Is this medication combination normal?

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Worried about my mum.. Diagnosed with 'sick sinus syndrome' December last year (happy Christmas), she had a pacemaker fitted in March 2014 and has been on 10mg of bisoprolol a day, and yesterday went on an additional 5mg a day of flecainide.

She is generally an active young 69 year old. Prior to the diagnosis she was dizzy, tired and feeling faint - had palpatations and a racing heart. Apparantly this was all due to the heart missing beats (sick sinus) accompanied by an abnormal (fast) heart beat.

Following the first follow up visit back to the hospital, it found the pacemaker was working well and kicking in when the heart skipped beats. The heartbeat itself was still too fast - up to 190 bpm on 2000 occasions over the 6 weeks. Hence the introduction of flecainide they say.

Mum is still tired and out of breath, she finds it exhausting to walk round the corner and feels her legs are so heavy its too tiring to walk.

From reading some of the other discussions on these forums I'm wondering if the bisoprolol is too high a dose... It didn't bring the heartrate down following the introduction of the pacemaker (maybe that not what bisoprolol does?), and now she'll be on 5mg of flecainide as well.

Does anyone have any opions or similar experiences? Thank you.

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  • Posted

    Your mother is more or less an exact replica of my own medication, except I have AFib and not sick sinus.  I was on 100 mg Flecainide twice daily and also 7.5 mg Bisoprolol and now I recently have a pacemaker also.

    I took the Flecainide for almost three years, and a low dose of Bisoprolol 1.25 during that time and was okay more or less, although I had two ablations, a cardioversion etc, none of which cured the AFib.  The problems occurred when the Bisprolol was increased to 7.5 mg after the pacemaker was fitted.  My main problems were utter exhaustion (feeling like weights were attached to my legs), blurred vision (sometimes associated with Flecainide) and pulsing tinnitus which kept me awake listening to my heart jumping about.

    This week I have had an AV node ablation to complete the pacemaker takeover and I have elected to come off all medication (the cardiologist says it is my choice).  If I don't try this, I just won't know whether these side effects are from the drugs or my heart condition - which continues to be AFib.  It is early days yet, and I am trying not to be paranoid about monitoring how I feel, but I will come back if I get any real result.

    You can read the comments on the forum about Bisoprolol and draw your own conclusions as I did, about the likelihood of this being the culprit which is making your mother so fatigued.

     

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    • Posted

      Thank you for your reply, it does sound very like what my mum experiences and with very similar medication.  I hope you get on ok with stopping your medication, I can understand why you're doing it - difficult to know if how you feel is because of the medication or the condition itself. 

      I know mum's concerned about introducing more medication into her situation, but she feels its early days with the flecainide so has to see how it goes.  It all seems very hit and miss.

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  • Posted

    Hi, Previously mentioned on this site under Bisoprol, if your mum takes the Bisoplol in the morning or daytime, get her to take it in the evening perhaps with supper, so that she sleeps off most of the side effects that Bisopprol gives. It worked with my wife and several people have tried this and it does improves ones life with less of the side effects in the day time.

    Regards Ken.

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    • Posted

      Hi, yes I did actually see your suggestion in another post.  I will tell mum about it and see if she will give it a go.  I know she's nervous about altering any instruction she's given by the doctors (i.e. 'take bisoprolol in the moring and flecainide in the evening') but she could give it a go.  To be honest, I don't have a great deal of faith in the doctors or consultants she has seen - they've all seemed dismissive, impatient and too busy to bother that much.
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    • Posted

      A question I asked elsewhere in this form. Is the medication as effective in controlling heart for the activities of the day if taken at night? Does the drugs effect/benefit last for 24 hours?

      When I was taking it I eventually swtched to taking it at night  but was not sure if that was a good thing

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    • Posted

      Can't see how it could make any difference medically.  However, I only know that when I took the advice of taking the dose early evening instead of breakfast, I felt heaps better almost immediately, especially in walking distance.  
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  • Posted

    Don't know if Bisoprolol and Flecainide work together but I certainly DO know that Bisoprolol NEVER helped my racing heartbeat at all.  Had to come off it (10mg) as it was doing me no good and was also told to stop Ramipril (for high BP) and my heart rate is now only 72-ish - and I'm on Flecainide alone.

    Each patient is so very different that it's impossible to say how these various drugs work for each and every person.  Personally I'd say that if the present medication is not working then it should be stopped. But that's only MY view of course.  Wish your Mother well.

    BTW are you sure that it's only 5mg Flecainide?  I seem to think that 50mg is usually the starting dose and this can be increased to 200mg or even 300mg daily.

    Regards, George

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    • Posted

      hmm.. I think she said 5mg flecainide, but i could have it wrong - i will check.

      Interesting to hear Bisoprolol didn't help your racing heart, the more I hear the more I think its that that needs to be reduced.  I will resume my nagging to go back to the doctors.

      Regards, T

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    • Posted

      hi, you're absolutely right.. I got the dosage wrong; 10 mg of bisoprolol in the morning and an additional 5 mg in the evening and 50 mg of Flecainide morning and evening.

      Regards

      T

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  • Posted

    Hi, I'm 26 and am on the exact medication that your Mum is on, although my cardiologist is yet to explain what exactly is going on with my heart.. he just shows me a diagram on an ipad everytime I go! It was caught going into an abnormal heart rythm once on an ECG recording but appears to never play up when I'm being recorded (typical!) I had ablation surgery a year ago which was unsuccessful as they tried for two hours to get my heart to 'play up' but it wouldnt go! 

    I still experience flutters and missed beats but as they cant catch it, theres nothing else they can do! 

    The medication makes me tired at times, however it is managable, I work upwards of 50 hours a week and continue to have a good lifestyle. 

    I have no idea what the next steps for me will be but if your Mum is having side effects maybe talk to her cardiologist about it or ask to see a different one? 

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    • Posted

      Hi, your situation sounds very like mums in the beginning of her diagnosis.  She ended up being sent away with a portable ECG monitor thing for a day and night to record all that went on as I don't think the ECG when she went to the doctors showed enough.  Perhaps ask for something like that if you haven't had it already?

      Glad you're able to continue with a normal life, but hope you get diagnosis or resolution soon.

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    • Posted

      Hi, I had a 7 day ECG that picked up the abnormality 4 years ago but the cardiologist just seems to have left it now! The cardiologist is hoping that if I have palpatations they will be able to dectect it if I go to A and E but normally by the time I get there its stopped! I also suffer with low blood pressure so Im not convinced the medication helps that. 
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  • Posted

    Hi again, I've clarified the medications mum is now on - 10 mg of bisoprolol in the morning and an additional 5 mg in the evening and 50 mg of Flecainide morning and evening.  So way more medication than I first understood.  No wonder she's not feeling the best.
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    • Posted

      From my experience it will probably be the high dose of the beta blocker Bisopropolo.  One of its common effects to make people feel so very tired and drowsy, almost zombie-like.  Do you know how long it took her to reach this high dose of Bisoprolol?  This I believe can have a very bad effect on the user if it is pumped up too quickly. For example, to get to 10mg a day it should have taken about 15 weeks or more.  Like most medications too much is worse than too little.
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    • Posted

      Mum was on 5mg of bisoprolol for years, then when she had the pacemaker fitted in March this year it went up to 10mg, and 6 weeks later they put it up by another 5mg taken in the evening (so now a total of 20mg per day).  I don't really understand why they did that as high blood pressure wasn't the main issue, it was the racing heart beat.  She was on the 5mg for years before all this and that was fine.
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    • Posted

      Please query this amount and tell the doctor of the effect it is having.  The highest dose I have known of is 10 mg.  I was on 7.5 and found this intolerable.  I have stopped taking it altogether as a matter of choice after the pacemaker.
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    • Posted

      This seems a LOT of Bisoprolol, especially in such a short space of time (from March to present time).  When I complained to my GP and then to the cardiologist that this drug was DAMAGING me in so many ways they said to immediately stop taking it.  I felt so much better within a few days and I now take Tildiem300 (diltiazem) and a small dose of Digoxin.

      I would suggest seeking a second opinion if possible.

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