me again confused ?

[Prosecco1997]

hello I spoke to my doctor , wanted to know how much propranolol is enough to take daily , when taking flecinide , I take 50 mg of flec twice per day , and currently take 40mg of propranolol twice aday same time as flecinide , but making me feel awful very light headed aswell , please can anyone advise me on what they take , my doctor did not seem very helpful , was like he couldn’t be bothered🙄

[CDreamer]

May I suggest you talk to your Pharmacist? I know when I was given a new med the Pharmacist would always do a follow up a week or so after starting the meds to see if how I was getting on with it. I found the Pharmacist more helpful and they are the experts, GP’s knowledge and experience tends to vary.

[Prosecco1997 in reply to CDreamer]

Thankyou , yes I think I will do that as they do seem to know more , thanks for your reply

[Prosecco1997 in reply to CDreamer]

Hello now been given antenolol to try 25mg once a day with increase to 50 mg if needed , I have not took them yet , I have felt realy heavy like concrete all day today awful feeling

[mrgwair567]

That’s disgraceful! he should be bothered! Isn’t that what he gets paid for!! Contact your pharmacy and see what they suggest. Hope you have some answers.

[Blearyeyed]

If you have another GP at the surgery I'd ring up and get another appointment with them. Or call your local Cardio Team or Specialist via their Secretary if you have one explain what's happening and ask for some advice. They can also contact your GP and pass on the recommendations you discuss with them to make sure your GP sticks to it and does not dismiss you in future.A Pharmacist won't be able to help much because although they know the side effects that Propranolol can cause and are experts about medication , they aren't trained to know why you as an individual patient would particularly react in a certain way , and aren't in a position to advice you on which dose you need as that is were the GP and their training comes in.

They also aren't meant to advice you to do , or not do things , that your GP hasn't agreed with, unless the medications you are on aren't meant to be taken together or the GP hasn't taken note of an allergy on your files the Pharmacist isn't usually allowed to advise you more than to tell you to speak to your GP to get changes made ( some will ring and make queries on your behalf) It's part of their code of practice.

There can be many reasons for how you feel.

If you've only just started Propranolol it can cause side effects as it begins to work which can take time to settle down before your body is used to the chemical change. It can help to start a new medication over a weekend when you can get more rest and get used to it. Drinking enough water each day and eating lightly can also help as it reduces stress on your body.

The dose is quite high so if you started it at that dose straight away it might be such a rapid change to your body that it's reacting badly to the affect the drug has even if you aren't allergic or intolerant to it.

Sometimes , even if you will need to be on a dose like 40 mg for your ideal dose, it can help to taper up from a lower dose over a couple of weeks if it isn't an emergency medication .

That can help your body adjust to the chemical change more slowly with less side effects. You could ask your GP if it's possible to try that.

My GP listened when I asked about this suggestion from a Specialist and now uses this method with many of their other patients too .

Unless you've been specifically told to take both drugs at exactly the same time you could ask if it's possible to take them and hour apart, finding out which to take first , it's another question for your GP or Specialist. You mightn't need to do this long term , but for a short time until you are used to the beta blocker.

Finally, even if you make GP approved differences to the times you take it or taper up the dose if you still feel the same side effects after being on it for 4 weeks or they are getting worse it could be that Propranolol isn't what will work for you or you aren't tolerating it.

At that point you need to tell the GP and ask to be changed on to a different beta blocker or possibly another medication if you find you react the same to beta blockers of different types.

It would help to keep a diary of your symptoms to discuss with the GP.

Note the symptoms and how soon they start after taking the medication.

Note if they get worse doing certain things or at certain times in the day .

It may also help to take your heart rate and blood pressure with a blood pressure cuff ( not a watch) before your medication and half an hour after it to see if it is dropping your levels more significantly than you need. Take screen shots of your results to show them.

This will help your GP make a decision about whether it's right for you , if you need a different dose or if it needs changing.

Evidence usually makes even the most arrogant GP take notice.

That was my experience. Beta blockers weren't what I needed.

Each patient has individual needs so even if others on the forum take different medications they may not be right or appropriate in your case depending on your medical needs and history and the reason you began this beta blocker.

If you do change the medication and are on a high dose it can also help to taper down from one medication over a week then taper up on the new one , otherwise you can still have side effects and be confused by what is causing it on the new medication even if it would work for you.

Hope you get this sorted out soon , take care , Bee

[Prosecco1997 in reply to Blearyeyed]

Hello Thankyou for your reply , iam going to try antenolol today 25 mg , but realy am in 2 minds if to to take flecinide with it ,as I don’t know if it’s the mix , my blood pressure is lower again today ? That’s without evening meds as I felt to ill yesterday, I feel ok until I take my heart meds , also very confusing, but surely something will work soon , been keeping a diary since , august 23 🙄 now got to a point of every morning, here we go again , mentally draining 😔

[JOY2THEWORLD49 in reply to Prosecco1997]

Hi

I rang the NZ Heart Foundation and spoke to a nurse. She had worked with the private Heart Specialist. Rung him and said I needed a lower dose of CCB Diltiazem. 180mg to 120mg.

Also to separate CCB and BB. Also to reduce BB down to 2.5mg from 5mg. I had reduced it from 10mg to 7.5mg to 5mg.

So AM I take CCB for H/Rate

PM I take BB for BP

For 2 years 3 months I have been AF controlled H/Rate and BP.

You know how you feel. I tell you that the Heart Foundation were the best. Specialists rely on patients to alert. But I took the new CCB at the weekend Saturday.

cheri JOY. 75. (NZ)

[JOY2THEWORLD49 in reply to Prosecco1997]

Hi

As another member suggested take the two meds an hour apart.

I would say that reducing and then adding is a better way of getting you right.

But I have never returned to the 180mg Diltiazem or returned to any higher dose of Bisoprolol.

The specialist's report read that the Dr could increase the Diltiazem up to 360mg!!!!!!

So heck on 180mg my h/rate reduced to 51 within 2 hours. I was light headed. I could not drive.

Be careful. Too high dose will make side effects.

cheri JOY. 75 (NZ)

[Prosecco1997 in reply to JOY2THEWORLD49]

Hello I have just took my first dose of antenolol 25 mg this morning with no flecinde , going to see how i go , as hopefully do not feel as ill as I did yesterday, it was strange because I took 20mg of propranolol instead of 40 along side flec 50 and felt more worse than on the propranolol 40 dose ? So I’m thinking could it be the flec ? Don’t want to stop flec but might have to try pill in pocket approach , but very anxious about that .

[dexter8479]

Very good advice from Blearyeyed. I am on Flecainide and 1.25 of Bisoprolol once a day, ie the lowest dose. It appears from an equivalency table that what you are taking in Propranolol is approximately the same as once a day 5mg of Bisopropol. That is a pretty hefty dose, and not deemed a starter dose from what I've read. The taking of a beta blocker when on Flecainide I've been told is to mitigate the risk of Flecainide actually causing a different type of heart arrhythmia. Both the EPs I've consulted believe this is a theoretical risk only, and take the view that if you can tolerate a low dose bb, it's a reasonable precaution. However, if you can't, they believe that the effects of a bb affecting your quality of life is not worth the price you're paying on something that's theoretical. Many Flecainide users do not take bbs.

With AFib, all treatments are solely to improve your quality of life. If a drug is making you feel bad , it's time to explore, with your doctor, stopping, reducing, changing it. You need to speak to another GP about it, if there's not a good one at your surgery, you can speak to a private GP for £50 or so, and you can consult a private EP for about £250-£300. Worth every single penny, as what you learn as an AFibber, is that you have to be proactive in your treatment, and be your own advocate. Also, you learn that GPs have very little knowledge or training on the subject, and the good ones freely admit that. But please don't mess around with a bb dosage yourself, or stop taking it without a tapering down/ change plan devised in conjunction with at least a GP - they do know a lot about that.

Do find a sympathetic professional ear, they can be found with persistence and homework. I hope you get help soon, there's no need to suffer in silence just because one GP can't be bothered.

[Prosecco1997 in reply to dexter8479]

Hello Thankyou for your reply , iam going to try antenolol today 25 mg , but realy am in 2 minds if to to take flecinide with it ,as I don’t know if it’s the mix , my blood pressure is lower again today ? That’s without evening meds as I felt to ill yesterday, I feel ok until I take my heart meds , also very confusing, but surely something will work soon , been keeping a diary since , august 23 🙄 now got to a point of every morning, here we go again , mentally draining 😔

[dexter8479 in reply to Prosecco1997]

So sorry you're suffering like this. I take my one Biso at the same time as my evening Flec. Fortunately I've never had an issue with taking the two together. My Afib almost always kicks off late in the evening or during the night, so my reasoning has been to take the bb nearest in the day to any episode. But I've never been told to take it at any specific time of day, nor at the same time as Flec. Hope you get some help soon, you shouldn't have to be struggling with this so horribly on your own.

[Prosecco1997 in reply to dexter8479]

My bisop flec never gave me any problems for 13 yrs , but now all change , how much flec do you take per day and biso if you don’t mind me asking , I always took mine together am and pm , have tried splitting aswell

[dexter8479]

I take one Flec 50 mg in the morning, same in evening. Biso 1.25mg in evening. Been on this combo 7 years or so. I have the blessing of my EP to take another Flec in the evening if I feel any of the little warnings of an episode coming on, also I can take the maximum of 300mg of Flec in 24 hours during an episode. But I emphasise that this is on the say-so of my EP. My episodes before Flec used to last 48 hours or so, with very high heart rate. Now they average 12-18 hours with a high heart rate of 120. The trade-off for my med regime is a very low resting HR of around 40, with the side effects of that, and a short time lag in my HR coming up when I exercise. The thing about treatment is that every single person has a different pattern, you and your doctors have to find the best combo of drugs that suits your body, I suppose for some that's an easy find, for others a longer path. I wouldn't be chopping and changing beta blockers and the dose you take without supervision, though. Good luck.

[Prosecco1997 in reply to dexter8479]

Thankyou , I have tried so many different ways lately , with doctor and arythmia nurse asked first , they have mentioned pill in pocket with flecinide but very anxious to try that , but might be my answer , thanks for all your help with my questions 🙂

[Ppiman]

I suppose that sometimes we all likely sound as if we can't be bothered. Maybe your doctor was stressed and busy?

A beta-blocker not only slows the heart and reduces the blood pressure a little, but it stops the heart responding to demand as quickly. This means that when the brain calls for oxygen, it can take a little longer for Amazon to deliver the order and the result is a feeling of fleeting wooziness or dizziness and a need to stand steadily for a brief moment. Unfortunately, this raises anxiety slightly which can exacerbate a higher heart rate and start a vicious circle. It's time, then, to sit down and breathe slowly for a few seconds till normal service resumes, and then to get up more slowly than usual.

I took an extra dose yesterday as my heart has been all over the place. It did help a little, but I had exactly what you described, and it was no fun.

Steve

[Prosecco1997]

Hello Thankyou , it’s an awful feeling isn’t it , at one point I thought I was going to drop to the floor felt so heavy in chest legs for hours