what mg do people use for the pill in the pocket approach is it generally 300mg
I am on 200mg but my cardio doctor was not against the Pill in the pocket approach he gave me the choice really of what I wanted to try first but edged in the side of regular times
I have been in Af all day and most of yesterday evening I took 100 mg last night I slept well 100mg today but AF started about 740 am and I have been breathless doing basic things
I am wondering if a regular dose is a waste of time and the 200 to max dose when there is a issue works better for members of the forum
My HB is currently 83 so not high but I am sat down
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For me it depends on the frequency of my episodes. If infrequent -- say once a month or less -- then PIP makes more sense. If frequent -- say once a week-- then daily Flecainide makes more sense, assuming of course the daily Flecainide prevents the episodes.
When I was on daily Flecainide, I was instructed to take an additional PIP dose, should I go into afib. The important thing here is to make sure you do not go over you maximum allowed 24 hour dose of Flecainde, which may vary person to person, depending on what your ep allows.
So, as a hypothetical, if your max allowed 24 hour dose of Flecainide is 300 mg and you're taking 100 mg bid ( twice a day) then you already have 100mg on board, so your PIP dose would be 200mg.
Personally, my daily Flecainide dose was 50 bid and my maximum PIP dose was 100mg, taken 50mg at the onset of an episode and 50mg an hour later if I did not convert. That would be a maximum of 150mg in 24 hours, which is less than the 300mg that some others may be allowed.
Hope this helps some, but just make sure you go over everything with your ep. Flecainide is serious medication and you want to get the dosing protocol right. That would be from your ep who knows your medical history.
Flecainide is a very potent drug which can have very severe consequences if not taken strictly in accordance with instructions from your own medic. Under “normal” circumstances, no one should exceed 300mg within any 24 period.
No I’m on 200mg or he mentioned 300mg max for anyone
I just wondered if I would be better off as a pill in the pocket than using 100mg before bed then having Af at 7am with only a 100mg to use to the evening
The cardio doctor at the time wasn’t against it but said as my monitor showed I was in AF a fair part of the week a regular dose at set times may work more
Thanks for your informative post. I'm 73 post 2 ablations. all good for a year. The 'assassin' has recently struck a couple of times. Cardiologist ordered Bisoporal 1.25mg. Reverted after 24 hours. I'm about to take a long flight for a vacation overseas, and I'm expecting there will be occurrences at some stage. The doctor suggested Flecainide 2x50mg as a PITP. In your experience, does this mean if an when one reverts to NSR, it's okay to cease the medication? Mike
So if I understand you correctly, you're currently not on daily Flecainide, but your doctor suggested 100mg Flecainide as a Pill-in-Pocket (PIP) in case you go into afib? And your question is do you continue taking Flecainide on a daily basis afterwards, or do you cease taking it?
In general, if you're not on daily Flecainide, the PIP dose is taken for conversion purposes only and once you go into normal rhythm it's stopped.
On the other hand, it might be reasonable in some instances to continue afterwards on a daily dose for a set period of time until things calm down.
This should all be discussed with your doctor in advance. You should also ask them what happens if your're still in afib after "x" hours on the 100mg dose. Do you take more, or is the 100mg the maxium amount you are allowed.
In my case, I was allowed a 24 hour maxium dose of Flecainide of 150mg, however some are allowed as much as 300mg in 24 hours. It depends on what you and your doctor agree to. Flecainde is a serious drug and you want to make sure in advance that you and your doctor are on the same page.
My current PAF treatment (Jun 19) is daily Flecainide 50mg (am) and 100 mg (pm).
Flecainide has generally worked well for me, no known side effects or issues so far. I had one AF episode (Jul 20), which spontaneously synced to NSR. Since then I am 3+ years ‘Afib free’ - no detectable, sustained arrhythmia.
I do have an ‘emergency PiP’ option too. Should I have an episode, I can try an extra 100 mg of Flecainide and 2.5 mg of Bisoprolol. My Afib is usually with RVR, so the beta blocker is there to protect my ventricles. The idea is this PiP will help ‘knock’ my heart back into NSR before I have to present at A&E. I am pleased to say, so far, I have never had to try it. In previous episodes, I returned to NSR spontaneously in a few hours. I do recall being told not to exceed 300mg.
I have mentioned this before on previous forum posts. The topic up for discussion at my review next year is moving from daily Flecainide to PiP only; I’m sure it will be a long consultation. I don’t ’experiment’ with my medication, strictly following the regime set by my cardiologist.
No but I think I have been lucky with my response to Afib so far, as I am generally’fine’ bar the telltale flutterings because of the irregular 150bpm HR. BP, etc holds up. The only other symptom is more frequent urination. Previous episodes, resync spontaneously to NSR in a few hours and I feel ok; even gone for runs on the morning after, at my cardio sessions.
That said, it has been a number of years now since a sustained episode. I will be pretty upset if (or when) it creeps into my life again.
50mg each morning and evening but take 100mg as PIP if trip into AF with a further 100mg if I’ve not reverted 2 hrs later. I’m normally back in NSR after 1st or 2nd though it can take up to 10hrs, if longer, then I keep topping up to the max 300mg in any rolling 24hrs. On one occasion, it took me 2 days before the old gal reverted.
Curious, in the few cases where you didn't convert during the first 24 hour cycle, did you take the second day's PIP dose in one 300mg shot, or did you divide it up?
Always took as 100mg dose as and when each earlier 100 mg dose became greater than 24 hrs. Always hopeful that just one more 100mg would do the trick. Interesting thought though, that if it didn’t revert within the first cumulative 300mg dose, do I wait 24hrs and hit it with a 300mg dose? Or maybe less of a delay and hit it with 200mg dose when timing is right?
I would emphasise the key aim is not to 'manage' episodes but to stop them.
So if you are having say more than one episode every 3 months (accepted by most these will increase if action is not taken) then I would discuss with your cardiologist/EP going on to a regular daily dose of Flecainide high enough to stop all episodes.
The above suggestion is based on my personal experience. Despite wanting to use PIP my cardiologist said this was too much of a roller coaster for the heart. He started me of 100mgs Flec daily, still had 2 episodes a week, offered me an ablation I declined and requested to try 200mgs daily, which has worked fine for 10+ years.
When I was first prescribed Flecainide as a PIP it was for 100mg and it always ended episodes in a few hours at most but as episodes occurred more often I was advised to take it regularly 50 mg twice daily and now 100mg twice daily and no episodes for months now! Only had one around the time I must have caught covid when an extra 100mg stopped it in a few hours. 300mg is the maximum daily dose so rather over the top as a PIP but we are all different. Hope you find what works for you.
I was told by cardiologist to take 300mg as a pip which converted me in half an hour but l flatlined and then my pulse slowly crept up to normal. I thought maybe 300 was too strong for me so l took 150mg the next time l l went into afib but it didn't work.
No, l was just given a pip and an anticoagulant when l had preserved e.f. When l deteriorated l was changed to a beta blocker. The cardiologist said flecanide wasn't suitable for me any longer.
Currently my pulse is 68 but if I get out if my chair to do some light every day jobs I will be breathless yet due to the beta blocker only have a Heart beat of 65 to 70 .
Everyone is different. What was explained to you was probably in the context of your circumstances. Presumably PIP is for people who have infrequent episodes of AF and when they do, they respond positively to PIP. As a consequence, their specific circumstances don't justify being medicated 24/7. If that wasn't the case then their treatment would be changed to something that was (more) effective. For some people, medication eventually becomes ineffective, so starting on the minimum required medication makes sense as this provides option to increase medication until you max out and lower dos/PIP also minimises impact of any side effects. Having stated that, I never had PIP. I started on daily meds (lowest dose), which was increased until it became effective. Presumably I didn't start on PIP because my episodes, although paroxysmal, were too frequent.
They help your heart beat more strongly or slower so you feel better. When you have afib you have it for life. Some procedures can lessen it but tablets alone can't stop episodes of afib.
If you get rare episodes, then PIP is great, but if they are weekly or more frequently than that, then a daily dose probably is better. The difficulty is if you are in between. I found that 300mg would stop my afib in 30 mins, but 200mg didn't work at all. But if I went on daily dose, then I could never take 300mg, since that would always put me over the daily limit. Bit of a dilemma.
The 250mg that I increased to from 200mg seems to be doing the trick only trouble is I only have a prescription for 200mg
Made a appointment with my GP for the end of next week to see if he will increase my amount as it’s so nice having a 60 HR and not waking up with 95-100
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