Flecainide - hospital stay necessary?

My EP won't give me flecainide (for pill in the pocket) until I have a monitored 3 day stay in the hospital. Is this standard procedure? I guess it's due to the potential dangers/side effects of flecainide?

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cirenepurzalot
My EP won't give me flecainide (for pill in the pocket) until I have a monitored 3 day stay in the hospital. Is this standard procedure? I guess it's due to the potential dangers/side effects of flecainide?

No, that isn’t the present standard though I believe it was in the past. When I started it I had to come back to the office a few days (2 - 3?) later for an EKG. I hear similar things from other patients—though it may be different if you are taking it as a pill in the pocket. I was taking it daily when I started it. Perhaps your EP would have a different recommendation if you started by taking it daily as it takes a bit of time for the body to adjust to it. I believe that Tikosyn is the only antiarrythmic that presently requires a 3 day hospital stay for monitoring.

Thanks Daisy!

No, that is not standard procedure, or at least it hasn't been for the last 25+ years. It was common when flecainide was first released (1985), but with more experience with the drug and more clinical trials they learned that you don't need to do that. They also learned that you really need to avoid giving flecainide to people with structural heart disease and who have had MIs.

I think your doc just doesn't want to give you flecainide. Maybe they don't believe in the PIP approach (a lot don't). The only other explanation is your doctor is decades out of date on their knowledge of the drug. This is an EP?

My internist wouldn't give me flecanide, but my EP did. Started with twice daily about a month before my ablation, which kept the afib away. After the ablation, it was pill in a pocket for two weeks, but was changed to daily for two months because of the many breakthroughs. Since I started taking it daily, no problems. I haven't seen any side effects from taking flecanide.

I'd be surprised if any non-cardiologist would prescribe flecainide. It's just not a drug GPs would be familiar with.

A local friend had to go to a number of cardio's/EP's before he found one that would prescribe PIP. Years ago, my EP prescribed it right off the bat without any hospital stay. He did want an ECG the day after my first use. My son-in-law got a PIP flec prescription in mid December. The cardio also wanted an ECG after first use. Hence it is luck of the draw.

In my case, the EP was the 3rd cardio I'd seen at the beginning of my afib. Cardio #2 would not have prescribed flec as he said it kills people. He wanted to prescribe digoxin instead ("my favorite afib drug."). I, of course, refused to take it and he, thankfully, referred me to cardio #3, the EP.

I've used flec PIP without any incident for 15+ years.

When I started flecainide my general cardiologist would end each visit by opening the door to leave, turn around and say “you are going to drop dead”. Every visit he would say this.,

In the end he was the one to suggest 300mg/day that sent me to icu.

That's a a weird bedside manner.

I had liked his honesty. He doesn’t sugarcoat. He is no longer my cardiologist because I moved from ny

So he said you'd drop dead and then STARTED you on 300mg/day? I.e. the max dose for a large man?? Erm.... NOT.
LOADS of folks - providing no existing heart disease - take Flec for many years with no issues whatsoever. Moving to a different EP was a good move all around I'd say.

Mwcf : yep, his advice sent me into the cardiac icu for 3 days and according to the icu, I’m fortunate to survive the flecainide overdose. He was my doctor for over 10 years.