propafenone vs flecainide for PIP?

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Marco
I have seen in some older posts that Flecainide contains Fluoride, is that still the case as today? does Propapenone contain Fluoride as well?

Other than the Fluoride that I would prefer to avoid, being paroxysmal afibber, would one be better than the other one?

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GeorgeN

I have seen in some older posts that Flecainide contains Fluoride, is that still the case as today? does Propapenone contain Fluoride as well?

Other than the Fluoride that I would prefer to avoid, being paroxysmal afibber, would one be better than the other one?

Propafenone: C21H27NO3
Flecainide: C17H20F6N2O3

Here is the 2004 paper about PIP flecainide & propafenone.

Recently most posters have mentioned flecainide, years ago, it was more even. Propafenone does have beta blocking properties built in. They are both in the same class of drugs. I've taken flec for nearly 19 years for PIP and for short periods of time prophylactically in small doses. Flec has never failed to convert me to NSR, including my first dose, which converted a 2 1/2 month episode. That took 20 hours, but the EP didn't even think it would work for an episode that long. My next episode, a month later, also took 20 hours. My hypothesis is my atria were still experiencing stunning from the 2 1/2 month episode. Most of my subsequent conversions were in the 1 to 2 hour range from taking the flec (which I always chew to get it into my system as fast as possible). More recently, it was taking longer to convert, as I've posted elsewhere, I figured out that 200 mg is a better PIP dose for me than 300 mg. Subsequent to dropping my dose to 200 mg, my conversion times are generally back in the 1 to 2 hour range. Flec is commonly prescribed with a beta blocker to mitigate the low risk of 1:1 conduction atrial flutter. Mine was not prescribed with a BB and I've never taken a BB.

Note that max flec is 300 mg for someone weighing over 154 #'s (70 kg) and 200 for those less. I weighed 205#'s in 2004 when first prescribed and 167#'s today. The propafenone doses are in the linked paper.

I think propafenone can be equally effective. One friend that was on it as PIP for a long time was switched to flec in January because the propafenone was losing its efficacy.

I may have been the one that mentioned the fluoride in flec. I do try to limit my fluoride intake and filter it out of the drinking water. I also do other things to eliminate it (like displacing it with intaking another halide) as well as heavy metals from my system. However, fluoride or not, I'm happy to take the flec and convert to NSR. One always has to weigh cost/benefit.

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Carey
I don't know the chemical composition of flecainide and propafenone, but they almost certainly haven't changed. Changing the chemical formula would create a new drug, which means new clinical trials and new FDA approval. That's millions of dollars and years of time, so it didn't happen.

You know that virtually all water and a gazillion other things you consume everyday contain fluoride, right?

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Marco
thanks. We do need a tiny bit of fluoride, but not too much. Too much Fluoride will almost certainly interact with the absorption of two very important mineral such as Magnesium and Iodine. Hopefully Flecainide has just a tiny bit in it

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Marco
thanks G. I'm assuming you are taking Iodine, if so how much are you taking?

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GeorgeN
Flec is commonly prescribed with a beta blocker to mitigate the low risk of 1:1 conduction atrial flutter. Mine was not prescribed with a BB and I've never taken a BB.

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Yuxi
Hi George, what's your typical heart rate when in an Afib episode? I am assuming not very high and you are not very symptomatic?

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Yuxi
Are you not concerned with the risk of 1:1 conduction atrial flutter?

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Carey

thanks. We do need a tiny bit of fluoride, but not too much. Too much Fluoride will almost certainly interact with the absorption of two very important mineral such as Magnesium and Iodine. Hopefully Flecainide has just a tiny bit in it

I understand, but you should also understand that humans evolved over millions of years drinking water that contained high levels of fluoride. I think the human body is more resilient to normal environmental conditions than many people think it is.

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Marco
Humans evolved over millions of years to drink spring water that contained some fluoride, high levels of Fluoride were unlikely ingested during evolution.

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Marco
DO you guys think I should make sure I ask for Flecainide?

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GeorgeN
Marco, how long do your episodes take to convert on their own? I ask because my philosophy has always been to limit my time in afib as much as possible as "afib begets afib."





the 3 times this happened, it took me 48 hours, or about 24 hours after being in the hospital on the IV Ca channel blocker. However, from what I read in the forum, I understand this trend may change. I do agree with your philosophy, the less info Afib the better.

Perhaps, if this ever happen again..., lowering the heart rate soon after going into afib with the betablocker, will be enough to self-convert soon after. I wanted to have something extra in case I don't though, because I understand the chance of stroke increase, I believe after 72 hours into afib? doc told me to take a full aspirin in the case. I was also pretty miserable during, I literally felt that was the end of the world.



Edited 1 time(s). Last edit at 08/06/2023 03:41PM by Marco.

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GeorgeN
Marco, how long do your episodes take to convert on their own? I ask because my philosophy has always been to limit my time in afib as much as possible as "afib begets afib."





not quiet sure what I'm doing with the quote response but I'm trying again:

"the 3 times this happened, it took me 48 hours, or about 24 hours after being in the hospital on the IV Ca channel blocker. However, from what I read in the forum, I understand this trend may change. I do agree with your philosophy, the less info Afib the better.

Perhaps, if this ever happen again..., lowering the heart rate soon after going into afib with the betablocker, will be enough to self-convert soon after. I wanted to have something extra in case I don't though, because I understand the chance of stroke increase, I believe after 72 hours into afib? doc told me to take a full aspirin in the case. I was also pretty miserable during, I literally felt that was the end of the world."

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GeorgeN
Marco, how long do your episodes take to convert on their own? I ask because my philosophy has always been to limit my time in afib as much as possible as "afib begets afib."

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Marco
because I understand the chance of stroke increase, I believe after 72 hours into afib? doc told me to take a full aspirin in the case.

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GeorgeN.
The number used to be 48 hours, but I think new data suggest the period when the risk starts is much shorter (I don't have the reference on this). Aspirin is not a great blood thinner. What is your CHA2DS2–VASc score? If more than 1, you should have a prescription for an oral anticoagulant like Eliquis or Xarelto, either to take all the time (as directed by doc) or to start if you have an episode and continue for a time determined by your doc. In my case, my score is 1, for my age at 68. I go to great lengths to keep a very low BP without meds and to have my metabolic parameters pristine (these are the two you can potentially control with lifestyle).[/quote


Hopefully this quote situation will work.

My score could be considered 0, that's probably why he didn't recommend much other than an aspirin when it happens, I will see an EP tomorrow as well

My BP at home is fine, doc agrees. My issue is when I go to doc offices my blood pressure sky rock, and I'm somewhat anxious is general. I saw the doctor thinking a couple of times before suggesting a BP medication. His concern is that because my anxiety my bp can be too high too often during the day. He told me I may only need to use it for a while.

As far as the time coagulation/platelets aggregations factors increase during paroxysmal afib, they seems not be effected for 6hr, and increase at 12hr, so you are right about that.
[www.jacc.org]

After 24hr into afib the first and 3rd time, because the 2nd time I went to the ER right away, they checked some coagulations factors, and they found them always at normal levels, that is why I was never offered a blood thinner for 3 times, I would assume.



Edited 1 time(s). Last edit at 08/07/2023 05:45PM by Marco.

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GeorgeN
If your BP is normally low, be careful of Propranolol (or any BP med). My daughter's father in law was recently prescribed a beta blocker for afib and he passed out due to low BP, fell and cracked some vertebrae. This may not be an issue for you, especially in afib, but just be aware.

I think your issue with the quote above is that the ending

Some breathing techniques are good for anxiety. Don't know what you've tried. Here are some resources:

Physiological sigh's

Coherent Breathing (5.5 second inhale and exhale) a free app here or really anything around 4-6 breaths per minute has been shown to lower BP

This mp3 will lead you through a light breathing exercise specifically for anxiety

My friend, Nick Heath PhD, has a site, TheBreathingDiabetic.com, Nick's a Type 1 diabetic who found that slow breathing helps his blood glucose control. Here is a search of his site for slow breathing

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Marco
an update after seeing an EP yesterday. He suggested Flecainide as a PIP, 300mg with no betablocker. I told him my concern of converting to flutters, but he confidently repeated few times not too worry about it, and that can only possibly happen when someone is on Flecainide every day.

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GeorgeN


What is your weight?