Flecainide - how often can you take 'pill in pocket'?

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I've had AF for about 9 months now and was on Dabigatran and Bisoprolol. I couldn't get cardio-version on the NHS as although I had permanent AF for 4 months (following an operation), I switched into parxoxysmal. I have recognised triggers which I now avoid - caffeine, salt, dehydration etc; the one trigger that I do not wish to avoid is excerice and 75% of the time this puts me back into AF. I'm 50 years old and do intense excerice at least once a week plus other excerice - the intence excercise puts me into AF and I do try and stay well hydrated. I've just been prescibed Flecainide and after 'spinning', I went back into sinus rythm - a few days later however I've just played touch rugby and the flecainide has not worked; I've remained in AF - I've only been prescribed 50mg. Should I take another one? How often can you take them? Should I have a higher dose? I have a relatively healthy heart for someone in AF, I have average blood pressure 117/72 (last check), my sinus BPM is circa 58-62 bpm average - but, I am 17stone (ex-rugby player) and carry a lot of muscle bulk but also fat. If I excercise three times a week, is it OK to take flecainide each time or until it stops? Should I have been kept on beta blockers instead? If I don't take any drugs I remain in AF - while I was waiting to take Flecainide I stopped my beta blockers for three weeks and remained in permanent AF 24/7. Stopping excercise or slowing down on my excercise is not an option.

My AF is not as dibilitating as most - my resting average BPM jumps to 85-120 and I have mild palpitations; I lose about 20% of my energy; I can still excercise on AF although I lose breath mor equickly than when in sinus rythm. What is the solution to regular excerce bring on regular AF when using the 'pill in pocket' approach?

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  • Posted

    I, too, have paroxysmal AF but am very well controlled on Securon 240mg (verapamil) as I was unable to take beta-blockers. Stress seems to be my trigger factor. I use Flecainide 100 mg as a pill in my pocket but have only needed them about four times over the last two years but have not found it to be very fast-acting. It takes at least three hours. If I'm able to take it in conjunction with Securon it works better and even a cold shower worked well on one occasion. I'll try anything to avoid going into hospital! I haven't repeated the dose on any occasion but have contemplated it and have wondered if that is possible. Sorry I can't be more help but will be interested in reading other replies you may get. 
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    • Posted

      Hi Julie, you have actually been of help. I expected the Fecainide to act as quickly as a beta blocker and your comment that it can take 3 hours is very useful. I'm also the same as you re hosptials - last resort for me, (but ablation would be welcome). Thanks.
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  • Posted

    Your only real answer I am afraid is not immediately helpful, and that is to go and see your cardiologist. Increasing your dose without professional advice is risky for this class of drug. In my experience, high doses affect my physical ability as well as having the effect desired.  Only your specialist is fully familiar with your history, ring his secretary, with luck he may give you a consultation by telephone.
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    • Posted

      Thanks for your help Malex, I guessed that this may be the case. I sometimes feel though that you get very useful advice on these forums and it is also interesting to hear from other people.
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  • Posted

    Hi Tony. I have had PAF for around 10 years now, I have been on Flecainide since the start I take 100mg x 2 in the moring and x2 in the evening and have on occasion taken an extra tablet or 2 if I get a real bad attack.

    I also take Tildiem 200mg once a day and also Digoxin 125mg x1 a day the Digoxin is a recent addition as I am getting the attacks more frequently and with a greater intensity.

    My pulse rate goes up to around the 180 mark but is common at around 120.

    I was prescribed Sotalol when I started but quikly got myself back on Flecainide as Sotalol droped my heart rate through the floor and I felt I was going to croak.

    my cardiologist tried me on Dronedarone recently but I had to come off it as fortunately I was on holidays at the time at home it gave me the runs magor I could not leave the house it was that bad also I experienced the worst cramps you could imagine in my thighs both at once so I could not walk at once stage.

    I was told by my wife's cousin a pharmascist that Flecaniade needs to build up to a level in the body and constant medication keeps it at that level to stop the attacks. Flecainide (as she puts it) puts the heart to sleep and the Tidiem suppresses the intensity of the attack, how you manage with only taking it occasionally I dont know but if I were to stop the medication my attacks would be major the pulse went up to 220 the night I was diagnosed it felt like I was being pounded on either side of my neck.

    well thats my story and experience with this medication another member said she found it slow acting I suppose that if you only take it occasionally this could be the case but having said that when I go into A.F I get a an attack thats debilitating, something to look at is that if you can take your pulse you may find that it is missing a what I call a beat in the sence of your heart goes beat beat beat then nothing nothing beat beat beat beat then nothing and then a beat when this happens I feel like I am dying so try this and see what your heart is actually doing as it may not necessarily be racing away just very irregular which is also a symptom.

    regards

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    • Posted

      Hi Alun, this is really useful. Funnily enough, I went into AF again last night with BPM 120 - 140 but really pounding and took my prescribed Flecainide dose of 50mg and I'm still in AF now, despite taking another 50mg this morning. Somebody said to me that because I have no sign of hypertension, that the doctors may be reluctatnt to put me on a regular or higher dose? Its really interseting to see how the combination of drugs work for you and I intend to ask my GP if this is a viable option for me.

      Its also interesting to see your reaction to other alternatives - it sounds like me when I was on various beta blockers; at one stage my BPM was at 38 and I could hardly walk. I'm sure that for all of us its just a matter of finding the right drug combination.

      Thanks again for your help - really useful.

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    • Posted

      I am on maintenance dose of 50mg twice a day. When my heart goes into AF, I take an extra 100mg. If I take the extra 50mg instead, it does not alway work. Lately, it's been two aor three days a week I have to do this.

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