flecasnide

I have paroxysmal afib and was on propanolol 60 ER. I then was put on flacainide 75mg 2/day. It works fine but now I am light headed most of the time and weak. Is this the expected side effect and will it go away over time

Per this paper, dizziness is the most commonly reported non-heart side effect of flecainide. Only 5.7% quit using flec in the first two weeks because of this. Weakness is a less common side effect and only 1.4% quit taking the med in the first two weeks because of it. Best to have a chat with your doc or EP about that.

From the paper: "Experience with flecainide has indicated that adverse effects are often relieved by dosage adjustments while efficacy is maintained. In some cases, the adverse experience was transient in nature and disappeared without dosage reduction. The incidence of adverse
experiences in flecainide patients tended to decrease over time; dropouts may have contributed to this tendency"



Edited 2 time(s). Last edit at 03/25/2022 01:20PM by GeorgeN.

I was dizzy and fainting until I realized I took the flecainide along with another drug that interacted. I ended up being positive in the tilt table test. Once I spaced the other drug by two hours to clear my liver enzymes I was good to go and never got dizzy or fainted from flecainide.

Flecainide is a 2D6 CYP enzyme / transporter substrate drug. Do you take it solo or with another cyp450 drug that acts as an inhibitor or supplements or certain foods?

I’m not unique. Read on how some drugs you take acts as an inhibitor. This topic of drug interactions caused by the CYP450 liver enzymes maybe my favorite that I’ve spent decades interested in. My husband is a retired pharmacist and originally taught me and now this is a topic I constantly follow up:

[www.acc.org]

[academic.oup.com]

[www.mayocliniclabs.com]

[bmcpharmacoltoxicol.biomedcentral.com]

[drug-interactions.medicine.iu.edu]

[www.researchgate.net]

[m.oxfordmedicine.com]
This is 10 years old but explains it:
CYP enzyme or transporter


And it’s not all about drugs. Supplement and food interaction:

[www.ncbi.nlm.nih.gov]

[www.ncbi.nlm.nih.gov]

[www.aafp.org]

[www.drugs.com]


Bookmark these pages for future reference. I am aware I provided many sources that many readers may ignore due to time restraints, but if you are interested in how your drugs interact with other drugs, supplements or food, it’s worth reading the above. Who knows…maybe an anti arrhythmia drug you feel has too many side effects that you want to stop is simply combining with other drugs, supplements at the same time that’s creating the problem.

Thanks for the input. Could you tell me where I can find this paper

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alfrae13
Thanks for the input. Could you tell me where I can find this paper

If you press on
paper
in my post, it will take you there.

{Edit} click or press HERE to take you to the paper



Edited 1 time(s). Last edit at 03/26/2022 11:09AM by GeorgeN.

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alfrae13
Thanks for the input. Could you tell me where I can find this paper

Even I didn't quite understand George's answer at first so let me give it a try....

In both George's and Susan's posts there are links to these papers. The links are the words or phrases that are underlined and displayed in a slightly different color. In George's post it's the word "paper" in his first sentence. In Susan's post it's all those things she put in brackets such as "[www.acc.org]".


On a mobile device just tap the underlined word or phrase to view it. On a PC or Mac you click them with the mouse.

I've just been prescribed Flecainide for paroxysmal AF. I'm wary about taking it as I only have AF once every 4 months or so ... I'd rather just take it as and when I have an episode. Is this possible? Thanks

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IanHolly
I've just been prescribed Flecainide for paroxysmal AF. I'm wary about taking it as I only have AF once every 4 months or so ... I'd rather just take it as and when I have an episode. Is this possible? Thanks

Certainly. I've been doing this for 17 1/2 years. Here is the original paper describing this approach [pubmed.ncbi.nlm.nih.gov] It is sometimes called PIP or Pill In the Pocket. A loading (large) dose is taken when you go out of rhythm to convert. Note the max dose is 200 mg/day for those under 154 #'s (70 kg) and 300 for those over. Flec is commonly prescribed with a beta blocker, taken say 30 minutes before the flec to reduce the risk of converting to high rate atrial flutter. I usually chew the flec and let it sit under tongue in my mouth to increase the absorption speed (tastes awful, but I'll put up with that for a faster conversion. Flec, taken in this way has yet to fail to convert me.

Thanks for this .... I take Carvedilol so assume I'd take this first... when I go into AF its usually at high rate (up to 160 bpm). That together with a low BP (70/40) sends me off to A&E. In the past they try amiodarone or dioxin but I think I normally revert after a few Hours irrespective of the drugs!

My Cardio doesn't want me to go to a&e in future, hence the flec. I already have Entresto, Carvedilol and Rivaroxaban and would rather not have a 4th!

I'm due for an ablation on Friday but my young son just brought Covid home from school so I'm probably infected and going to miss the procedure!!

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IanHolly
Thanks for this .... I take Carvedilol so assume I'd take this first... when I go into AF its usually at high rate (up to 160 bpm). That together with a low BP (70/40) sends me off to A&E.

Why are you taking carvedilol? Is that for hypertension or the afib? If it's for the afib, I wouldn't take it or I would cut the dose in half. And I wouldn't go to A&E. The 160 HR for a few hours won't do you any harm, but a BP of 70/40 might. You're probably not far from passing out with a BP like that.

I have idiopathic cardiomyopathy with a LBBB. My EF was 33% 7 years ago but after my last EKG it was up to 58% and my cardio believed I am now 'recovered cardiomyopathy'. I take Entresto (valsartan/sacubitril) to help relax my heart and beat more smoothly, and I guess the BB is for high blood pressure, although never actually been diagnosed. I think Entresto & Carvedilol work well together for me. I used to take 12.5mg Carvedilol bd but reduced a few months back to 6.25 mg as my BP kept dropping. It is typically 110/70 but in the mornings it does drop to 90/60 first thing. Strangely I have never fainted nor even feel like fainting. I do take care when going from lying to standing though if I don't want to feel dizzy!! My resting hr is 55-65. My 5 afib episodes over the past 2 years have all been when my hr as been in the 50s when at most rest.

I worry that the combination of high hr and low BP is not good hence the trip to a&e 🙂

Okay, then you can't stop taking it. It's a big part of what improved your heart conditions.

A HR of 160 and a BP of 70/40 isn't dangerous if you're not in danger of passing out. If you don't feel lightheaded or dizzy then there's no danger and there's nothing meaningful that A&E can do for you. I would save myself the time and hassle and just stay home and take it easy until the episode ends.

I did that for several years with afib that routinely hit HRs of 180-190. Certainly no fun, but still not dangerous because it always stopped within hours.

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alfrae13
I have paroxysmal afib and was on propanolol 60 ER. I then was put on flacainide 75mg 2/day. It works fine but now I am light headed most of the time and weak. Is this the expected side effect and will it go away over time

The paper George referenced was for "extracardiac" adverse effects. The weakness could possibly be from the Flecainide causing reduced cardiac contractibilty, or heart function. Not common at the dose you are taking, but It has has the side effect in some people. I have had heart failure and know what it feels like to have a weakened heart muscle, and I have also had an acute adverse reaction to the Flecainide. I would definatly follow up with your Dr. and if it was me, I wouldn't take the Drug if it was causing weakness on a daily basis.