An effort to help others - Flecainide first timers?

As they often say, a little knowledge is dangerous and my insistence of learning about drugs before I take them unnecessarily delayed me taking flecainide the very first time and made the intervention less probable to work.

Cardi # 2 prescribed and said "just take it". I had a trip to Italy planned and delayed during that trip. Cardi # 3, scheduled a stress and echo but cancelled at the last minute because a Dr wasn't available. Cardi # 4, told me to take MulTaq instead which IDK, rarely leads to chemical conversion (anyone know better?) Cardi # 5 said get off the MulTaq and try Flecainide but because a change in insurance and a delay in his office was MIA for any help after that.

So finally, I just had to do it out of desperation.

My plan was this, print out following text and sit in an ER waiting room with this note while the drugs took affect. I told the desk staff, exactly what I was doing, gave them a copy also, so that if they saw me fall to the floor or some other distress they would be able to act quickly.

I had my pocket EKG with me which gives pretty accurate info and a BP cuff. I took MetSuc at 8:00 AM and Flecainide at 10:00 AM and began taking readings every 30 minutes while surfing the internet. Nothing happened either way.

Maybe overly cautious and I know that Flecainide doesn't kill like cyanide but I still needed to get over that hump.

Hopefully, this helps someone else.

-----------------------------------------------------------------------------------------------------------

My name is (name)

I have been in AFIB since (date)

At the advice of my Dr, (name) at 10:00 AM on (date) (today) I took a (amount) mg dose of Flecainide. I also took (amount) mg of Metoprolol Succinate at 8:00 AM earlier today.

I also take 5mg of Eliquis 2X daily.

(list other drugs and amounts)

No other medicines or supplements are in my system.

Along with heart rhythm issues, it may be possible that a blood clot moved from my heart and into my lungs or brain due to the use of these prescriptions.

I have insurance with (company) and request that all life saving measures be conducted if I am unable to respond for myself. My insurance information is printed behind this sheet.

My emergency contact is (name and number)

My attorney is (name and number). He can provide medical directives if needed.

Flecainide Toxicity: Although I did not take a ‘toxic’ dose. This information is presented to save time should it be necessary:

The mainstay of medical therapy has been the use of high-dose sodium bicarbonate to offset the cardiotoxic effects of the drug by inducing a high-dose sodium load along with serum alkalinization. This therapy alone has been shown to rescue patients from even life-threatening overdose

Flecainide overdose may cause potentially fatal arrhythmia, myocardial depression, and ventricular dyssynchrony. Hypertonic sodium bicarbonate is the mainstay of medical therapy, though there may be a role for other antiarrhythmics and intravenous fat emulsion. In the failure of initial medical therapy, consideration should be given to the early use of venoarterial ECMO, which can provide life-saving hemodynamic support and promote natural drug clearance.

Are you sitting in a virus ridden Er right now??? Wear a mask!

I'm surprised they allowed you to sit in the waiting room.

me too! Wear a mask!

This was early February. I took 300 mg today, still alive and not anywhere near an emergency room nor worried about it. I wouldn't do anything to take any bandwidth out of the healthcare system right now.

Why don’t you spread it out 100mg every 8 hours or 150mg every 12 hours?

Using as PIP in hopes of popping back into NSR. Doesn't look like it will work.

Last EKG was wonky as hell.

[imgur.com]

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susan.d
Why don’t you spread it out 100mg every 8 hours or 150mg every 12 hours?

Because the whole idea of a PIP approach is to hit it with the biggest dose you can safely use as fast as possible. Typical instructions call for chewing the pills and swallowing with warm water as soon after the episode begins as possible.

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NotLyingAboutMyAfib
Last EKG was wonky as hell.

I can't be sure with just a single lead but that looks like it could be mixed AF and AFL, which isn't unusual. It's clearly very irregular, so that's AF, but it looks like I might see multiple P waves between some of the QRSs, and that's AFL. You also threw a couple of PVCs. I experienced mixed AF and AFL many times, and it often produced ECGs that looked wonky like that. The trouble is, they sort of feed each other. The AFL will trigger the AF, and vice versa. It's kind of a vicious circle.

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NotLyingAboutMyAfib
Using as PIP in hopes of popping back into NSR. Doesn't look like it will work.
Last EKG was wonky as hell.

First time I used 300 mg PIP flec (15.5 years ago), I converted a 2.5 month episode. However it took 20 hours. So if you've been out of rhythm for a long while, it may take a while (EP didn't think it would work). Not saying it will work, just that my first one did take a long time.



Edited 1 time(s). Last edit at 04/01/2020 11:25PM by GeorgeN.

Carey thanks - it's nice to have someone that can actually interpret an ECG. Thank you.

George - fingers crossed. I had to wait for the MulTaq to wear off, I might try again tomorrow and maybe throw in acupuncture.

Steven C - maintaining your regimen (other than D)

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Carey

Why don’t you spread it out 100mg every 8 hours or 150mg every 12 hours?

Because the whole idea of a PIP approach is to hit it with the biggest dose you can safely use as fast as possible. Typical instructions call for chewing the pills and swallowing with warm water as soon after the episode begins as possible.

I do try to take it as soon as I notice I'm out of rhythm. Not that this is a good idea, but a BB was never prescribed to be taken in advance & I've never used one. Nobody ever told me to chew the pills, yet that is what I started doing, nearly from the beginning of my use of PIP flec. I think it was my third use of it, I was in a 3 person snow cave I'd constructed with little help from the other two. The exertion of breaking trail with a heavy pack and of the cave construction created a delayed parasympathetic trigger for me. It was about 11 PM. My water bottle was partially full of ice. I chewed the flec and swallowed with ice water (the flec does have a bitter taste). That turned out to be one of my faster flec conversions on record - significantly under an hour (a typical time for me). I've even swallowed without water, depending on where I was.

George thanks again.

Everyone - let's say I get back in NSR - how do I wean off Flec and Metsuc safely? Just keep proportions same and reduce?

I have 25mg and 50 metsuc and 150 flecs. I've gotten pretty good at cutting pills in half/

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NotLyingAboutMyAfib
George thanks again.

Everyone - let's say I get back in NSR - how do I wean off Flec and Metsuc safely? Just keep proportions same and reduce?

I have 25mg and 50 metsuc and 150 flecs. I've gotten pretty good at cutting pills in half/

In 2012, calcium was negatively impacting my afib. Prior to that had only used flec PIP. A cardio suggested I use it prophylactically - I'd had 4 episodes in a row (meaning daily). All were converted by flec PIP. So the first night I took 300 mg before bed. No afib. The next night I took 200 mg before bed, again no afib. So I decided to continue slowly titrating down. I had 100 mg pills. Just cutting them appropriately. I continued this, then I read Hans' ginger article, so added that in and titrated more quickly, as described here (written in early 2013). I think I titrated down to zero over about a month's time. Was only thinking about taking enough flec to keep me in rhythm. In May 2013, reread the calcium/afib literature and thought that could be my issue (I'd gone through a divorce and was stress eating wheels of brie - thought it was divorce stress & thought since I was eating a low carb diet I had a pass). I dropped the brie and my control returned to pre-divorce status.

Anyway, from my experience with flec, cutting pills is fine.

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NotLyingAboutMyAfib
Everyone - let's say I get back in NSR - how do I wean off Flec and Metsuc safely? Just keep proportions same and reduce?

You don't need to wean. If the PIP works, it works and you're done. If it doesn't work, it doesn't work and you're done. Well, okay, you can make another PIP attempt a day later, but if that doesn't work, you're done. Just don't take anymore.

I'm not sure where this notion came from that all drugs require a weaning process, but it's just not true. Some drugs, yes, but most others, no. You don't need to do anything other than just stop taking the flec and metoprolol.

Thanks everyone. This is a great forum.

I am going to do nothing today but try flec and acupunture tomorrow with positive thoughts.

As I still have D and its calcium effects as last remaining suspect, not scientifically hopeful but NSR was so nice, I'd like to have it again.

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Carey
You don't need to wean.

I'm not sure where this notion came from that all drugs require a weaning process, but it's just not true. Some drugs, yes, but most others, no. You don't need to do anything other than just stop taking the flec and metoprolol.

Just to be clear. In my post above, I was trying to find the minimum level of flec that would keep me in NSR, using it prophylactically not PIP in this case. As I posted, I found that by adding in ginger spice, I could titrate to zero. I was not worried about how quickly I went off the med.

Yeah, I got that, George. I was responding to NotLying and didn't think you'd said that.

George - ginger spice? TIA

Never mind - found the PDF.

I am on eliquis so I'll need to look deeper.



Edited 1 time(s). Last edit at 04/02/2020 04:09PM by NotLyingAboutMyAfib.

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NotLyingAboutMyAfib
George - ginger spice? TIA

See also this recent post by Johan.

Took MetSuc 50mg at 7:00 AM today,, 1 tbs of ginger paste at 8:00, 300 mg of Flec at 9:00 did acupuncture at 9:15 and nothing happened.

Other than trying the same ginger extract that Johan used and staying on Steve's protocol minus the D - that's it until next ECV. Which I won't get until D is in the 30s.