what would happen if I skipped my flecainide tonight

Hi,

This is my 2nd day in a row to feel extremely dizzy, moderately nauseated & headachey. I wonder if I could just skip flecainide tonight as I have come to the realization that it is most likely the cause of my worsened problems now.

History:
Natale ablation 8/1/19.
Atrial flutter episodes November 2019 & April 2020, both were converted.
Since this past April, post ECV, was put on flecainide 50 mg b.i.d. & carvedilol 6.25 b.i.d. Have been on this 6 weeks.

Prior Hx: 2/1/20: Severe vertigo with vestibular nerve damage most likely, which left me with some dizziness & balance problems. Did a couple of months vestibular retraining therapy & was doing better until put on cardiac meds after ECV.

Today I researched once again my drugs & found significant evidence that flecainide has adverse CNS side effects, the first of which is dizziness. Other things noted I have as well - mild nausea w/the motion sick feeling, sometimes headaches, fatigue, slight intention tremor of hands, waking more often after 2-5 hr of sleep only & having to use a low dose zolpidem to get more sleep.

I have seen my cardiologist once since the ECV & am due for another visit in 2 wks. I have not switched to an EP locally yet. Do I need to just call for an appt with an EP now bec if I wait til my visit w/my cardiologist, then it makes 2 visits & I am so worn out with heart & thyroid dr visits. I wonder though if I am setting myself up for the need for my touchup ablation to be local if I choose an EP here now & tell him I have to get off of flecainide. In the past I was on sotalol, but it gave respiratory side effects not unlike the COVID-19 symptoms, so that is why flecainide was tried this time. Long & short, I do NOT do well on any of these antiarrhythmics. The dose of carvedilol (Coreg) 6.25 mg b.i.d. is tolerable though.

Will I be risking more atrial flutter if flec is stopped & not replaced with another AAR? This April cardioversion was my first ever & maybe it will hold. I do not want to go to Austin for my touchup ablation until I feel more comfortable about travel & accommodations during all the uncertainty of the coronavirus.

If I have to, I might even prefer to switch back to sotalol if the dizziness would not be as much of a problem as it has with the flec. However, when I was on sotalol before, I had not yet had the severe vertigo with resultant damage. Might add that for many years I have had an acoustic neuroma (more specifically an intracochlear schwannoma - more rare than regular acoustic neuromas) & it caused deafness in one ear. It has been followed with brain MRIs & has been stable in size. Still, it could have had something to do with the vertigo, but the vestibular damage effects that had improved after therapy & exercises flared very much after beginning flecainide.

Maybe you could offer some helpful suggestions. If it were not for COVID-19, I would have scheduled the Natale touchup ablation already.

Thanks.

Nothing terrible will happen if you skip the flecainide. Could you end up back in flutter again if you stop taking it for days? Yes, possibly, but there's no way to predict that with any sort of certainty. Is it possible you could stop the flecainide completely and remain in NSR? Yes, that's also possible, but again, no way to predict.

Honestly, it might be worth stopping it for a few days just to find out if it's the flecainide or the neuroma causing the vertigo. When you have a condition known to cause vertigo I wouldn't be so quick to blame meds.

And yes, find a local EP instead of a general cardiologist. You won't owe him anything and aren't obligated to do anything with him. I have a local EP who's quite widely respected as a competent ablationist, but he knows perfectly well that if I need ablation work, I'll be in Natale's office, not his. And he's fine with that, as he should be. Quit worrying about doctor's egos.

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Carey
Honestly, it might be worth stopping it for a few days just to find out if it's the flecainide or the neuroma causing the vertigo. When you have a condition known to cause vertigo I wouldn't be so quick to blame meds.

I would like to see if the flecainide is making these worsened symptoms of dizziness exaggerated, but I wonder how long one needs to stop a med to see the effects disappear. Would about 3 days seem safe enough to give a trial so I can see if I feel better? I will still continue my carvedilol.

I have had the schwannoma for maybe 10 years now followed with brain MRIs & auditory testing. The MRI this year showed no changes, but just having a tumor there is irregular. But I will say my balance is still very good, better than most my age, perhaps because of my years of yoga. It is just the sickening dizziness in my head, like after a long drive on a winding road in the mountains. I stop, but the momentum is still with me. Also, remember I said after that one severe vertigo episode Feb 1st, I did get better after exercises and therapy. Then I began to get worse after starting flecainide & increasing carvedilol, both of which are known to cause dizziness.

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Madeline
I would like to see if the flecainide is making these worsened symptoms of dizziness exaggerated, but I wonder how long one needs to stop a med to see the effects disappear. Would about 3 days seem safe enough to give a trial so I can see if I feel better? I will still continue my carvedilol.

The half-life of flecainide is about 20 hours, so three days would reduce your levels to about 12% of what they are now. That should be enough to make you feel better if it's the drug.

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Carey

I would like to see if the flecainide is making these worsened symptoms of dizziness exaggerated, but I wonder how long one needs to stop a med to see the effects disappear. Would about 3 days seem safe enough to give a trial so I can see if I feel better? I will still continue my carvedilol.


The half-life of flecainide is about 20 hours, so three days would reduce your levels to about 12% of what they are now. That should be enough to make you feel better if it's the drug.

Thank you, Carey. That is very helpful. I did put a call into my cardiologist today so that I can check with him to help me with this too.