MULTAQ

So I avoid reading side effects on meds for obvious reasons.

Since my ablation on June 15, I was taken off Flec and put on Multaq. I wondered why at the time and cant help but think Im part of yet another experiment. I guess docs have their reasons and favorite drugs to give out. So after having days of upset stomach, nights of indigestion including last night when I thought I may have to go to ER. extreme fatigue, toe, foot and calf cramps so bad they wake me and are so painful I wake up sweating profusely.

So I did it; I looked up the side effects

#1 slowed heart beat, inflammation of the lungs including scarring, low potassium and magnesium in the blood SERIOUSLY !!!! ISNT THE LAST PART WHAT WE ALL ARE FIGHTING AGAINST!!

#2 stomach problems diarrhea, nausea, vomiting, stomach area pain, and indigestion. feeling tired and weak

Check...Check and Check

I hope that yes I can maybe come off this med after the blanking period, but shouldnt we be addressing pot and mag levels here especially when someone has obvious symptoms,
My point is this website and other informative materials are available and crucial for all of us. Sometimes YOU have to do some of your own doctoring and get things addressed.......and.............I do not like MULTAQ
Tim

Yes Tim,

Definitely address your mag and electrolytes per The Strategy which is good to start up with again right after your ablation. The AAR drugs are generally not a lot of fun but typically you will adapt to it to a fair degree over the first two weeks (if you are going to adapt) and I doubt you will need it much beyond the blaming period in any event.

Hang in there,
Shannon

They probably put you on Multaq because they probably get kickbacks for getting patients on Multaq which is expensive. I've heard of doctors getting kickbacks for putting patients on new, expensive drugs.

Tim, I had my Ablation 2 days after you. My LAA was isolated/ablated etc. My report in in the forum. After this 2nd Ablation, I was not put on ANY antiarrhythmic drug. My insurance company would not approve Multaq; I was on Sotalol before the Ablation but Dr. Natale decided to not put me on any antiarrhythmic drug. All I take is 25 mg of extended release Metoprolol which I have been taken for years and of course eliquis. I go back for a TEE in December.

I have taken Multaq in the past; I hated it.

Anyway, Tomorrow is 4 weeks and I am doing well. I have no idea why I was not put on a antiarrhythmic drug during the 3 month blanketing period. I was the 1st Ablation in Feb. 2014 and it was Multaq. I was already taking Multaq before the Ablation. My insurance company approved it 3 years ago but not now.

I do continue to take Magnesium and also eat food that has potassium in it.

Good luck and I hope you get to feeling better.

5 mg Valium a day as needed.
20 mg Prozac daily
15 mg Prevacid a day
60 cc shot of Testosterone Cypionate every 10 days. Testosterone is low due to schedule two narcotics.
.5 mg Arimidex 2x a week to keep Estrogen levels in check. T shots can cause rise in Estrogen.

100 mg Metoprolol ER 1x a day
25 mg HydroDiuril fluid pill 1x a day every 2 days.
Neurontin 900mg a day (for Neuropathic pain IC/CPPS)
800 mg of Magnesium daily . Different types
81 mg aspirin 1X a day. Heart Doctor order due to stent installed in Jan. 2012.
2.5 mg Eliquis 2X a day

Miralax 1x a day for constipation issues. I have tried so many different methods for Constipation since 2008. Fiber is in my diet but to much Fiber really Constipates me.




25 mg/hcr Fentanyl.patch changed every 2 days

1st ablation done Feb. 27, 2014 for Long term persistent AFIB Dr. Natale
2nd Ablation done June 16,2016 Dr. Natale LAA isolated



Edited 1 time(s). Last edit at 07/14/2016 02:09AM by smackman.

Smackman good to hear from you. Im glad you are well. So far I am having blurps here and there few short runs that break fast but overall very good other than the med. Its weird they took me off Metoprolol/Flec and on Multaq
Im looking forward to peace of mind for both of us!!!
Tim

In my opinion depending on the Metoprolol doseage you was on, You should have been "weened off" Metoprolol. Maybe you did but Multaq does not have a beta blocker in it but when combined with Metoprolol, It can cause a low heart rate.
When my issues started in April, My Cardiologist put me on Multaq along with my beta blocker and my resting heart rate would drop to 50. Now this was before we found out my insurance would not approve Multaq anymore. I had enough samples to stay on Multaq 3 weeks but I ran out. 3 weeks later I am back in the Hospital and they start me on Solatol 40 mg 2x a day.
Since Solatol has beta blocker in it, I stopped the Metoprolol but I had some issues stopping it cold turkey. It lasted about 4 days. Jitters, affected my sleep etc.

I have a low resting heart rate when things are normal taking the medications I take.
Anyway, We will get through this. I would call the nurse educator and tell her about the Multaq issues. It dried my skin out big time also. I am 58 years old and I know we have the best EP doing our Ablations.

Hi everyone! This lovely AFib start in March and I take 380mg Diltiazem, 5mg lisinopril, xarelto and 400mg multaq 2 a day. The xarelto made me sick and then they put me on the multaq and that made me sick too. I'm feeling better. I went to see an EP doctor yesterday day. He wants me to have cardiac ablation. I'm scared too death! I have Afib flutter and he says he can cure it. It sounds like some of you have had multiple ablations??
I do pretty much go in to Afib flutter every day. Mostly at night when I'm watching TV. It doesn't last long and I don't really get dizzy or short of breath just feel tired and my jaw feels funny sometimes. I just thought I could live with it if stays like this and not damage my heart in the long run. I really don't want to have this procedure
is it bad??

ssrehman,

Make sure if you are considering ablation find the most experienced person your insurance will pay. This time I traveled from KY all the way to Austin TX to be cared for by the best EP in the world. It is worth the time and effort. It was my 6 th ablation, but only the 2 nd on the left atrium for Afib. The reason you will see many multiple ablations is because of EPs that are not at the top of the experience ladder with high case numbers. They may be great docs but just not enough experience. The procedure is not bad at all. You will be uncomfortable after the procedure for a couple days. The entrance site areas is the worse part of the procedure.
My care at St Davids in Austin was by far way better as far as attention and caring of nurses, pain, accommodations, etc.
Im hoping for positive results this time

tim

Smackman wrote:

"you did but Multaq does not have a beta blocker in it but when combined with Metoprolol, It can cause a low heart rate."

Multaq does have a Beta-blocker in it. It is not a strong one though. Multaq can be taken without a separate Beta-Blocker. The only AAM that does not have a Beta-Blocker in it is Flecanide.

I took Multaq for 2-3 years or so without noticable side effects.
Multaq is thought is have less side effects than other AAM, and is is a modified version of Amiodarone, one of the most effective AAM's ever. It was modified to produce less side effects. Nevertheless thanks for those posting negative experiences with the Multaq.

The Anti-Fib Wrote:
-------------------------------------------------------
> Smackman wrote:
>
> "you did but Multaq does not have a beta blocker
> in it but when combined with Metoprolol, It can
> cause a low heart rate."
>
> Multaq does have a Beta-blocker in it. It is not
> a strong one though. Multaq can be taken without
> a separate Beta-Blocker. The only AAM that does
> not have a Beta-Blocker in it is Flecanide.
>


My understanding is Multaq does not contain a actual beta blocker but due to its chemical "makeup" it will interact with your beta blocker possibly causing bradycardia especially if you already have a resting low heart rate which I do. I ask my Cardiologist about this and he gave me the "laymen s" answer I am giving you.



Edited 2 time(s). Last edit at 07/16/2016 02:40PM by smackman.

Clips on Multaq properties

Irregular Heartbeat

Reports of irregular heart rhythms on Multaq included 18 “potential” cases of bradycardia (abnormally low heart rate), 47 cases of atrial tachycardia (fast atrial heartbeat) and 13 cases of ventricular tachycardia (fast ventricular beats).

Comments: The total number of adverse events reported for Multaq could be skewed if one event was reported more than once, or by multiple people, or to multiple recipients. How could that have happened?

I am willing to accept some of the blame for this. When I received early reports of serious issues from specific afib patients, I reported those adverse events directly to Multaq’s manufacturer, sanofi-aventis. To protect patient privacy, I never reported any individual patient names in these reports. Sanofi was very diligent about making sure I had all the right forms to report these incidents and also asked me to ask these patients to report their events in detail or to ask their doctors to do so, to be sure no detail was overlooked.

Some of these reports could have been sent directly to the FDA while others may have been sent to Sanofi, or to both. The company, in turn, was required to report all discrete events to the FDA, so it’s possible that the FDA database of adverse events could contain events that were double- or triple-counted. In fact, QuarterWatch specifically mentions this problem, saying that the FDA system was flooded with duplicate reports taken from the same sources because the FDA requires companies to monitor the literature and report from it. Since I didn't report patient names, there is no way to know if my reports were duplicates, so I take some responsibility for potential redundant data and over reporting.

Thus we can't know for sure how many events actually occurred of each type below, so please consider that these adverse events could be much more rare than the numbers below indicate.

Bradycardia

I personally reported several cases where people who were started on Multaq ended up in the ER with bradycardia. Two were already taking beta blockers and their doctors did not decrease or discontinue these drugs when starting Multaq. Since Multaq has beta-blocking properties, those patients wound up being double-dosed. One of those cases occurred because the doctor was not there when the Multaq representative came to train the doctors in the practice. That case was clearly not the fault of the drug.

I suspect this is far from being an isolated incident, and as soon as I discovered what happened in those initial two cases, I alerted the afib community to be aware of this risk and to raise this issue with their doctors when Multaq was prescribed. I have continued to sound this alarm.

I suspect that most of the bradycardia was due to similar circumstances. So while this issue is being blamed on Multaq, the fault clearly lies with mistakes by the prescribing doctor.

Atrial Tachycardia

Is it possible that some of the 47 cases of atrial tachycardia were breakthrough arrhythmias, not adverse events? These could simply be cases in which Multaq didn’t work, not unlike with other antiarrhythmic drugs. Amiodarone is the most effective antiarrhythmic drug, yet it only works about half the time. So was the arrhythmia already there or did the drug actually cause it? I don't know how we would know.

Since some afib drugs can be pro-arrhythmic in some patients, notably beta blockers, we have to consider whether it’s Multaq’s beta blocking properties that caused the problem. It is widely reported in the afib community that those with vagally-mediated afib should not take beta blockers because for those patients, beta blockers may be pro-arrhythmic. This could apply to Multaq as well.

Ventricular Tachycardia

The 13 cases of ventricular tachycardia are of great concern, but it must be noted that ventricular issues are very common with many antiarrhythmic drugs. That’s why doctors must admit patients to the hospital for several days to start many antiarrhythmic drugs, though not Multaq. While this is a very small number of cases in the greater scheme of things, it is nonetheless something to be aware of if you start Multaq.

Between the potential for gastric upset among some small percentage of those starting Multaq, and the very small potential for other rhythm issues, it seems appropriate to not start Multaq when you have big plans, such as a trip or family event. Perhaps it is a good idea to plan to be home for 2-3 days upon starting it to make it easy to address any issues that might arise.

Source: [www.stopafib.org]



The co-administration of beta -blockers or calcium antagonists with depressant effect on sinus and atrio-ventricular node should be undertaken with caution. These medicinal products should be initiated at low dose and up titration should be done only after ECG assessment. In patients already on calcium antagonists or beta blockers at time of dronedarone initiation, an ECG should be performed and the dose should be adjusted if needed.
Source: [www.ema.europa.eu]

Jackie Wrote:
-------------------------------------------------------

> Bradycardia
>
> I personally reported several cases where people
> who were started on Multaq ended up in the ER with
> bradycardia. Two were already taking beta blockers
> and their doctors did not decrease or discontinue
> these drugs when starting Multaq. Since Multaq has
> beta-blocking properties, those patients wound up
> being double-dosed. One of those cases occurred
> because the doctor was not there when the Multaq
> representative came to train the doctors in the
> practice. That case was clearly not the fault of
> the drug.

Jackie , What is beta blocking properties? My understanding is Multaq actually contains no beta blocker in the actual pill BUT due to interactions with beta blockers, It will lower your heart rate. This happened to me. They did lower my beta blocker dosage and put me on Multaq and my resting heart rate went below 50.
I might have missed it but I can find no where that says Multaq actually contains a beta blocker.
I went through all this April 2016 when they put me on Multaq while I was in the hospital. I got some samples and took it maybe 2 weeks before I found out United Health Care would not approve Multaq.
Anyway I could be wrong and my cardiologist could also be wrong but Multaq will interact with a beta blocker lowering the heart rate.



Edited 1 time(s). Last edit at 07/16/2016 03:51AM by smackman.

Smackman... For clarification:

The term, "beta blocking properties," means that this drug or some other drug or substance "acts" like a beta blocker in that one of the substance's "properties" is the ability to bring about a lowered heart rate. It doesn't necessarily have to contain an actual BB chemical constituent.

Note that the text I copied and pasted for the response I offered was from Melanie Truehills Afib forum and she is the "I" referenced in the text.... (in case you thought that was my personal comment).

I can certainly see how you (or anyone) could experience a low enough heart rate considering what the literature on Multaq indicates. Certainly, if you are also using a separate BB, it could also be trouble.

Sorry if I confused you. I was trying to help clarify and support what you had posted as your personal observations.
It's not uncommon for people to respond differently to various drugs, nutrients or even foods. We are, obviously, not totally identical in body chemistry or identical in how we process and eliminate or detox from various drugs or substances so it's good they give a head's precautionary warning that some people may not tolerate well the action of Multaq.

I'm sorry also because the last paragraph/statement and the link provided was mis-managed by the automatic conversion to an abbreviated URL link... inherent with this website... but unfortunately the link is not functional.
I did a search when I had the report open for the words, beta blocker, and several statements of caution were mentioned regarding using Multaq along with a BB. (I'll try to re-locate the report and send it to you by PM)

You and your cardiologist are not mistaken.

Jackie