My newly found Consultant Cardiologist has prescribed me two new drugs. Sotalol and Flecainide.
In respect of the Sotalol he prescribed .... " one tablet twice a day". My tablets are 40mg dose.
This replaces Bisoprolol and Nebivolol that I have taken at different times in past years gone by.
Anyone know if this is a normal dose, anything to be aware of ? in peeps experience ..... is there a best time to take each tablet ? I was thinking morning with other morning meds and at night before bed and my other night meds. Any weird side effects ?
Believe it or not in all my AF experience over 14 years I have only ever been prescribed meds as one tablet a day, either morning or night.
Many thanks.
Written by
BenHall1
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Are you in the hospital at the moment?Just wondering as the usually prefer you to start these medications with some professional assistance at hand, just in case you get dizzy.
The Soltalol can make you a bit dizzy in the first few days and the usually recommend that you start it in hospital as your body needs time to adjust to it over 2-3 days.
It's usually better to have the first dose at night to reduce the risk of the dizziness causing a fall.
Doses are better about 12 hours apart , or in the evening and morning. Although many people only have one larger dose a day after they've shown that they aren't getting side effects on it.
40mg two times a day is the starting dose , the minimum to see how you respond , you can go up to 320 mg each day .
If you feel any new Arrhythmias or sudden AF changes in the first week they suggest you ring the cardiac helpline straight away or the GP.
They usually suggest you have a medical grade ECG at the surgery or hospital 7 days after starting it to make sure it isn't causing any unusual change in Arrhythmias which is one of its side effects.
You need regular blood checks , and should have the first one after a month on the drug . Liver and Kidney function needs supervision and they need to be sure that your potassium levels are correct.
Taking care about how much potassium you have in your diet is important.
You can take it with food but avoid dairy for an hour before and two hours after and don't take supplements with calcium in within 2/3 hours of taking the Soltalol because it can interfere with the bodies uptake of the drug.
With Soltalol and Flecainide it's even more important to listen to the advice to have 2-3 restful days when you first start them to give your body time to adjust to the new chemical effect and reduce side effects like dizziness rather than trying to just push on with normal activities . Giving yourself a gentle week and having someone about to call for a week if you need them is also recommended.
Avoid cardio activities and things that involve a lot of bending up and down like gardening , yoga etc. in the first week too , just until you are sure that your body and nervous system responses are stable.
The first dose of Flecainide is usually given in hospital too, and prescribed after certain arrhythmia of AF presence proves the requirement for the drug, and it also requires regular ECG checks and blood tests.
Although it is more common for people to take a dose of it in hospital or at the surgery then just carry on at home.
Again the usually start you at the minimum dose ( 50mg approx) and build it up as required after ECG and blood testing to make sure it's working for you and dose timings are similar.
There are also similar guidelines about taking the first dose of Flecainide in the evening , especially if you are not under supervision, and not eating dairy or calcium two hours either side of taking a dose. Red meat is better kept to small occasional portions and low sodium diets are better.
Have they told you to begin them both at once , or stagger the change if you are doing it at home from one set of drugs to another?
If you weren't advised on the best way to do this change over and you are doing it at home I think it would probably be a good idea to double check with your original doctor or GP about his they recommend for you to proceed.
It's not that the drugs won't be a positive change for you but that talking these drugs in particular usually requires a bit more planning and guidance than others.
If you don't have an urgent or emergency need to just jump into starting them I would suggest not beginning them over a weekend when it's harder to get to speak to a doctor, and possibly ring for more advice on how to go on Monday.
Didn't the Cardio give you any instructions to follow?
Thank you for such a comprehensive answer. Really appreciate your time. Have printed it off and will now include it in weekend study 😂. I will give you a response to your questions a little later.
Well, I printed out your reply and was quite gobsmacked at the detail you have gone into. Really appreciate your trouble. So now I'll move on to providing my response to some issues you have raised.
No I'm not in hospital and there was never a suggestion that I should be in order to start. I took my first tablet this morning and plan on the second this evening - and will continue on that basis. I must tell you that all this started because I hit the panic button when my BP did 2 things - bounced up and down like a yo yo hitting 166/88 then stabilising in the 152/80 range. And that is with an existing diet of BP medication and Nebivolol.
The Consultant was quite adamant that he would not start the Flecainide until I'd had a cardiac CT Scan ( which will be this Thursday in Exeter ). So far in pursuit of my problem I've had, Echocardiogram, BP check and have just finished a 7 day Holter Monitor. So I now will not start Flecainide until Consultant gets the results of the cardiac CT Scan. This probably won't be for a few weeks yet, and certainly the Holter Monitor results won't be for another 2 weeks at least. He wants to ensure all the arteries etc are clear and free. Of course my added problem is that in my original diagnosis I have been described as asymptomatic.
My diet is fairly steady and was one I went on years ago as part of my fight with AF. Dairy/Calcium food products are not part of my regular diet. I might have one banana a day, but not necessarily every day.
My Cardio guy has put my instructions as part of a letter that was sent to my GP and myself. I have not involved my surgery because they are incompetant and I have more chance of pulling hens teeth than talking to my GP much less having a face to face consultation with her. Basically, I stopped Nebivolol last night and started Sotatol this morning ....i.e. no phasing out of one drug and starting another. So far feel fine, just tired.
Unfortunately, I didn't open your message until after I'd had my morning meds including Sotalol and breakfast. Not that it means anything of course but I am a fortunate one in that so far, whatever drug I'm prescribed they have never had a bad side effect on me. Except Edoxaban and I very quickly reverted to my old mate Warfarin - which I self test my INR at home.
If anything I've said jumps out at you I'd appreciate your comments but thanks again for your interest.
Yes , you are fortunate that you haven't had an issues with new drugs so far , especially as you seem to have done the complete opposite in timings with no supervision for Sotalol which can pack a punch by causing different irregular Arrhythmias to the ones you take it for .😆😆😆Maybe try the appropriate timings for the Flecainide, and either ensure someone is with you or have some supervision.
It's also a reason that unless it is because of urgent need , and again , in a surgery environment under supervision that you wouldn't start both of these drugs on the same day.
Having that break in-between beginning these strong medications and having the ECG and blood tests after starting Sotalol and before starting the Flecainide does two essential things
1. It allows the doctors to be sure which medication could be causing side effects or abnormal tests results rather than having to use guess work , or cause you to yo-yo off and on the drugs again to work things out,
2. It allows your body to adjust to the new chemical effect of the medications one at a time , lessening the burden and meaning your body is in a better condition to cope as each new drug is begun and less likely to have initial or severe side effects.
I can empathize with your thoughts on your GPs.
I spent years waiting and being undiagnosed because of my GPs lack of knowledge beyond the most common conditions.
(They weren't alone though as many Consultants didn't look properly either.)
That was compounded by some of them being unwilling to start more expensive treatments despite recommendations from Consultants, or believing they could just prescribe anything until the Consultants had to rewrite to insist on treatments .
And then the times they made me worse , by not listening to what I know about my own conditions but not checking themselves, and often giving inappropriate prescriptions for things I shouldn't take , or under treating infections because that's the guidelines for antibiotics for generally healthy people,
Luckily , we have now got a new GP whom listens or I would have moved surgery instantly after my diagnostics were complete.
It's worth moving surgery , and getting some recommendations from a local heart support group if they are very bad and you feel what they are doing actually causes you a lot of Stress or affects your health negatively.
Why?
Because , despite their shortcomings, your GP Surgery, Dentist and Optician , or Primary Care Team, are vital in your everyday treatment with a Chronic Health issue, no matter what that condition is.
That's especially true if you are put on strong medications or treatments, like Sotalol or Flecainide, Steroids or other drugs that can affect liver, kidneys or heart function , that require regular blood tests , ECG or EEGs and x-rays or scans to ensure those drugs are still giving you benefit without causing damage or risks.
Without their help to get these tests done it can also mean that you get stuck on a dose of medication that is lower than you need because you need to know it's ok for you to increase them first.
And , it's also important for the humdrum stuff or getting additional support for other syndromes or side effects that can happen commonly with you illness that you wouldn't need to , or get, to go to see a Consultant for without a referral from them first. Unless you are on private insurance or are prepared and able to spend thousands a year to see a private doctor every time something needs checking your GP surgery counts and us worth it's weight in gold as long as you know the way to use it productively.
So , even if you stick with your current surgery , I would recommend that now you've got them the guidance they need by seeing a Specialist, you need to get a professional, proactive positive dialogue going with them to work in partnership to use their resources and safety net testing as you need to .
You may want to poke them in the eye occasionally for their ignorance and need to politely spoon feed them through you requirements after listening to their inaccurate drivel first , but it's better than cutting your own nose off to spite your face. I'm sure you get what I mean.
Just try and take it easy in activities this week at least , and please get on the phone to your surgery for those follow up blood tests and ECG so you can make the most out of the Consultation you've paid for,
I'm on Sotalol 80 mg three times a day - no problems at all. I must say it's strange you might be on Flex and Sotalol as it's normally one or the other?
I'm going to put an extract from the Cardiologists letter for your interpretation .... I may have got it wrong ..... here goes ....
I have outlined the natural progression of atrial fibrillation and discussed some potential medication changes to try and see if we cannot settle things down far him. He is still very active and independent despite his years. and is keen for a rhythm control stmtery which I think is very senslble. I have suggested we could try switching him to Sotalol 40mg bd as a next step and stop his Nebivololto see this does not gain a better rhythm control. The anti-arrhythmic properties of Sotalol can sometimes be effective. I will order a cardiac CT scan on him and if his coronary arteries are clean, then we could potentially try Flecainide combined with a small dose of Nebivolol, if the Sotalol is ineffective at controlling his rhythm. I will also arrange a7-day holter monitorto map out his heart rate profile and document his AF burden. lf these drugs are ineffective, then he could consider AF ablation or concentrate more on a rate control strategy with acceptance that long-term atrial fibrillation will become persistent in time. From a lifestyle perspective, I have advised him that alcohol can be a very potent trigger of atrial fibrillation and to try and abstain as much as possible. I think long-term better control of his blood pressure will also be helpful for him. Once he is settled on an anti-arrhythmic drug strategy, then we could potentialty introduce a small dose of Amlodipine 5mg to his above drug regime to see if this does not control his blood pressure better.
My cardiac CT Scan is this coming Thursday in Exeter - I guess it will be a week or so before we get any results.
Needless to say if anyone else is interested in this reply to you and they want to comment ... please feel free. All this is new territory to me .......... after 14 years of this AF thingy.
Now I understand! You maybe put on Flex instead of Sotalol. They normally start you on 50 mg two times a day and up it to 100 mg after a month or so - just to see how your body reacts.
From my own personal experience I found Flex to be highly effective. In fact I wish they would put me back on it.
Good luck whichever way it goes. By the way - booze can be a massive trigger for afib. I would advise cutting down by 10% a week - 10 weeks and you have cracked it. Combined with Flex (or Sotalol) you may go into sinus.
Looking at the write up again - following on your very latest comments - I can see I got it wrong. So we'll see what this cardiac CT Scan offers.
On the question of booze, this cardio guy ( a south African who did his early training and work at Groote Schur, Cape Town ) recommend taking this course of action now. I last saw him on 30 April, since then I have tried to go 'cold turkey' and have had 2 330ml bottles of beer. No red wine. 2 small glasses of white wine on both Saturday and Sunday.
My previous booze intake was 2 x 330ml bottles of beer and 2 small glasses of red wine daily with my evening meal, 7 days a week. There has been a massive change in my blood pressure I have to say, not just a dramatic lowering but it is much, much more stable - no more peaks and troughs/ ups and downs in the readings.
Paul, you state ............. "From my own personal experience I found Flex to be highly effective. In fact I wish they would put me back on it". Was there any particular reason why they took you off Flec - to make you wish they'd put you back on it ??
"From my own personal experience I found Flex to be highly effective. In fact I wish they would put me back on it". Was there any particular reason why they took you off Flec - to make you wish they'd put you back on it ??
Yes!
It's never a good idea but I 'self diagnosed' and took extra - for example after a big meal 'to play it safe'. Wow wrong move. It lead to flutter.
I take my Sotalol when I wake up in the morning and after my dinner in the evening. I was monitored when I first started it. It did make me a bit dizzy when I first went on it, but they reduced the dose and I was ok then.I’m now going to stop it, after having an ablation last September, but am I doing it very slowly.
There are a lot of drugs that react with Sotalol, so I keep a list, on my phone, of the drug reactions with Sotalol, which you can get from the NICE website and I check it every time I’m given some new drug. Also some over the counter medication can react with Sotalol. A couple of times the Doctor has prescribed something that would react with the Sotalol, they don’t always check.I also have the list for the anticoagulant and statin I take. It’s a vey useful to have these lists. . Hope you get on ok with your new drugs.
I was originally on Bisoprolol but later prescribed Sotalol twice a day like you.. I take one in the morning with my blood thinner ( between 8/9am) and then the other one in the evening at 8pm. All the best
Thanks .............. must say by the time I'd read all the responses to my original post I felt a bit unsure of my journey. However, I threw caution to the wind and started my doses on Saturday. The next day, Sunday, 19th, I felt dreadful worse than I felt in my final days on Bisoprolol (totally brain dead, brain fog and sooooo sleeeeepy ..... like you wouldn't believe ) ............. today Monday 20th I feel as Get Go and dynamic as I used to when I was in my late 20's. Feel incredible, just incredible ...... Sotalol .... the new pick me up ! Just hope it lasts ............. mind you as I mentioned to Paul the other day ........... I've also made a major reduction in booze !
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