flecainde

[NLGA]

what kind of mg are people on and for how long have you been taking it

I am now on 200mg a day i take 100 morning and night

[mjames1]

I have about a year's experience with daily Flecainide. I took it alongside Diltiazem, which acted as a nodal blocking agent for safety reasons.

Starting dose was 50mg bid (twice a day). Had a few episodes the first week on that dosage, got impatient and asked my ep to increase to 100mg bid. Did not feel well on 100mg bid and a captured ekg on my Kardia while on a treadmill which suggested to my ep it was too high a dose, so back to 50 bid. After another week 50 bid started working and no more episodes.

Later, I started having a few morning episodes, so my ep let me titrate up to 100mg night/50 morning, which helped. Some dietary changes helped my morning episodes, so went back to 50/50 and even as low as 25/25 at one point. The idea here was to take only as much as needed and also to be able to reduce my Diltiazem dose. Fortunately, my ep believed in shared decision making and was onboard with the dose titrations. Long story short, my original dose 50/50 seemed to be the sweet spot balancing efficacy and tolerability, but I did have long periods of sinus rhythm on only 25mg bid.

After about a year, with only a handful of short episodes, I decided it was time to see if I could get off daily Flec completely and only use it as PIP. I could not. As soon as I got down to 25mg once a day, I started having frequent afib episodes. Then I had to decide whether I wanted to take daily Flec for life or try an ablation. I decided to have an ablation which has worked out well, at least for my afib.

For the handful of episodes I did have, my instructions were to take an additional 50mg at the onset of an episode and then another 50mg an hour later if still in afib. Half the time I did not need the second dose and in all cases I converted to sinus rhythm in 1-4 hours.

Jim

[NLGA in reply to mjames1]

Great information I will have another read of that for reference

Thanks

[mjames1 in reply to NLGA]

I think the big takeaway from this thread is that the right Flec dosage for person "A" is not necessarily the right dosage for person "B". That said, I don't think too many will disagree that ideally you will take the least amount of Flecainide that will achieve your goals. Unfortunately, IMO, some people start a bit too high and never test whether a lower dose will work or not.

Jim

[Drounding]

I started with 50mg as pip, then 50 am and pm, now on 100 am and pm. All over about 5 years or so. I also take my dose earlier if I get an episode. I don't get any negative reaction to it thankfully.

[secondtry]

200mgs/day with no accompanying drug.

I started on 100mgs at age 60 but still experienced 2 episodes a week. Was offered an ablation but requested 200mgs as that was still just a 'medium dose'. This dose level stopped the episodes and I have been fine for 10+ years on the same dose.

Why no accompanying CB or BB drug: I have discussed this several times with my cardiologist and he maintains the advice that due to my BP and HR levels being on the low side, they would make me feel unwell.

Personal view: I put the success to date down to not just the Flecainide but a host of other lifestyle changes I have made; in other words in my case with Lone PAF a 'hybrid solution' was the answer.

[Spoiler]

I currently take 50mg every 12 hours, but have taken up to 150mg every 12 hours (for 13 months) I have been taking it for about 7 years. I also take metoprolol with it. 25 mg every 12 hours, had been 50 mg twice when I was on the higher dosage of flecainide. Hope this helps

[NLGA in reply to Spoiler]

Thank you

[jwsonoma]

Started at 50mg 2x day. had a couple of break throughs so went to 75mg 2x. 1 break through in 5 years. Take 1.25mg Bisoprolol to prevent side effects of Flec.

[Lizty in reply to jwsonoma]

I have been prescribed Flex after hopeful all clear from angiogram. What are the side effects of Flec? I can't take bisoprolol..

[jwsonoma in reply to Lizty]

Check with a chemist or your Dr. but I was told I had to take a Beta Blocker to help prevent a rapid HR which is a side effect of Flec. I take 1.25 mg Bisoprolol but could also take Metropolo.

I would google Flecainide to read about the drug then ask your DR.

[AAJJTt]

PAF - chem-cardioversion - Flecainide 50mg (am) and 100mg (pm). Additional PiP too - 100mg + beta blocker. Been administered for 4+ years, well tolerated, no known side affects , functions (liver, kidneys, etc) ok so far. Currently very fit and healthy, ‘Afib free’ for 3+ years - no sustained arrhythmia or breakthroughs - never had to use the PiP.

[Vonnegut]

Snap! I’m on the same dose now and it has stopped AF episodes mostly but comes with added fatigue and has messed up my previously fine digestion. I’m 79- female-

[Finvola]

My EP started me on 2 x 100mg daily 'in the interest of clinical effectiveness' (his words) just over 9 years ago. I've had no AF that I am aware of in all that time.

I did try to reduce to 2 x 50mg after a few months on the higher dose but felt dreadful with hours of ectopics and racing heart, so I contented myself that I needed 200mg. It is accompanied by 2.5mg Nebivolol daily and I feel great.

[NLGA]

my 10mg Bisoprolol seems high compared to others

Any views why that is ?

[wilsond]

I started on 100mg as a PIP,then 50 x 2 then 100x2 .100x2 for several years,ntil my ablation last year and still on 50 x2 now( awaiting RF ablation)

Had no problems with it. 300 mg is the maximum advised

[NLGA in reply to wilsond]

Thank you

I’m now on 200 so hopefully this will help 100 didn’t do a thing for me really

[mike1961]

2006 and 2007 I used 300mg Flecainide as a PiP once a year (20mg propranolol first and the Flecainide 10 minutes later) - episodes terminated in around an hour.

May 2008 (after an episode in each of Jan, Feb, Mar and Apr) I switched to 100mg Flecainide twice a day - right up to the present day with no side effects whatsoever. Still one or two episodes per year for next 10 years but always terminated with extra 'PiP' 100mg Flecainide within an hour or two.

Then in the first 6 months of 2018 I had 1 episode every month with the extra 100mg PiP taking 5+ hours to work rather than the 1 hour it used to. So I had a PVI ablation in August 2018. I tried coming off Flecainide 3 months after this ablation but soon ran into some minor arrhythmia issues so went back on it. Then bad bout of Covid in Oct 22 put me into persistent AF. Second ablation (PFA + Marshall Vein Alcoholisation) in Jan 23 and been in NSR since. But with a few 1 or 2 minute runs of atrial tachycardia in the first few months after I decided to continue the Flecainide (each 100mg being taken with 10mg propranolol).

Would love to get off Flecainide ideologically but that said the inescapable fact is it has been a good friend to me this last 15 years. In 2010 had intracellular testing which showed very low Mg and very high Ca. My mother and both her sisters had AF from their 30s onwards, so I suspect a genetic ion channel problem with sodium also being implicated. Monosodium-glutamate has always been a potent AF trigger for me again suggesting ion channel (sodium) involvement and why Flecainide works well for me in suppressing arhythmias. By the way my episodes (even the one in Oct 22 which turned out to be persistent) have always started nocturnally typically 4 or 5am in the morning.

By the way, I only use the original Tambacor variety/brand of Flecainide (which I have to order from overseas - and it ain't cheap...) as I am firmly of the opinion that the generics are not as effective as the original patented versions. Accord is likely the best option out of the generics.

[dedeottie]

I was on that dose for around 3 years. It worked for me but eventually caused something on my ecg that shouldn’t be there and had to change to Sotolol.

[Suesouth]

I have been on same dose as you since last December!

[bassets]

I have been on 50 mg twice a day with dilitiazem for the last year with no hiccups after my first ablation and an AF breakthrough. I can't take more as I once found after a month on 100mg with nothing else.