Episode if on daily flecainide regimen

I take 100mg flecainide twice a day and am on the calcium blocker Norvasc also. My episodes occur about every two months and are vagal, usually waking me from sleep. I'm interested in what others do when an episode of Afib comes on. That is, how much extra flecainide do you take and whether or not you add a beta or calcium blocker also. I believe I remember Jackie's regimen of beta blocker followed by flecainide when the rate lowers. I appreciate any input. Tom

Tom, I am interested in answers you might receive.

After 10 years of fib, I finally went on flec after my pill in the pocket approach increased my events to every 2 or 3 days. I was put on 300mg daily and am weaning off it slowly to see how much I really need.

To answer your question, here is what I will do with no formal instructions from my EP, I forgot to ask the question when I was in. Since 300 is the maximum daily dose, I will just take on occasion when needed the difference in the dose I am taking and 300 mg. So, If I was taking 200mg daily, I would take 100 extra as needed. I only take a beta blocker if my HR goes over 130.

...ron

I am taking 50mg twice daily. I have not yet had a breakthrough episode. This is not surprising or necessarily due to the Flec as last winter, when I was not yet on Flec, I went from the start of September to May without one. In case of a breakthrough, my cardiologist has told me to take the 5mg beta blocker I was previously using as a PIP (without noticeable success) and also, if it is 4 hours or more since my last dose of Flec, to take another 50mg. I had noted that Jackie mentioned taking the beta blocker BEFORE the Flec, so that is what I would do. It would make no sense to wait until the beta blocker brought my HR down, as this often would not happen for hours. BTW during an episode my HR often goes up to 200. By the time it comes down to 130 I consider I am on the mend.

Tom - the beta blocker or calcium channel used at the start of an AF event helps to lower your heart rate so when you add in the antiarrhythmic, it can work and convert back to NSR. I was told that conversion can't happen with flec when the HR stays high so I always used it as directed. I'm not sure if all calcium channel blockers are equally effective for this purpose, but I know that the beta blocker, metoprolol, does work effectively. My dose is 25 mg at the onset. However, for vagals, a beta blocker has other downside effects so you don't want to take a BB regularly; the CCB would be a better choice.

My experience using first the BB (25 mg) and then 100 mg flecainide after 30 minutes, is that it typically works well in one hour or less. At times, I have had to add a second dose (another 100 mg) of flecainide and that typically worked in less than 2 hours total.

However, I recently learned that current PIP (pill in pocket) recommendations for chemical cardioversion has increased the amount of flecainide to 200-300 mg as a dose.

Jackie

HI Tom - well, this happens to me quite a bit lately, especially. I am on the maximum dose of Flecainide - 300 mgs/day. If I do get a breakthrough, it usualy comes during the night (while sleeping) or early morning while laying in bed. Occasionally it happens in the late evening before I go to bed. So I take 25 mgs. of Atenolol (or shave it a bit as my heart doesn't usually feel like it's going all that fast), wait at least 1/2 hour, and if it's been at least 8-9 hours since my last dose, I take my next dose of Flec. That usually gets it to stop within an hour or so. If I took a dose fairly recently and then get a kickup soon afterwards, I usually just wait it out and it usually goes back to NSR within 2 hours or less.

My feeling is that it's better to take the doses a little closer together in time (at least 8 hours apart, however), as it's better to be in NSR that not. So I do watch the clock to be sure I don't take a dose too soon after my last one, and so far, that has been working out pretty well.

Hope that helps ~ Barb

When I was using Flec+Diltiziam as a PIP, I used 300mg Flec and 40mg Dilt. It worked normally within a few hours but on a couple of occasions took 8-9 hrs. I am about 175 lbs. I never had any perceived ill effects from it. HTH

First, thanks to the people who responded to my query. Every bit of info we can gather adds to our storehouse and allows us to have hope and preferably success. My BP and vagal is controlled much better with a calcium channel blocker than with a beta blocker. (thanks to Jackie's input from several years ago) I ordinarily take 12.5 mg metoprolol at onset of Afib and then 100 mg flec. 30 minutes later and convert within a couple of hours. The last time I did this my heart rate and BP were very low after conversion, leaving me lightheaded and weak so I wonder if I even needed the beta blocker. I guess I will monitor my heart rate the next time I'm in Afib to see how fast it really is going.

I'll put this info here even though it is not about daily doses, but flec in general:

Had a PVI ablation, put on 100 mg flec twice daily, one day post-op I had a one-hour long tachy episode, 6 days later a 6 hour tachy episode. Following the second tachy episode I stopped taking flec and have had no arrhythmia problems since (about 3 weeks).

Tom