Pill in the Pocket flecinide

[chrisan200]

I have had AF quite regularly for about 3 years and use 300mg of flecinide as a pill in the pocket. It always puts my back into SR. This time it hasn't. Has anyone experienced this before and know why it would stop working for them?

[BobD Volunteer]

Flecainide does not stop working. It is not like some drugs with receptors in the body where more is needed until it stops having any effect.

AF is a progressive condition and yours has. "outgrown" the drug.

[chrisan200 in reply to BobD]

Thank you

[pottypete1]

For 30 years I have taken Flecainide both regularly and as a PIP.

I cannot count the number if times PIP worked but it was the vast majority of occasions - many times a year!

However, like you there were some times when it didn’t work.

I am a difficult case and am very symptomatic when in AF. For this reason I was instructed to contact the Arrhythmia nurses of attend A & E. On all but one occasion they carried out a cardioversion as they did not want me to be in AF for more than a day or so.

You will no doubt find that the Flecainide PIP will work next time it is not necessarily going to stop working.

Pete

[chrisan200 in reply to pottypete1]

Thank you

[Blearyeyed]

It could just be a one off.Did you notice if the event was in any way different to your usual episodes. with any new symptoms?

It's worth noting down the date and time it lasted in a diary.

If it happens again also note down these to see how frequently it starts to happen.

If these events happen a number of times it is worth getting an appointment to see if you need a change in your medication dose.

If you haven't had a general check up at the GP surgery or medication review in the last twelve months now would also be a good time to book one of those. You can mention part of the reason you want to get a regular check up now us because this event happened and you might also need some advice.

Take care , Bee

[Alweoh62]

I’ve had 2 ablations and prior to these had used 300mg flec. which had become less effective over time. It’s a progressive condition .. best to try to stay out of AF, avoid your triggers and try to get back into SR asap. AF begets more AF. Good luck

[Bhoyo]

I also have Flecainide and Metoprolol to assist as aPIP. I take 100mg of Flecainide when first occurs and then a maximum of 300mg over 24 hr period. I take 25 mg of Metoprolol to assist if heart is also racing(most times). Both drugs have adverse effect but help me to attain NSR. I have had PIP for close to 10 years and as BobD stated my AF now takes longer to be controlled. Whereas previously I might have only needed 200 mg of Flecainide before back into NSR. I am finding I need the maximum 300mg and in some occasions I have taken myself to A and E as after 48 hrs and high heart rate still no NSR. On a positive note and not wanting to jinx myself I have had a good run of nil AF(touch wood). All the best Cam

[secondtry]

My cardiologist told me taking PIP is only a short term answer as the 'roller coaster' approach unsettles the heart; I suspect he would emphasise this to you taking 300mgs. I have Lone vagally mediated PAF, initially experiencing 2 episodes a week.

Instead he told me go on a daily dose, assuring me the residues would be expelled from my body, so no side effects. I started on 50mgs x2 daily, wasn't enough, so went onto 100mgs x2 daily and been virtually AF free for 10 years. So far he has been right, so I would discuss this option with your trusted medic.

PS. I have also made a lot of better lifestyle choices which I believe have helped me stay AF free ie a 'hybrid cure'.

[Tapanac]

I was told it was better to have a regular daily low dose (50 x twice a day) rather than pip

It will probably work next time if you carry on as a pip

[TopBiscuit]

It's possible it was a one off..? Was there anything else going on for you at the time? I take 200 mgs Flec as PiP which has always brought me back to NSR in an hour or so, but when I had Covid recently it didn't work so I just took an anti coagulant and let it run its course.