ( UK ) . I was told to take 300mg in one hit 30 minutes after the onset of an episode; 7 times out of 10 it has worked, I was on Amiodarone and now Dronedarone, so I guess it just reiterates what different needs we all have ( 69yrs and 82kg ) , I have had two ablations and 5 cardioversions. However, after my last visit to A & E when the Flec didn't work after 12 hours, I was put on a list to have a 7 day Holter and was then after 6 months given a call from a new consultant ( registrar ) who said due to the fact I have narrowing of the arteries ( diagnosed 12 years ago ) I should not be taking flecainide and have now gone full cycle and have a 2.5 mg Bisoprolol as a PIP, will be interesting to see if it works? I was also left in the dark as when he said to stop the Flecainide he didn't give an alternative and stupidly forgot to ask ( I was in a state of shock in my defence ) so I had to email the secretary and this week had a letter via the doctors giving the Bisoprolol instruction! Do hope yours works going forward.
Very good point. Normally when the Flecainide hasn't worked my heart rate is high 140 bpm but has stopped fluctuating ( 40-190 bpm ) , so maybe that is why I have been given Bisoprolol , however as my normal heart rate is circa 50bpm he has warned I need to be cautious it doesn't make it too low. Previously after my second ablation 5mg Bisoprolol in conjunction with Flecainide 100mg as my main daily meds would bring my rate down as low as 40, my doctor was truly concerned but the cardiologist wasn't but reduced it to 2.5mg and that was ok.
1.25 mg of Bisoprolol was too much for me to take daily as it brought my heart rate down to the 40s but my surgery couldn’t come up with anything else so we went to see a lovely EP in Bristol we found through the AFA who didn’t think I had it at first but after he had introduced me to having a smart phone and Kardia ( thus changing my life considerably) I sent him the first crazy reading and he sent a prescription for Flecainide to my surgery. At first I just took it as a PIP with an added Bisoprolol 1.25 if my heart was over 140 twenty minutes after taking the Flecainide 100mg as he had instructed but now, as advised, I take that dose morning and evening and only rarely have episodes which can be stopped in a couple of hours with an extra Flecainide and very rarely, a biso on top ( sometimes, even if it isn’t over 140, to get it over more quickly!) Of course, as we know, we are all different and I do hope you find what works for you.
I was prescribed 300 flecanide as a pip. It made my heart stop within half an hour , then back into n.s.r. When l tried150 mg it didn't work, even trying another 150 a few hours later. It seems that my body needs to be shocked to get back into n.s.r.
I was given Flecainide 200mg as a pill in the pocket approach when my AF episodes became more frequent. I was told it should work within an hour but if not, to take another 100mg. I never took it as worried about it then my cardiologist changed (thank goodness) and he changed the dose to 100mg with another 100mg after 1 hr and if that didn't work, go to A&E. I have now been taking Flecainide weekly but have only once had to take 2 tablets. I find exercise or drinking a lot of squash sometimes work just as well. However, my cardiologist said he didn't want me on Flecainide long term as it could kill me! So, as my episodes are fairly frequent now, I have decided to go for the ablation and due to have this in August. Scared stiff about it but as AF is progressive, feel ablation is the best option as it gets less successful the more AF you get and the longer the AF lasts apparently
Hi Lizzie, Ablations scare me as well, but to some degree, the worry over my next event has taken over my life to some degree. Even though I know mine is new/mild compared to most on this forum. So I am thinking Minimaze, maybe drastic. I am a fixit kinda of person.
Oh goodness! Why did your cardiologist say it would kill you ?? I’m really worried now as it’s working so well for me , I can’t imagine life without it .
I take 50 mg twice daily along side diltiazem. Flec also use as a PIP 100mg if a run of fast AF for over 30 mins as instructed.
Hi. I didn't mean to worry anyone but it did bother me at the time. I can only assume he meant if I ended up on the highest dose long term at my age. It seems everyone on here with AF or PAF is taking a different cocktail of drugs and doses. I was already on Diltiazem for blood pressure and it was just increased for the PAF and then further down the line, the Flecainide was added in yet it seems you have been put on Flecainide from the word go. It must depend on the severity and frequency of the PAF plus age must be a factor. Please don't worry because if it is working for you, then that is good. We have to trust our cardiologists. I'll let you know how I get on after the ablation next month. Take care
Thank you , yes I’ve had a chat with myself to trust my cardiologist & to try not to get anxious about it . I’m 56, so could be in it for a long time. It’s way better than daily episodes of AF flying along at 190-250 that’s for sure .
Although he seems to think the AF will probably become permanent & slower over the years … will wait & see . For now I’m enjoying some normality with a healthy dose of lifestyle change.
Please did he tell you how Flecainide can kill you? I’ve taken it for several years now, first as PIP and now regularly. It has added to my fatigue but I’m still alive at 79, having outlived both my parents!
I don't know why the cardiologist said this especially now that I see so many people on here are taking it daily rather than as a PIP. I will ask him when I go in for my ablation next month but I can only assume we all have different problems etc meaning some medications don't suit all of us. I know I can't take betablockers because I had mild asthma at one point so maybe the Flecainide has a similar effect. If you're 79, it obviously is not doing you any harm. Take care
As you can see, different folks different strokes out there for PIP and medication in general. Hopefully you can talk to your main provider and talk about this episode and the ERs advice and be more comfortable the next time this happens to you.Me..I'm jealous of your low doses. I'm on 240 diltiazem daily and 150 flec twice a day now. When I was using it as a PIP after going off the drugs post my first ablation, I took diltiazem and then half hour later, one big dose of 300 flec. Usually would work within 4 hours. Unfortunately for me I started having episodes too often, so had to get back on meds full time, plus anticoagulant.
Good luck and cheers to getting some good info for you moving forward. Really that helps with peace of mind, which is as important as anything.
Thanks Banquo, I know I am a newbie. Its still making making me anxiety riddled. Sorry your ablation did not hold, and you are back on the full meds. This sucks!
I have paroxysmal afib and when it happens it take 100mg.Flacanaide and am in NSR in about 2 hours. If 50 does not help you go to 100 and if that does not help go to 150. 200 is a max
That was never mentioned to me. I thought it was too much for me as my partner said l flattened. I went hospital the 1st time l took them as l was nervous of taking them at home. That is why l reduced them the next time, but they didn't work. Bob says 300 max.
I take 200 mgs Flec as PiP and it stops my AF in about an hour. The last time I had an episode I took 100 mgs and waited an hour and a bit but I was still in AF so I took the second 100 mgs and it stopped within 10 minutes. My understanding is that the 'usual' PiP dose is 200-300 mgs. But the dosage has to take into consideration what other meds you're taking - in your case Diltiazem. I don't know if that would have had an effect on the recommended dosage? I don't take any other meds.
I ended up getting a response from the EP, he wanted to try the 50 mg first, and says that after 30-60 minutes if I don't convert, that I can take another one up to 200 mg.
He never shared that with me when he prescribed it, and its not on the prescription. But now I know. Thanks for the reply!
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I'm on 240 diltiazem daily and 150 flec twice a day now. When I was using it as a PIP after going off the drugs post my first ablation, I took diltiazem and then half hour later, one big dose of 300 flec. Usually would work within 4 hours. Unfortunately for me I started having episodes too often, so had to get back on meds full time, plus anticoagulant. 
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