Felcanide query again

[Maymuna]

Hi, I appreciate there have been a few recent posts about Flecanide this week which have been helpful but havent answered my own issue. Pre stroke last November I was taking 100mg pill in the pocket. Post stroke I was put on 100mg daily. Had a 48 heart monitor and got a call to say I should reduce to 50mg twice daily which I did. With either dose I was still getting an AF episode once a week. They lasted a lot less hrs than before and were different -more of a rapid heartbeat than the original all over the place ones. When I saw the cardiologist last Thursday he said once a week was too often so put me back on 100mg twice a day which initially wiped me out for a few days.

Yesterday all I did was tidy up the rubbish bags outside as the foxes had got into them (London problems...) but when I came inside the AF started, only 4 days after my last one. I felt so discouraged that nothing has changed even with a higher dose after a little physical activity.

Question 1: I'm fasting for Ramadan so is the Flecanide not working properly due to my strange timetable? I have to take it before and after the fast and its not an hour before food. I have to take it then eat. Does this stop the absorption it needs to fully work?

Question 2: can I vary between 50 and 100 mg as I saw on another post, as if 100mg makes little difference then why am I subjecting my body to a higher dose? Or am I just being impatient and should give it time to settle in?

I always find the forum so helpful so thanks to all in advance.

Maymuna

[Mightnot]

i’m on 100 mg of flecainide and I’m increasing it to 200 mg after going back into AF on my doctors advice. My doctor said that this won’t get me back into AF but other forums and other threads suggested the higher dose of flec might get me back into AF. I’m not sure but I’m gonna give it a try. You can take up to 300 mg but I have read some post that if you suddenly take a lot of then it it can be very toxic and very dangerous so chat with your doctor before increasing your dose of course. I’m raising my dose to 150 then 200 on doctors advice. As for whether fasting can trigger atrial fibrillation I don’t know and for me there is no firm evidence that something triggers my atrial fibrillation it could be caffeine it could be bad sleep it could be stress I don’t know there’s too many variables to manage. I will be in af until I get some sort of surgical procedure, e.g. cardio version et cetera

[Desanthony]

I presume you neither eat nor drink during daylight hours so would imagine that you are dehydrated and this can have an effect on AF.

[Buffafly]

I’m not sure why you can’t take your medication an hour before food even if fasting during the day?

[secondtry]

Ans 1: Very likely not able to work properly. I religiously take 3 hrs after a meal and then don't eat for 1 hour.

Ans 2: My heart prefers stability so suggest don't vary the daily dose, my cardiologist agrees. 100mgs didn't stop my AF but 200mgs did for 11 yrs, felt odd for the first 3 months.

[Model52]

I’m on Flecainide 1 x 200 mg/day in the slow release version (Apocard retard). It keeps AF at bay for about 2 months. If there is a breakthrough, I take another 200 mg fast acting Flecainide (Tambocor) which will usually stop the episode in between 2 and 5 hours. No side effects worth mentioning besides some tiredness the day after I took the maximum of 400 mgs.

[Vonnegut in reply to Model52]

I thought the maximum dose to have in one day was 300mg! I have found that taking 100mg twice a day has worked very well for me and I haven’t had an episode for well over a year now. The last one occurred around the time I must have been infected with covid (no other symptoms but a positive test) and that was ended in a few hours with an extra tablet so just reaching the maximum daily dose of 300 mg. Of course, we are all different but hope you get yours sorted out successfully.

[Abbyroza in reply to Vonnegut]

My cardiologist advised 200 + 200 in case of breakthrough. When two breakthroughs occur in 24 hours, he even advises to take a second extra 200 mg. Which then amounts to 600 mgs/24 hours. He knows that this is way above the advised maximum of 400 mgs, but he says that will not have any negative consequences as my heart is healthy, with an ejection fraction of 65% and no remodeling after my heart attack of 6 years ago. But not to be taken as general advice! Every heart is different! In my case it terminates AF episodes very efficiently .

[Vonnegut in reply to Abbyroza]

My advice came from an EP, the cardiologists who deal with electrical problems in the heart and he told me that 300 mg was the maximum daily dose and when taking as a PIP to take a Busiprolol ( in my case 1.25mg) if my heart rate was above 140 twenty minutes after taking the Flecainide which rarely ever happened. It’s worked for me but we know we are all different.

[bean_counter27 in reply to Vonnegut]

I saw my cardiologist last week. I am on 300mg Flecainide (150mg twice daily) and I mentioned something about it being the maximum dose. He said he would be comfortable with me going up to 400mg daily if required (no impending need, 6 episodes in 12 months, last one 3 1/2 months ago, all short-lived bar one, which went for 10 1/2 hours. Discussion moved on pretty quickly as it was annual appointment with a lot of ground to cover.

I recently had echo and stress test echo, which cardiologist requested for my appointment. They showed my heart was still sound after 5 years since being diagnosed with AF and that I had a high tolerance for exercise. So maybe like Abbyroza, if heart is in good condition then 300mg daily can be exceeded?????

[Vonnegut]

Is there not some exception or reduced fasting times possible for those Muslims with health problems? I seem to remember that in Judaism it is not mandatory to keep all the 24 hours of the Day of Atonement fast in those circumstances. This was for the person who is fasting for Ramadan.

[Auriculaire]

Both dehydration and low blood sugar are likely effects of fasting and both can bring on afib. I thought that there were exemptions for taking medicine and indeed for people who have medical conditions regarding fasting . You should be taking your meds as advised by your doctor not altering them to fit in with fasting hours.

[Maymuna]

Many thanks for all the replies. I think I'll give it time after Ramadan to see how it settles under the usual regime.

[bean_counter27]

I found this in Flecainide information "Steady-state plasma levels not achieved for 3-5 days", so maybe wait a few more days.

Staying hydrated is important for managing your AF so not being able to drink during daylight hours won't be helping.

Ramadan is almost over. If I were you I'd wait a few weeks and see whether your AF settles with the new dose and being back to your normal eating and drinking habits.

[Singwell]

Hi Mayuma, a few thoughts. It's best to take Flecainide away from food. Is it possible to take your doses before the times you can eat during the fast of Ramadan? Even if that means taking one during the night - I do this with my levothyroxine for hypothyroidism because it doesn't work well with food, or with other meds.

The other thing to consider- do you think the additional stress of the fast is adding to the situation? I'm not au fait with how Ramadan works in case of medical needs. For example if you feel very hungry, does your heart tend to race? Or do you get sugar lows and highs? The latter certainly tends to set me off.

Re dosage. It's perfectly possible to take a higher dose in the morning and a lower one in the evening. Or vice versa depending on when you're more likely to have AF episodes. I certainly did this for a while - taking the full dose in the morning and half dose in the evening. But of course you'd have to clear that with your medical team.

I hope this helps.

[Maymuna]

Hi Singwell, I'd not thought of that idea, thankyou. Fasting is not obligatory if you're not well but you have to make it up later in the year hence my reason for keeping all the fasts. Its also an incredibly special time too. We don't eat or drink from sunrise to sunset so can't take a tablet earlier. As meninges, I'll see how it settles down after Eid which is next week. Many thanks again, this forum is so helpful