Diltiazem with Flecanaide

[iggyrich]

I'm 69 and I have lived with Paroxymal AFib for 20 yrs with episodes every few months, After taking Flecanaide, 200mg per day, for 15 years I have been taken off it as it has recently started to affect my heart rate taking it up to and sometimes over 130bpm regularly. I now take 120mg Diltiazem Prolonged Release (Adizem XL) each morning which has helped in bringing the heart rate down.

I'm considering asking to be put back on Flecanaide again so that I can take it alongside the Diltiazem if possible. Although Diltiazem has reduced my heart rate down to 80/90bpm and 50bpm when resting, which what was needed, I'm now experiencing annoying erratic and irregular heartbeats which hopefully I think the Flecanaide can take care of as it is used for rhythm control.

Anyone taking Diltiazem Prolonged Release alongside Flecanaide. What dosage of each do you take and at what times of the day, spaced out or together and more importantly does it work for you?

I'd appreciate your input but please don't suggest ablation as an alternative as that is not going to happen. Thanks

[mjames1]

What did the ekg show when your heart rate was 130 bmp? I'm sure that at least in part guided your ep to take you off Flecainde.

If you qualify and and tolerate it, Flecainide works well for afib and ectopics, however it is not used for aflutter and in fact can make aflutter.

But to answer your question, I took 120 mg Diltiazem per day alongside Flecainide. I either took it as a single time release capsule, or as 30mg fast release tab, taken four times a day.

But I didn't take it to lower my rate, since I was in sinus rythm with a normal rate. I took it as a nodal blocker for safety reasons, as it's often given.

You haven't given us a lot of info, nor are any of us doctors, but let us know what your ep says, and just as important, why.

"Why" is a question that often gets left out of the doctor-patient conversation and it answers a lot of the questions we all ask.

Jim

[iggyrich in reply to mjames1]

I know why my EP put me onto the Diltiazem, specifically to reduce and control the heart rate. He took me off Flecanaide as it has the potential to convert atrial fibrillation into atrial flutter with 1 to 1 conduction and also ventricular tachyarrhythmias. Which is what I have been experiencing for months before my EP stopped the Flecanaide and started me on Diltiazem alone. Usually Flecanaide is used in combination with beta-blockers or calcium channel blockers to prevent this but for 15 years I have taken it on its own as directed.

I have been on Diltiazem for 4 weeks now but unfortunately I now have developed ectopics. I just wanted to find out from the forum if anyone was successfully using both Diltiazem and Flecanaide before discussing this option with my EP.

Do you tolerate taking both well and what dosage of Flecanaide do you take?

Iggy

[mjames1 in reply to iggyrich]

I tolerated both together ok, although it took a few weeks to get used to them. My sweet spot was Flecainde 50mg twice a day and 120 Diltiazem/day. I took the Diltiazem fast acting tabs at 30mg each 4x/day. I hear the fast acting tabs may not be available everywhere, however the 120 mg time release should do the same thing and once a day dosing is more convenient than 4x/day dosing. Hopefully, your doctor will concur wth this combination and it will keep you out of afib, reduce or eliminate your ectopics and keep you out of afib! They did for me.

What I did notice was that it was very hard to get my heart rate above 100 during exercise with the Diltiazem. I think that ended up affecting my cardiac conditioning to some extent. Also, at one point I developed edema (swelling) at the ankles and feet, which is common for Diltiazem. But an ok tradeoff for going into afib.

Jim

[Foxglo in reply to iggyrich]

Yes I had Flecainide for a few years first with Bisoprolol stopped because Redprstory conduktant didn't like it because I have adthma so changed to Diltiazem. The Flecainide was stopped after my ablation but reintroduced after 2 AF episodes later being weened off the Flecainide so was done to 120 morning and evening. Just evening now as my BP was low which was an issue after a TIA Altjough I do not want to talk things up at oresent I am settled. Ectopic are an issue some times but I hat go months without any.

[iggyrich]

Thanks Jim for your reply. Unfortunately after 20 yrs of living with this you learn that there always seems to be a lot of trade offs when you have AF. Hope all continues to be good for you in the future. Take care

[secondtry]

Please keep us informed on your chosen pathway. I have been on 200mgs Flecainide only for 10 years with no AF (well 2 v short episodes) and interested in future options should they be necessary.

[bassets]

I am taking both - 50 mg flecainide twice a day and one 120 mg Adizem at night. I feel well on these doses at present. A few years ago I was taken off the Adizem and my flecainide was put up to 100mg twice a day following a trip ti A&E which made me feel really ill.

I complained and was put on 120 mg Adizem twice a day aagain and the flecainide reduced. This worked well but the Adizem made me very lethargic, so I asked if I could reduce the dose, taking the 120 mg just at night as my Af occurred then. The Adizem works well with it as far as I'm concerned and things seem stable (for the moment!)

It took a while to get the right dose for me. I hope you can sort things out for you soon. Best wishes x

[custard1]

Hello ye I'm on diltiazem and flecainide. been on.it for about 5 years. I take 50mg flec twice a day, and 60mg diltiazem twice a day. generally works well for me.

[Singwell]

Not any more, but yes. I was on 50mg Flecainide X 2 with originally 200mg prolonged release Diltiazem. When I lost weight (over a stone), the dose of Diltiazem was too much abd I reduced to 120mg, which suited me better. Only issue otherwise was occasionally I'd get a BP hypo after a long episode of AF. The Diltiazem has about a 2 hour rise time to it's peak in the prolonged release form. For me that was sometimes problematic. You can also get in modified release form in the UK which is a tablet. So I eventually moved to that at 60mg X2. Now I'm not on either as I've been AF free since May 2022.

[Sniggetts]

Hi there , very interesting reading all of the reply’s to iggyrich … we are all slightly different.

Having had PAF at 200-280 bpm at times & ending up in the coronary care unit , I have finally settled on 50mg of flecanide twice a day and 90mg of prolonged release ( Adizem SR) twice a day .This has worked a treat .., get a few thumps & bumps … but nothing that makes me feel unwell at all & is apparent quite normal. My HR has settled well & so far so good. I’m 56 & normal weight .

All the very best 😊

[lizzieloo2]

I am 69 and have had paroxysmal AF for about 10 years. When I was diagnosed, I was taking 240mg Diltiazem for blood pressure and it was increased to 300mg to act as an anti-arrhythmic as well. A few months/years in, I was given Flecainide 100mg to take as a pill in the pocket - 2 to begin with, then another 1 after an hour if no effect. This was later reduced to 1 x 100mg to begin with, then another 1 after an hour if necessary. I put off taking the Flecainide for ages but eventually succumbed with no ill effects and it did work usually within 2-3 hours rather than 1hr. However, my EP wanted me off them and I had an ablation in August and he's told me not to take them if possible. Waiting now for my 3 month follow-up appointment to see what happens next. Had 2 AF eps since ablation, first lasted 6hrs but day after procedure and went after a cup of tea, second lasted 3hrs at most (fell asleep) and then just went on its own. From what I gather, Flecainide is not a good idea for some people but I don't exactly know why. All the best

[JOY2THEWORLD49]

hi

no flecainide as my heart is structurally abnormal.

have another ECHO, 24 hr monitor.

only DILTIAZEM 120 mg AM controls H/R on rest. 60sday 47night.

BB Bisoprolol 2.5mg PM controls BP.

123/69. 60s H.R at rest.

HAD AN ECHO 10 days ago. changed 70 H/R DAY 3PM ECG

CHEERS JOY. 74. NZ