PIP and Flecainide

[Debjimmay]

I’m taking 50mg of Flecainide twice a day. The Flecainide does not seem to be helping my arrhythmia very much so I was wondering if I can take a PIP while I’m on the daily dose of Flecainide? And if so how, how often can you take the PIP? And would 100mg of Flecainide be enough for the PIP?

[mjames1]

The usual protocol is if 50 mg twice a day (bid) is not working, then the dose is increased to 100 mg bid. Sometimes eventually to even to150 bid. Of course your doctor has to approve these higher amounts, because not everyone can tolerate the same dose.

And yes, you can take a PIP dose of Flecainide in addition to your daily dose, but that is usually reserved gor those who are mostly in normal rhythm, with only occasional afib episodes. That does not seem to be your situation.

The maximum daily dose of flecainide is 300 mg which would include the sum of your daily dose, plus any PIP dose(s).

But important to know that not everyone can take 300 mg -- that's just a maximum dose -- and again, your doctor has to authorize the dosage based on your individual situation. For example, I was only authorized by my doctor to take 200 mg of Flecainide within any 24 Hour period.

Jim

[Debjimmay in reply to mjames1]

I searched all over the Internet and couldn’t find an answer to this question. Thank you so much. You answered it perfectly!

[mike1961 in reply to mjames1]

mjames1 - I'd be quite happy with you as my cardiologist where AF is concerned !

[BobD Volunteer]

That is something we really should not advise on. Only your cardiolgist or EP should be giving you such advice but it is not uncommon to take a maintenance dose as well as PIP so long as you respect the maximum 24 hour dose of 300mg.

[OzJames]

each of us is different and so are our Cardiologist’s. You must follow their protocols not ours. Having said that my Doctor has given me advice since I started on Flecainide twice a day in January. He has me on 25mg which is now at 20mg twice a day as my HR goes down low when it’s with low dose metoprolol. When in AF and not on drugs my HR at rest is around 80.

His advice if I go into AF is to take 100mg in addition to what I’m on and wait an hour then take another 100mg. If not converted then increase my twice daily 20mg to 50mg until I convert or get another Cardioversion.

[John3333333 in reply to OzJames]

I have never heard of anyone on such a low dose of Flecainide. Does 20mg x 2 daily work for you, and where are you based?

[Debjimmay in reply to John3333333]

Hi John,

I’m based in the US and I’m currently on 50 mg of Flecainide 2x a day. The doctor has changed it from 50 mg to 100 mg a couple times. Since the Flec doesn’t seem to be working, so he wants me to try a different antiarrhythmic. I really need something that will work because I’m severely stressed and anxious every day.

[John3333333 in reply to Debjimmay]

Dronedarone might be worth a try.

[JOY2THEWORLD49]

Jimmy Cricket!

What makes you think Flec isn't doing ANYTHING?

PIP is just that to try to normalise you when you have an attack.

What is your episode like? Spiked H/Rate?

cherio JOY 75 (NZ)

I take Diltiazem 120mg AM for rapid H/Rate AF which is persistent.

It acts as an antiarrhymic and first time brought me down from Biso 156 heart rate to 51 on 180mg. This was reduced along with Nisoprolol to 2.5mg

[Debjimmay in reply to JOY2THEWORLD49]

I think maybe the reason why the Flecainide is not working is because I’m not in Afib very often and most of my issues are etopics (irregular heart beat) or trigeminy which is two normal beats and then one early beat. It wouldn’t be so bad, but I’m aware of every irregular beat which causes extreme anxiety. Sometimes it feels like a fish flopping around in my chest. I also have tinnitus so I can tell when I’m not in regular rhythm as I can hear each beat. I just don’t know what the answer is for me and I’m trying to work with my EP (on my second one now). I have a feeling he’s going to recommend an ablation but this has to be my last resort, I’m starting to think more seriously about it now though.

[Ppiman]

I am about to switch from bisoprolol (1.25 mg) to the same drug as you. Your doctor will have started the flecainide at the lowest dose to see how you cope with it as it can bring side effects. He or she might now check back with your cardiologist to see if this can be increased. I presume you had an echo or other scan before being given the flecainide?

Not all doctors agree with the "PIP" method, so you will need to ask. You might need a higher daily dose to produce a useful effect. These drugs are only given to relieve symptoms, not to cure the problem that causes the arrhythmia, so presumably you were experiencing symptoms?

Steve

[Debjimmay in reply to Ppiman]

Yes, I had a stress test before starting Flecainide. My EP started me out on 100 mg and cut me back to 50 mg because of side effects plus the medication wasn’t working.

And you were right about some doctors, not agreeing with the PIP. I did ask about it and was pretty much told no.

I’m hoping this new drug, Propafenone , will work better than the Flec as I’m desperate to find relief for my issues. It seems like living like this has to do damage to your heart.

[Ppiman in reply to Debjimmay]

I have read widely as I enjoy medical knowledge in general and... I fear this thing! In general, it doesn't seem to cause any important damage - in most cases. The heart is so complex that many things that do come its way might not be related to the AF but become blamed on it. I always think about my now 90-year old friend with persistent AF for very many years. He has some valve leakage but many elderly folk also have that.

Steve

[kitenski in reply to Ppiman]

Steve are switching to Propafenon from Bisoprolol?

[Ppiman in reply to kitenski]

No - I have been prescribed flecainide 50mg bd but have only taken it once. It worked well but did give some odd heavy heartbeat side effects, so I haven't taken it since - partly, though, also because (thankfully) my ectopic and AF issues have been generally quieter of late.

Steve

[kitenski in reply to Ppiman]

ah cheers, my latest is I'm off both flec and biso now and going to just try Pill in a Pocket approach.....

[Ppiman in reply to kitenski]

That’s what I think might suit me, but the specialist I see prefers permanent treatment. It seems wrong to take a strong drug like flecainide when symptoms are bearable.

Steve

[kitenski in reply to Ppiman]

for me both drugs actually gave me more issues than they solved after a few years of daily usage!!

[Ppiman in reply to kitenski]

What were the symptoms?

Steve

[kitenski in reply to Ppiman]

Flec read this thread: healthunlocked.com/afassoci...

Bisoprolol I had 3 episodes of >14 hours Afib 2 months after increasing the dosage and also feeling muzzy headed, eyes felt "weird", feeling dizzy and Wellvue showing pacs/pvcs about every 10 mins over an 8 hour period. healthunlocked.com/afassoci...

[Ppiman in reply to kitenski]

I had read the thread before but forgotten. It was interesting to read it again. You do a lot more exercise than I do. I wonder if that is why the flecainide caused you the issues it did? There's plenty about this online, as I recall, when I was trying to work out if it was something I would take. I see from Jim that in the US, doctors monitor patients taking flecainide much more closely than over here. I wonder why that is? I doubt ours are being in any way remiss. I think to start the drug, also, requires a hospital stay and observation, again different from here.

Your experience with ectopic beats and the effects they caused sounds similar to mine. I can go dizzy just tying shoelaces on bad days. I can't make out what the cause is as it's rather random. My cardiologist said it was all down to the ectopic beats. Apparently, these can lower the blood pressure in ways a BP machine cannot record, causing a sudden reduction of oxygen to the brain.

Steve

[kitenski in reply to Ppiman]

interesting I've not seen anything re exercise and flecainide, can you share any links? I'm hoping the ectopics will reduce as the bisoprolol gets out of my system!

[Ppiman in reply to kitenski]

If you search flecainide wide QRS exercise as key words you’ll find plenty.

Steve

[Vonnegut]

Of course you can! The daily maximum dose is 300 mg! I was first prescribed it as a PIP to take when episodes occurred ( with an added 1.25mg of Bisoprolol on the rare occasions when my heart rate exceeded 140, twenty minutes later) but then as episodes increased, I was put on 50mg twice daily and as I still had the occasional episode it was upped to 100mg twice daily and that has virtually put an end to episodes - the last one 18 months ago around the time I must have been infected with covid with no other symptoms but a positive test result (and that one was ended in a few hours with an extra 100mg, thus reaching the maximum daily dose!)

Good luck!

[Afibtastic]

Hi. I am like you. 50mg x per day. Don't think it is making much difference at all. Cardiologist told me to double the dose. Heart started beating faster and harder. Told cardiologist and was told to persevere. I didn't as it was too violent in my chest. Went back to regular dose and a week ago tried PIP. Heart misbehaving again. So I might wean off it and see what happens. My heart rate is usually low so hopefully not dangerous. Just be aware of the change you might feel

[Debjimmay in reply to Afibtastic]

We sound so much alike! I started out at 100 mg twice a day. It wasn’t helping my arrhythmias and I was having side effects like blurred vision, dizziness, ankles swelling. So the doctor put me on 50 mg twice a day. It helped with the side effects, but it didn’t do anything for my arrhythmias and Afib. In fact, it seemed to make them worse.

I went back to the DR and he wanted me to try the 100mg again. I tried it for a few days and couldn’t handle the arrhythmias and pounding heart so I decided to try and stop taking it. I stopped for two days, but still no relief from the arrhythmias and Afib. I’m so stressed out at this point because nothing seems to be helping. I called the doctor and he wants me to try a different arrhythmia drug.. I’m not sure I want to try another another one since this one is not even working but I’ve decided I’m going to give it a try and I I’m going to call tomorrow to get the prescription.

Oh, after I went off the Flecainide for 2 days I thought I would try the PIP to see if that would help calm things down. At first, I thought it did, but then everything was back to the way it was and I’m totally stressed and miserable.

It would help if friends and family would understand what you are going through but unless you have this disorder no one will ever understand what it does to you and how it makes you feel.. Thank you for writing to me and the best of luck to you. 😊

[Afibtastic in reply to Debjimmay]

Yes it's sort of funny how people don't seem to understand that there is a problem because we appear to be functioning normally until we have to run for 50 metres or do something strenuous and then fade out. Or that is me anyway. Much better when in NSR.

[JOY2THEWORLD49 in reply to Debjimmay]

OH

Aren't I lucky not having any symptoms that I can feel. I do have a 'bad ribcge and it heart hasa pushed itself further left.

But before using Flec.. an ECHO, ECG and 24hr heart monitor is warranted.

If anyone promotes cardioversion, ablation or Flec.. I remind then that I can't have them.

Now discharged from cardiac outpatients I don't mention it on my travel insurance. If I am controlled then I have nothing to be myself concerned about except taking the regime of pills.

I've started to book TRAVEL yippee. And carry them on. I ask for assistance as missed a flight in Germany walking and walking .. rather have exertise to guide me.

cherio JOY. 75 (NZ)

[Decaf_Andy]

It took a few months for me to see much benefit from the same flec dose as you. Initially I got a similar frequency of attacks, but at least they were generally shorter. Over the months this improved however. I also sought and got an ok to take additional doses both in the event of an attack and prophylactically (if I schedule a long bike ride for example). All subject to the 300mg max dose of course, although I’ve never been close to that.

[Buffafly]

Only if approved by your cardiologist.

[Ersilia2]

I would check with your Cardiologist, I asked if I could take Flecainide as a PIP and the Cardiologist said it would not be good for me. He didn’t give me a reason as to why not.