flecanide - how to start

This is for someone else,,someone who has had a few episodes over the last 35 years. Last time it happened, at the followup appointment EP told patient, "tell them you want to do flecainide when you go to the ER. I will put that in the notes." I didn't think that sounded right but he did have another episode, went to the ER, they would not do the flecainide. I have already gone down this trail and did do a flecainide PIP and then ongoing for awhile. I don't think PIP ever worked but I don't recall having to start that in the hosptial. What's the normal protocol for that one? Do you have to start flecainide in the hosptial? (I did dofetilide for awhile and did start that in the hosptial.). So far each time the patient has been cardioverted. The first time he went in the hospital and did meds but that was ... 35 years ago. He has another follow up on Friday and trying to help him gather questions. It could be his specific ECG lends itself to starting it in the hosptial but it sounded like a generic recommendation.

Thanks

I suspect what that doctor meant was to ask the ER for flecainide as a one-time dose to help keep the cardioversion from reverting quickly back to afib, but that begs the question of why the doc didn't just write the prescription themself. ERs are typically very reluctant to start new meds they're not familiar with, and particularly something like an antiarrhythmic that needs a cardiology review. And they'll almost never write long-term prescriptions for anything. They're just not setup to manage refills, do follow ups, answer questions about side effects, etc. The role of an ER is to stabilize you until you can reach definitive medical care, not to provide ongoing care.

No, you don't normally have to start flecainide in a hospital. I've started it a half-dozen times but never in a hospital and the same goes for most people I've encountered on this forum. But I have heard from a person or two who was required to start it in a hospital, but I believe those people had preexisting conditions that made it riskier. Also, keep in mind that 35 years ago was 1990 and flecainide had only been FDA approved six years before that. So doctors were much less experienced with it and would have been more cautious.

Thanks. What about use as PIP... same? no hosptial stay necessary? There are no pre-existing conditions. And this is a RECENT recommendation from the EP (a couple years ago maybe max) regarding the flecanaide. I am hopefully going to join the appt by phone.

Flecainide PIP you need to know the safety guidelines on dosage limits.
[www.afibbers.org]

I too started flecainide at home.

I also started Flecainide at home. With regards to using Flec as a pip when having a breakthrough episode of aFib…. It was suggested on this forum that during a “breakthrough” chewing the Flecainide followed by a glass of warm water helps the med get absorbed more efficiently. I have tried this and feel the method has value. Perhaps the original poster can expand on this. In any event be sure to stay within the tolerances alluded to above. Good luck.

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bettylou4488
What about use as PIP... same? no hosptial stay necessary?

Unless your friend has unusual circumstances, no hospital stay should be necessary for any use of flecainide. I just think the communications between them got mixed up somehow. So just make sure the question gets asked: Will I need a hospital stay? And if the answer is yes then: Why? But I'll be very surprised if the answer is yes and would love to hear the explanation.

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Carey
I suspect what that doctor meant was to ask the ER for flecainide as a one-time dose to help keep the cardioversion from reverting quickly back to afib, but that begs the question of why the doc didn't just write the prescription themself. ERs are typically very reluctant to start new meds they're not familiar with, and particularly something like an antiarrhythmic that needs a cardiology review. And they'll almost never write long-term prescriptions for anything. They're just not setup to manage refills, do follow ups, answer questions about side effects, etc. The role of an ER is to stabilize you until you can reach definitive medical care, not to provide ongoing care.

No, you don't normally have to start flecainide in a hospital. I've started it a half-dozen times but never in a hospital and the same goes for most people I've encountered on this forum. But I have heard from a person or two who was required to start it in a hospital, but I believe those people had preexisting conditions that made it riskier. Also, keep in mind that 35 years ago was 1990 and flecainide had only been FDA approved six years before that. So doctors were much less experienced with it and would have been more cautious.

Yes I agree with this, this is a very good answer. The Doctor would need write out the exact protocol he wants the ER to perform. Most ER Docs are not very familiar with Flecainide. I strongly suggest you tell your friend to go back to the Dr. and have your friend admitted as an out-patient in the regular Cardiology unit. They will be much better prepared to handle this.

I started Flecainide at home but was required to go into my cardiologist’s office for a 12 lead ECG a day or two later.

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Daisy
I started Flecainide at home but was required to go into my cardiologist’s office for a 12 lead ECG a day or two later.

Same here.

Back when I started (20+ years ago), there were a number of members here reporting having start flec under observation, but not necessarily as a hospital inpatient.