Donedarone (Mutaq)

I have paroxysmal afib that comes on about every other day. I am on propranolol 30mg and flacanaide 100 2/day. The flacanaide does not help. I also have an AV block.
Does anyone have experience with Donedarone, how well it works and side effects

Yes, I've been on it twice and many others here have been on it at one time or another. Multaq is probably the "mildest" of the antiarrhythmics. You could try it but if flecainide isn't working for you then I wouldn't expect Multaq to be an improvement. The first time I was on it was when my afib was in full swing and it did nothing for me, completely ineffective. The second time was following my last ablation, and in that role it did a good job of keeping my heart quiet for the 30 days I was on it.

You could talk to your EP about upping your flecainide dose. The maximum dose is 300 mg daily, so you're not quite there yet. You could also talk about Tikosyn, which tends to be very effective. However, it requires a 3-day hospital stay to start it. And finally there's amiodarone, which is extremely effective but comes with possible side effects, some quite serious. I would consider amiodarone the drug of last resort, and not one you should be taking for years.

If I were you I would start looking into ablation. All these drugs have limited effectiveness and come with side effects.

BTW,,The max dose of flecainide is 300mg only if you weigh more than 154 pounds. If under 154 pounds the max dose in a 24 hour period is 200mg.

In many ways you are right. There seems to be no long term or permanent solution either by drugs or procedures. I am a 92 year old male with a enlarged heart. I have been toying with either cardiovision or living with afib My HR is mostly less than 70 but I get dizzy and weak which passes. This might be preferable to the drug side effects

I was on Dronedarone from Aug 2016 through last summer tolerated it very well and suffered no side effects but stopped it when my afib went persistent again after six hears of NSR. After my third ablation and a Watchman implant last month I'm chugging along just fine with 10mg Xarelto and 81mg aspirin daily.

There can be multiple reasons why one medication works for some (or many) and not for others. One of those reasons has to do with genetics, usually Cytochromes P450 (CYPs) enzymes. CYPs are enzymes that metabolize many drugs.

Some of us have one or more variants that impact how we metabolize certain drugs (including cardiovascular drugs amiodarone, carvedilol - coreg, diltiazem, dronedarone - Multaq, flecainide, metoprolol, quindine, simvastatin, timolol, verapamil and warfarin). Some variants make these drugs clear quicker, some delay clearance, and some can cause these drugs to build up to toxic levels. Depending on the gene variant, it may have no effect, or may require drugs that use these enzymes be avoided, or in some cases the drugs need to be taken in different ways (such as smaller doses and/or more often, etc.), or the patient needs to be monitored closer for potential side effects.

I'm one of those people with some CYP variants that prevent me from taking over 50% of all pharmaceuticals, including the ones listed above. I found this out the hard way, and was able to verify some of the variants using consumer genetic testing; now my doctors and pharmacists are limited as to what can be prescribed, but it has made a huge difference in how my heart and body respond, and in overall quality of life.

There was a time when cardiologists tested their patients for the impacting CYP variants up front, but they found that insurance would not cover the expensive test, leaving the patient to pay out of pocket, which upset many patients, so these variants are no longer routinely tested in most cases. The sad part here is that studies have shown that insurance companies would save more money by testing up front than paying for the additional medical services required when the wrong drugs are prescribed.

Drug responses are as individual as we are. Until full genetic testing is available at a reasonable cost, or until insurance companies routinely cover pharmaceutically-related genetic tests, determining which pharmaceuticals are best for an individual can't be determined until the doctor sees how the individual responds or doesn't respond to the drug. Hopefully this will change sooner than later.