I took Flecainide as a PIP (100mg) as prescribed by my cardio on Tuesday. Sadly it didn’t work on day 1 but I felt much better after 3 hours or so. But didn’t revert to NSR. my cardio has upped my dose to 100mg twice a day starting today (day 3) and days continue until he sees me in 10 days.
Has anyone had experience of reverting to NSR after taking Flecainide for several days or weeks even?
In all 3 of my prior AF episodes I reverted naturally after 10 days or so. So I’m worried that by taking Flecainide I’m stopping the body doing it’s natural reversion to NSR. Is this likely?
Am I being paranoid? Has anyone reverted after using Flecainide for extended periods?
Any answers most welcome.
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OscarN
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Anything is possible, but I don't think you have to be too concerned that the Flecainide is impeding your return to normal rhythm.
Most probably the opposite -- that is that the dose you're currently taking is too low to convert. That said, your cardiologist may have reasons for proceeding cautiously and may want to do further observation and/or testing before upping the dose.
Personally, I've converted with as little as 50mg of Flecainide and my ep allows me no more than 150-200mg in a 24 hour period. Others have been advised to take 300mg in one PIP dose. It really depends on the individual.
Given your history, you hopefully and probably will convert before you visit your doctor in 10 days. If not, your cardio may want to up the dose or try something else.
If I'm having an episode of AF, I'll now take a 100mg pill, then wait 3 hours. If i'm still in AF, I'll take another one. So far, 2 pills has worked every time to get me back into NSR, within 4 - 5 hrs of an episode starting. Before Flec, my AF episodes would last between 1 - 3 days or sometimes longer.
Recently I've started taking Flec everyday to prevent episodes from even starting and it has been working very effectively. I take 25mg in the morning and 50mg in the evening. I haven't had an episode since doing that (I started in May). Before that, I'd get an episode about once a month or so.
To me your episodes sound too long and you need to be on a medium dose (100mgs x2) of daily Flecainide to stop them coming back; of course to be discussed first with your trusted medic.
Initially I was determined to stay on PIP as like you I didn't want my body to become dependant on Flec. However, my cardio said PIP was too much of a roller coaster for the heart, I accepted the advice begrudgingly and have been fine for 10yrs. I also take supplements and have made many lifestyle changes, which may have been part of the solution, who knows 🤔😀.
Hi Oscar - 100mg as a PIP seems a low dose to me as I was prescribed 300mg for PIP - maximum dose in 24 hours. That worked for a few years as an PIP, taken on an empty stomach and within an hour or so of AF starting. I then went onto daily 100mg every 12 hours which mostly worked, for about 10 months, taking the occasional extra 100mg if I experienced an episode but eventually AF broke through,. In my case, with or without Flec I self converted within 3-5 days.
If you self convert then Flec should help rather than hinder but everyone reacts differently. Whatever cures can also cause and certainly Flec can cause arrhythmias as well cure them. Flec is not like Amiodarone which builds up in the body so may take time - 3 months for my husband’s persistent AF to convert to NSR.
I would say if Flec is not working for you in that dose - I cannot see the point in continuing to take a med with risks if it is not doing it’s job for you but you must talk to the prescribing doctor for advice, sooner rather than later.
The longer the AF continues then the more likely it is to become persistent. Is Cardio version or Ablation a possibility?
Thank you. My cardio said to up my daily dose to 100mg twice a day. I’m minded to take the full 200mg in one go this morning. Plus I’m having an MRI this morning!
I would hold off from taking a higher dose until after you have had the MRI results.
Sounds like your cardiologist maybe playing it safe until after they have looked at the MRI results. Flec is not a drug to mess around with as it is an extremely potent drug which can also harm and first rule is DO NO HARM.
We are not medically trained here and at best can only speak for ourselves bearing in mind that we are all very different. What is right for one can definitely not be right for another.
In my opinion you should do absolutely nothing different until your EP has is able to assess again and review your medication and guide you.
I have taken Flecainide as PIP for many years. If you are already taking a daily dose whatever you do must NOT exceed 400mg in 24 hours ( 300mg is even safer) and never take more than 200mg at any one time. I have done that accidentally on a couple of occasions and it made me feel absolutely awful for 48 hours.
My Doctor has prescribed PIP metoprolol 100mg followed 20 minutes later by 100 mg of flecainide and if not reverted in 60 minutes another 100mg of flecainide.
I typically have an episode every four months or so and have been able to revert with only the single dose of each. Until last week…
I was to run a 10k race at 5 AM, and woke up at 1 AM in AFIB. It took the total dose to bring me back to rhythm. I ran and finished but really labored with my time 20 + minutes longer than normal. My legs felt wobbly , had some light headedness and recovery time much longer.
I have paroxysmal Afib and to keep episodes to a minimum I take Flecainide on a daily basis of 200 mg. slow acting Apocard Retard. When and if Afib breaks through that medication, I take an extra 200 mg regular Flecainide (Tambocor) which will stop the episode within between 2 and 5 hours. I then am at the maximum dose of 400 mg. daily. But it works every time.
iI take 200 mg of Flecainide slow-release daily. If and when AF breaks through -mostly due to stress- I take an extra 200 mg of fast-acting Flecainide, which will convert me to NSR in between. 1 and 4 hours. Works every time. Maybe 100 extra dose is not enough in your case…
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