Propafenone 325 mg with Metoprolol 12.5 mg experience?

Good evening everyone! First time poster here. I do not suffer from Afib but I do have runs of SVT and Atrial Flutter that usually are non sustained but happen several times a day. I am currently on propafenone since last year when I had an ablation done. Though they found and ablated an area I am still having the same issues so they put me on propafenone 225 mg extended release twice a day last fall. With that said had a visit last week and my runs are getting longer and they are worried about atrial flutter. I currently mainly have several runs of Atrial tachy each day. So now they upping my dose to 325 mg twice a day with metoprolol 12.5 mg once a day with it.

My question is has any been on this dosing before and was it good or bad? Everything I read online says to not mix the too of them so kind of hesitant of taking both together. I go through the Veteran Affairs so getting answers in a timely manner is not always easy and the Nurse practitioner is the one that changed my dosing. I have reached out for further info form them before I start it but thought I would ask to see if anyone has tried this. My resting heart rate at night while I sleep is in the 50's and about 65 during the day and my blood pressure is usually normal ranges. Anyway thanks in advance looking for any input. Thanks. -Jason

Propafenone worked great for me as a PIP (300mg to covert in 3-5 hours usually or 150mg chewed was the best use for a 1 hour conversion rate) but was an anchor on my body as i took it everyday for around a month...did not feel great + i am extrem. active + it stopped nothing at 150 mg every 8 hours....it gave me no relief from my 5K at least pac's a day or most import. AFIB....made my episodes a little less severe but thats it....so i stopped that + went to PIP exclusively for Propafenone.

Obviously your ablation worked but also left a lot to be desired....Propafenone + Met. are just bandaids and as your finding out are not much if any help like i found out....with Met. also for about 10 days or less i cannot remember but that was a 100% complete dud on my symptoms.

If you parachuted my brain into your body i would stop...or wean off both + let your heart take that fork in the road 1 way or the other + i would be hoping for it to get worse frankly if i were you....yes sounds a little cruel maybe but THEN you can wear your 24 hour holter monitor with a lineup of all you known triggers (foods/drinks/activities) sure to get your heart to act up MEGA during that 24 hour period or a good part ofthat time anyway so the tech. reading the data + the data itself will clearly show that you need to get back in EP room for a 2nd + BETTER ablation/touchup this time to make you whole again....no Tach...Flutter + don't rule out AFIB again down the road if you let things slide long enough...it can only get worse not better.

There is a caveat here....the above suggestions are only nec. if your current doctor does not think its bad enough to put you back on the EP table again but it does not sound like it ......by the way he is pushing these bandaids on you...i had an Cardiologist like that....no matter what i told him about how bad i was + how many/frequent times between episodes i was getting AFIB or the fact i even showed up in his clinic 1 time (which had an ekg. machine in it) after i told him on a friday visit i will be there on monday morning at clinic opening at 8:30 am sharp in a violent as i call it AFIB around 130-160 bpm my 150th or so in the last 3 years or so.....+ he looked at my EKG readout + casually wrote me a persc. + again + again for a bunch of different Bandaids after i begged him to put me on the Ablation waiting list that's about 7-9 months up here in Canada after the holter test then the readout that takes a month for the tech. to return the data to our doctor then the scheduled procedure about 6 months later...kind of slow up here but pretty good ONCE THEY GET AROUND TO IT BUT SLOW...the worst mistake i ever made probably was sticking with that TOP RATED Moron/Cardiologist...just goes to show the these doctor ratings are very fishy at times. I switched to another cardi + he IMED. got me a holter test to facilitate an ABLATION....2 completely different mindsets from 2 highly Qualified Cardiologists....the 1st 1 said it was not bad enough to justify an Ablation...the 2nd said i was LONG OVERDUE for 1.....so either get yourself another Cardiologist + ask him to get you on your way to a touchup Ablation or let the Sym. aka flutter or tach get bad enough to SHOW your current doctor that you need another procedure.....little to no doubt that's the place you need to end up AGAIN to find relief.

GL

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JasonZ
My question is has any been on this dosing before and was it good or bad? Everything I read online says to not mix the too of them so kind of hesitant of taking both together.

What you're taking is very common, and whatever you read saying not to combine them is either wrong or you misunderstood it. Those two drugs are combined all the time. That's a tiny does of metoprolol and it's only purpose is to protect against a rare side effect of propafenone called 1:1 conduction. Although very rare, it can cause a heart rate well over 200 bpm, so you definitely want to take both as directed.

Vanlith is right that those drugs don't cure anything, but without them how often do you experience episodes, how high does your heart rate get, and how long do they last? You said these runs were non-sustained but you also said they're lasting longer, so could you please clarify?

Jason, you can space the two drugs an hour or so apart to give your liver enzymes a chance to process each drug instead of causing a inhibitor effect.

I have mainly non sustained AT several times a day. Meaning they dont last longer than 30 seconds or so. But I also have sustained that can last from a few mins or longer. Before ablation I had sustained SVT that was causing Vtach to happen which I would pass out. The fear is that my SVT could trigger Vtach again and its also very bothersome. I feel every beat and I have hundreds of premature beats a day on top of my SVT. I have a loop recorder so they see everything and are upping my dose based on what they see. I think there as some Atrial Flutter this last check up so they said they were adding the metoprolol. I was on metoprolol before which did little to help my PVC's and SVT runs by itself. The propafenone has greatly reduced the amount of pvc's and svt runs that I have or notice at least. As for another ablation that is on the table and was told it will probably be sooner than later. I also was diagnosed with CHF in 2018 after being on Humira and steroids. They believe it was induced by Humira since it has been known to cause new HF. Since then my HF has been in remission for the most part as my echo last year showed normal EF and structure. Since I go through the Veteran Affairs I am kind of locked into what they want to do. I do not get to say just do ablation again etc. I cant complain in that its free and they have taken care of me for the most part just sucks getting answers out of them when you want them. I am only 41 and when I first started having these issues it was like the end of the world reaction from everyone. Since then they dont say much but adjust my meds and keep moving on lol. Guess I just need to trust them to do their jobs.

It sounds to me Jason you are like we are up here in Canada.....at the whim of your doctor....only the most serious cases get the attention up here for the most part with the others just get bandaided.

I hope they give you the att. you need but i am fearing you need to get worse before they do what's needed to be done....i hope i am wrong.

Jason, you don't have a simple case so it's not just a bunch of VA docs blowing you off and giving you drugs. Everything they've done so far makes sense. In fact, it sounds like the ablation they did was possibly even life-saving since it stopped the v-tach episodes.

I know from others who've been under VA care that you can go outside the VA system if you push hard enough and have a compelling case, which you probably do. All is not lost.

Have you been diagnosed with an accessory pathway between the atria and the ventricles, such as Wolff-Parkinson-White syndrome? Normally SVT (superventricular tachycardia - ie, the atria) can’t conduct 1 for 1 with the ventricles owing to the refractoriness of the atrio-ventricular node which will reject pulses that are too close together. That’s what gives AF its “regularly irregular” characteristic.

You can take propafenone without the beta (I did), but in your case it may be warranted. And 12.5mg is a minimal dose, as previous posters have mentioned. It shouldn’t be a boat anchor when you’re in NSR.