How to switch from Sotalol to Flec + Diltiazem?

Due to fatigue and other side effects, plus the fact that I have had a few short breakthrough events, my new EP has recommended I change from Sotalol 80mg BID to Flecainide 100mg BID + Diltiazem SR BID (no dosage given).

The letter he's written to my GP just says to stop Sotalol and start
the new meds. I have yet to speak to her, so not sure how she will do this, but the Sotalol packet says stopping it suddenly can cause fatal arrhythmias.

So before I speak to my GP I'd like to know if it's safe to just stop sotalol one day and start the new meds the next?

Thanks in advance.

Sally

That warning is intended for patients taking sotalol for ventricular arrhythmias. You can disregard it unless you have more serious cardiac issues than afib.

Yes, you can stop sotalol one day and start the others on the next, but ask your GP how to proceed. It's possible she'll want you to give the sotalol a day or two to wash out of your system.

Thanks for your reply. That's reassuring. I have lone PAF. My heart is normal and no other issues.

I will follow my GP's advice but just wanted to be a bit more informed about it myself first.

I took flec for about a year after going to Bordeaux, and then I went back into permanent afib. My EP switched me to Sotalol, which converted me and which also worked for about a year, then back into permanent afib. This time he cardioverted me, and then put me on flec again, 100 twice a day, with diltiazem, I think 120 mg once a day. That was about 7 or 8 years ago, and except for a few fairly brief episodes, I really haven't had afib since then. Recently though I have been getting tons of ectopics. But I have to assume that the diltiazem made the difference.

But I feel very tired and drugged, yawn a lot, and generally find that my quality of life has been affected. Wonder if I should try something new, but kind of afraid to. I experienced 6 years of virtually permanent afib, and I dread going back there. The only thing my EP could suggest was dronedarone, which he said a lot of people complain about.

Quote
Doug S.
Wonder if I should try something new, but kind of afraid to. I experienced 6 years of virtually permanent afib, and I dread going back there. The only thing my EP could suggest was dronedarone, which he said a lot of people complain about.

The only complaint you'll probably hear about dronedarone (Multaq) is it didn't work. It has very few side effects and would be a great drug if it worked for people with hard core afib, but it usually doesn't. It's a good drug for people who need some light afib suppression, like after an ablation, but if you've been battling persistent afib for years then I doubt it's going to work for you. It might, but I would bet against it.

Your EP didn't mention Tikosyn?

And are you really sure you want to keep battling this beast with antiarrhythmics? You've been on them a long time.

Good question. But I've had a number of ablations, and finally had some success in Bordeaux. I guess I'm worried about upsetting the applecart and possibly making things worse. My life is much better being in NSR, even with drugs, than it was in permanent afib. I really dread going back there.

I know I've heard of Tikosyn, but don't think I've ever tried it. I could run that past my EP, but he's already told me that he thinks dronedarone is the only real option. I'll try him again though.