Pill in the pocket

[Renault4]

Good Afternoon I wonder if anyone can tell me when you should use a PIP?

Whenever there are arrythmias or palpitations or when there has been a run of them?

I am on 100mgs of flecainide twice daily but have had a couple of days of arrythmias and some palpitations/ectopic beats. Am waiting for an appointment at Papworth following 72 hour Holter

with the possibility of having an ablation or other intervention.

[BobD Volunteer]

ONLY as instructed by your EP! You are on a maintenance dose of flecainide already for which the maximum daily (24 hours) dose is 300mg and taking 200mg so not a lot of wriggle room.

[Renault4]

Many thanks I was given 50mgs as a pip by a cardiologist after visiting A and E a couple of years ago but have only used this twice since then as yes I understand that 300mgs is the maximum dose allowed Just not sure how long or severe a run of AF is to warrant using the PIP

[Gezp in reply to Renault4]

I’m in a similar situation after first event 7 years ago. My cardiologist has told me to take 50mg as soon as possible after an AF event starts and then a further 50mg 30 mins later if not back in sinus. Only had to do this once and went back into sinus after around 3 hours. Cardiologist also told me to go to A&E if not back in sinus within 24 hours (or of course if feeling unwell).

[babs1234]

I use when I’m in an episode with rapid heart rate

[Model52]

I used to take 150 mg of slow-acting Flecainide daily and it caused my AF to increase to very frequent episodes, almost daily. I stopped taking it and replaced it with D-Ribose, L-Carnitine and Ubiquinol. Now an episode every 8 to 15 weeks. When it occurs, I take 250 mg of fast-acting Flecainide as ‘pill-in-pocket’. All the best!

[Renault4 in reply to Model52]

Thank you for your reassuring response and to the others to who kindly replied. I guess that I will try to be a little more stoic and less anxious! But I have found all the replies as I said reassuring, and letting me I am not alone.

[Ppiman]

I would say the only reason to use a PIP is (and always only with medical approval) when you feel you need it for health reasons, i.e. your AF or ectopic symptoms are overwhelming or too uncomfortable to bear. So far I have taken 50mg flecainide once only and, although it did entirely stop both palpitations and AF for the day, I didn't like the heavy heart beat it seemed to produce, which caused me more anxiety than the condition itself.

Steve

[Renault4 in reply to Ppiman]

That is very helpful, thank you.

[Vonnegut]

How different we all are! I was prescribed Flecainide 100mg to take as a Pip originally by an EP after he had introduced me to having a smartphone and a Kardia and I had sent him a reading of my heart in AF. It always ended episodes in a few hours and only very occasionally required 1.25mg of. Bisoprolol if my heart rate exceeded 140 twenty minutes after taking the Flecainide. As episodes increased I was prescribed to take it regularly and it has virtually put an end to episodes. I now take 50mg in the morning and 100mg at night and have been free of episodes for ages.

[Renault4 in reply to Vonnegut]

You are absolutely right and I guess the lesson/guidance I have taken from all the helpful replies is be cautious with the use of a PIP, and if possible use only when AF causes really unpleasant symptoms.

[Vonnegut in reply to Renault4]

But it was always pretty upsetting when my heart went into AF, so I was glad I had the Flecainide to use as a PiP and get it back to normal while I rested.