Well last week I bit the bullet and went to see my cardiologist. He has a brusque manner and is possibly the most uncommunicative doctor I have ever met so I am not keen on going! His first remark was that I had not been to see him for 4 years. Well actually it was only three and a half but having expected a lecture (as I am supposed to go for a checkup at least every two years) rather than just a raised eyebrow I thought better not say anything and launched into what had brought me - the increasing frequency of my afib episodes and the total uselessness of Nebivolol to reduce my heart rate during them. After a cursory look at my Kardia traces he muttered "Need to change the treatment . Flecaine" and waved me into the adjoining room for the checkup . I asked if that was Flecainide and said that it was used as a "pilule dans la poche" in England and was that what he was proposing ,as I was under the impression it was only used as a preventative taken every day in France. He said in English "Yes. Pill in Pocket! "and yes that was what he was prescribing. After listening to my heart, doing the ECG and taking my blood pressure he said everything was fine (of course it always is when I go to the doctor) . When we went back into the office I saw he had looked at my blood test results. This time my GP had ordered a BNP which at 54 was good . He said nothing at all about my 6.86 total cholesterol and typed out the scrip for the Flecainide. I asked him tentatively if I had plenty time before thinking about an ablation and he muttered "Ablation we'll see" and that was it.Foolishly I did not look at the prescription till I was back in the car and then discovered that what he has prescribed is 100mg capsules of slow release Flecainide with the instruction to take one at the beginning of an episode . He did not say whether I should continue with the Nebivolol but I assume yes as he did not say to stop it either. Has anybody taken slow release Flecainide as a PIP? I looked online and Flecaine does come in immediate release tablets of 50mg and 100mg here. The patient info also says you can take it either before or after food or with a meal but I have read people saying here you need to take it away from food or it causes nausea. I suppose all I can do is wait for the next episode ,take it and see what happens.
Slow release Flecainide? : Well last... - Atrial Fibrillati...
Slow release Flecainide?
First and most important advice: find another cardiologist.
Second: slow-release Flecainide (Apocard retard) does not work as PIP. Normal acting Flecainide (Tambocor) does, if you take at least 200 mg. (I take 250 to 300).
Third: forget about an ablation if your AF is not ruining your quality of life.
All the best!
I stick with him because I suspect he is a maverick who does not believe the cholesterol theory of heart disease - also during the pandemic he did not wear a mask. I suspect he isn't keen on ablations either! He has never suggested a statin and I do not wish to argue with some new cardiologist who might try to pressure me into taking one. If the slow release Flec goes not work I can go back and ask for Tambocor or try and get my GP to change it.
It is true my afib does not bother me that much. If I had had the BNP result before I made the cardiologist appointment I might not have bothered to go. But I was worried that 12 hours or so of a heartrate around 140-150 bpm every 2/3 weeks was damaging my heart.
OMG don’t just hate these so called professionals who need patient communication training! I had a GP who could be outspoken, well he’d met his match with me! I answered him back 😂 Grasp the nettle and write yourself a script to use when you go.
Well it's hard to answer somebody back who says next to nothing! I don't really see the point of going unless I actually want something as I tend to want to avoid doctors in general. My GP who is the best I have ever had in my 72 years of life made a "joke " once. He said the best way to stay healthy was to avoid doctors! I do have to see him every 6 months as no visit no prescription. I think I have been once in the last 10 years outside of these twice yearly visits -when I got the rash after being bitten by a tick.
My outspoken GP once told me that surgeons were all knife happy, he’s not wrong 😂
You made me laugh LaceyLady, because GP's don't scare me either. Mine told me that never in all his years had he had another patient like me. I think he meant charming and kind - ha, ha. He still says hello if he sees me though. I generally try to see a lady GP these days as I think they actually listen more to what you're saying.
Jean
That high a heart rate would bother me too. But I can lower it with Bisoprolol, luckily. Tambocor as PIP works for me in 2 to 4 hours. But I’m in sinus most of the time, since I discovered my main triggers.
It seems quite french to not be obsessed with cholesterol levels and I agree with you I prefer to not mention statins if they don't 😄
Is your cardiologist an EP ?No offence, but you should find a better one. A good doctor must be human first of all.
And if you are worried about cholesterol and taking stations, I suggest having a healthy diet and do intermittent fasting.
well i tried PIP of flecanide 100mg and did't work then tried 150mg didn't work so next time its going to be 200mg and its not slow release. i am now on very low dose of 25mg twice a day with metoprolol to see if that delays recurrence and hopefully the PIP is only needed once every couple of years or so!.
Can you get 25mg flecainide or are you having to cut the 50mg unscored ones in half as best you can.
Some countries have 25mg tabs but I use a pill cutter and purchased a $20 Amazon/Ebay jewellery scale that measures the weight (approx 135mg) and divide by 2!
Thanks I’ve been using the pill cutter, but never thought to weigh the halves, especially as I have a set of jewellery scales I use to weigh yeast. Everyday a school day
They are capsules as they are extended release. There is an excipient in the capsule itself which delays release
Are you supposed to cut unscored pills? I was always told if a pill does not have the score line you should not cut it - don't ask me why !!!!!!
I thought so too, but EP told me to cut them in half.
From your description of the cardiologist and the fact you are in France, I find myself wondering if you might be located somewhere in 49400.... if so,. say no more, I know the 'gentleman' concerned.... though French doctors and cardiologists can be both very rude and awkward and many charming and understanding. My 'bete noire' was however someone so dreadful he reduced me to tears during my consultation just a few months after my stroke, and I would never see him again. Nebivolol was also the drug he tried to prescribe to me though he refused to explain what it was or why I needed to change my current medication. He was just plain rude and insulting.
I hope the Flecainide works out for you but do consider whether you might be better finding another cardiologist. There is no necessity for any human being in a caring profession to treat patients in the kind of imperious and unsympathetic way some do.
No I live in the Limousin. He's not really imperious just uncommunicative.
😀 Glad he's not the individual I was thinking of! But most consultants seem to be arrogant and bossy; it comes with the territory!
Well my gastroenterologist is lovely lady . So was my endocrinologist though I haven't seen her for years now. Maybe it's more the men!
Sorry to hear about your more frequent episodes. Before my ablation I was on slow release Flecainide every day. I haven't heard of it as a PIP (and as you know I live in France too). I shouldn't think it would be very effective at working immediately to stop an episode. Your other med is a beta blocker do should be fine. My cardiologist took me off Flecainide and Bisoprolol after my ablation and has prescribed Sotolol as a PIP for any breakthrough episodes. Yes I find they are very casual about cholesterol here. Mine hovers between 5.8 and 6.5. My dr is more interested in BP and Triglycerides . I see a endocrinologist as well and she just says "hmm cholesterol a bit high " before talking about something else.
Flecainide ( slow release)never caused me any problems over the 8 year period I took it just a bit of indigestion which is one of the side effects. I just swallowed it with some banana which did the trick for me.
Take care
Thanks Lilypocket. I have done some digging on the Internet and have found the patient info for Flecaine LP and LI (liberation prolongé and immediat). The difference is in the capsule for the LP. There is an excipient which stops the capsule dissolving immediately in the stomach. So I think ifI open the capsule and put the contents in a teaspoon of honey it will work quicker. I also found out that the LP reaches peak concentration in 26 hours as opposed to 3 hrs for the LI which is no good at all as my episodes usually last about 12 hours. How do you get on with the Sotalol?
Well when I have an episode I take 80 mg but it doesn't work straight away but she doesn't want to put me on Flecainide again as for her it was pro-arrythmic after my ablation ( I did have some weird moments after my ablation with really long pauses and nearly passing out). But never any problems with Flecainide before my ablation. My episodes are not too long ( max 4 hours ) and stop by themselves. I got on well with both drugs. Maybe you could try Sotolol but not sure if you are already on a beta blocker . I suppose we are all individual and have to tweak our own buttons to find what works for us. Drs tend to do a " one size fits all".
Last summer in Normandy I went into Afib just before going for a swim in the sea. " Sod it " I thought "I'm going".
18° ❄️stopped it I can tell you 😅
I have had afib start just breathing in cold air! Maybe I should try a cold shower to stop it!
,😅
Hi Auriculaire, I take flecainide as PIP. I'm on verapamil daily and when I have an AF episode I that initially 1 x 50mg Flecainide, and if it has not eased I take another after an hour. I have a lovely cardiologist and electrophysiologist who suggested the above. They also said that if it had not gone back into NSR after 4 hours and hr is above 140 to go to A&E. I've just had my pre-op for my 1st ablation, no date yet. Feeling nervous! I think you need to look at getting a new cardiologist!
if he is so awkward I think I would look for another EP. Having said that doctors with no bedside manner can be just as clever!
Remembering that, as you know, nebivolol like bisoprolol is a rate control drug and also lowers BP whereas flecainide is a rhythm control drug. Yes some take it as a pill in the pocket and others (like me) take it usually starting with one 50mgs twice a day 12 hours apart.
So having said that if it is the fast heart rate I would have thought upping the nebivolol or changing to bisoprolol would have been better I know if I go into tachycardia I take an extra bisoprolol and it lowers the rate
However presumably as you are not persistent perhaps that’s why he did 100 pill in pocket. Normally you are started with 50 and take another if not work, but I can’t think a slow release flecainide would help very quickly as don’t know why he prescribed a rhythm control drug rather than a rate control
Regards pat
I have tried upping the Nebivolol. I used to be on Bisoprolol but that gave me too any side effects on a daily basis. The Nebivolol is much better for that but just does not work as well to bring my heart rate down during an episode.
Oh I’m sorry you didn’t get on well with bisoprolol as I take 1.25 every morning but when my heart goes madly high I take snother 1.25 snd thst usually works, or occasionally another 1.25
Were you on a high dose of bisoprolol if it gave you side effects?
Hope all well soon
I started off I hospital on 5mg after my first episode and felt like death warmed up. Told my GP if I had to live feeling so awful for the rest of my life I didn't want to live. He halved the dose immediately and I halved it again myself. I didn't need it really in NSR. My afib came back after a major op and again the hospital doctor put me on 5mg. I went to my own cardiologist and asked for Nebivolol after reading good reports about it on here. When I found out it wasn't bringing my heart rate down during an afib episode I used to take some of the left over Bisoprolol I had and that did the trick. But of course it ran out. I asked the doc if I could have some just to take during an episode but he said no. Cardiologist said double the Nebivolol. Well I tried quadrupling it and it still did nothing!
Crumbs that seems unsatisfactory. If you were ok and it helped you out unless there is some medical reason other than just feeling yuk I don’t see why you can’t try bisoprolol again. It does take a few weeks to acclimatise .
I hope you feel ok xx
You really need to see an EP as they are the cardiologists who deal with electrical problems in the heart which ours is, rather than a plumber! I was prescribed 100mg Flecainide by one after he had introduced me to having a smartphone adaKardia andI had sent him a reading of my heart in AF. Now I take it regularly but have reduced the first dose of the day to 50mg and take 100mg at night. I seem to remember that it is to be taken “on an empty stomach” or an hour before food. I have agreed to take the low dose statin too- 10mg daily and that can be taken with or without food!
Agree with others, PIP and slow release doesn't seem to make sense. The only thing I can think is that he saw something in your ECG to make him want to slow the take-up of Flecainide. QRS widening is the concern.
By the way, the penny has just dropped on your forum name! 🤣🤣
Re ablations, France has possibly the world's top EPs at Bordeaux, Profs Haïssaguerre and Jaïs. They did my ablation in 2002. Not really done in the UK back then, and certainly their result on what by then was for me continuous AF was fantastic.
I don't really want an ablation just now. We live about 2 hours drive from Bordeaux and I think I would get sent there. One of my husbands squash partners had an ablation there and got pericarditis afterwards and had to be hospitalised in Limoges. My afib is not really affecting my QOL much. I was worried about not getting the heart rate down and it damaging the heart but I am reassured a bit by the BNP being OK. The problem is that my episodes last about12 hrs and that might be too short for the slow release to work. I'll just have to see.
True that if your AF is not affecting your quality of life then it's wise not to rush to an ablation.
Best wishes to you.
Thanks
Hi
Beta Blockers did not control my heart rate, Metoptolol 186 and pauses at night, Bisoprolol 145. Both checked with 24hr Heart Monitors.
Enter Private H/Specialist. Introduced to CCB Calcium Channel Blocker Diltiazem 180mg CD. Heart dropped from 156 to 51 within 2 hours. Reduced Diltiazem to 120mg.
So I took AM Diltiazem 120mg CD for control of H/Rate Day down to 60s but climbing in afternoon.
Bisoprolol 2.5mg PM for control BP - Keep 12 hours between these two different meds said the NZ Heart Foundation Nurse.
Dr says Diltiazem is working 8 hours but allowing my 'normal' H/Rate Night 47bpm avge. Proof of normal over 3 Heart Monitors for thge 3 changes in meds as above.
I've been on same Diltiazem 3 years 3 months.
But when BP dropped near end of 2024 I reduced Bisoprolol.
Settling BP now 120-135 over 79-85. Day.
Heart Rate now 69-89. Day.
I should have had Diltiazem from Seo 2019 when I had the Stroke - Embolic. With Rapid & Persistent AF and Thyroid Cancer. AF caused the clot whch caused the stroke. As I said NO to Metoprolol "It will make me breathless" - It did. Prescribed 3 x 23.75 daily.
No one would listen.I was a zombie.
So 2 years 5 months in rapid, uncontrolled heart rate. ECHO shows severely dilated Left Atrium damage. 2023 diagnosed with soft Systolic Heart Murmur but Systollic working well.
Drs should listen. And why didn't I have a Heart Monitor before discharge. I was breathless walking up stairs. 5 steps up.
cheri JOY. 76. (NZ)
Flecainide SLOW release V immediate release
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