Am I taking too much flecainide

Since taking flecainide (200mgs extended release daily) I have experienced,
gait disturbance, blurred vision, hand tremor and mental fogginess.
Or is this just old age catching up. I just turned 80 this year.

Those aren't normal signs of aging. I would try stopping it for a day or two and see if those symptoms improve.

For those reading the above flecainide thread, the maximum recommended dosage to not exceed 200mg in a 24 hour period if one weighs less than 154 pounds and if one weighs more than 154 pounds, the maximum dosage in a 24 hour period is 300mg flecainide.

Quote
colindo
Since taking flecainide (200mgs extended release daily) I have experienced,
gait disturbance, blurred vision, hand tremor and mental fogginess.
Or is this just old age catching up. I just turned 80 this year.

My EP overdosed me on Flecainide and I experienced similar symptoms. When I stopped, the worst of the symptoms receded within 12 hours so stopping it to see what happens sounds like a good plan. Note, flecainide dosing depends not only on weight but on genetics. I had a genetic variation that meant that I should only take half the normal dose of Flecainide. (CYP2D6)

As I've posted before, I'm now getting much better results for PIP flec with 2/3's my former dose (went from 300 mg to 200 mg). I also had good results with very small doses of flec (like 25 mg/day) for daily dosing. So perhaps doing what Carey suggests & if the symptoms go away, trying a lower dose to see if the flec will be effective at that lower dose. As a side note, I take the PIP dose infrequently (four times in the last year) and stopped the chronic 25 mg/day dose in June, so successfully back to my historical zero chronic med approach.

I agree with the others, that is too high a dose of Flec for you.

I'm assuming you qualified for Flecainide both by ekg and some sort of stress test and/or echo? In addition, Flecainide should be closely monitored by ekg, both before and during treatment, especially with any dose increase or with symptoms as you describe.

I started at 50mg bid (twice a day) but when it was upped to 100 bid, I felt unwell while exercising. Ekg changes prompted my ep to drop my dose back to 50mg bid. At one point I was doing well on as low as 25mg bid, but 50 turned out to be the sweet spot. Hopefully, you will find your sweet spot, but if not, they may want to switch you to another drug.

Jim

Quote
mjamesone
I'm assuming you qualified for Flecainide both by ekg and some sort of stress test and/or echo? In addition, Flecainide should be closely monitored by ekg, both before and during treatment, especially with any dose increase or with symptoms as you describe. !/quote]

That's the by-the-book answer, but it's very common these days for EPs to prescribe it based on nothing more than the presence of afib. Sure, they've seen EKGs but they don't do monitoring after you begin the drug, change dosages, etc.

Quote
Carey

That's the by-the-book answer, but it's very common these days for EPs to prescribe it based on nothing more than the presence of afib. Sure, they've seen EKGs but they don't do monitoring after you begin the drug, change dosages, etc.

From what I've read on various forums, the majority now require some pre-testing.

Personally, I saw five ep's. All at top cardiac teaching hospitals. Only one would have prescribed Flecainide without an exercise stress test and fairly recent echo. My ep's protocol was exercise stress test to qualify. Then ecg one week later. Then ecg with any dose increase.

In my case, ekg's were good at rest, however I was symptomatic on my home treadmill after a dose increase and captured an ekg showing Wide QRS on my Kardia. EP then lowered the dose and wouldn't let me go back to higher dose without another exercise stress test.

As to "by the book", I've read that some are tested during exercise. My ep was not going to do that until I sent him my home treadmill ekg. Looking back, he should have. Flecainide is not to be taken lightly.


Jim

Quote
Carey

That's the by-the-book answer, but it's very common these days for EPs to prescribe it based on nothing more than the presence of afib. Sure, they've seen EKGs but they don't do monitoring after you begin the drug, change dosages, etc.

From what I've read on various forums, the majority now require some pre-testing.

Personally, I spoke to five ep's. All at top cardiac teaching hospitals. Only one would have prescribed Flecainide without an exercise stress test and fairly recent echo. My ep's protocol was exercise stress test to qualify. Then ecg one week later. Then ecg with any dose increase.

In my case, ekg's were good at rest, however I was symptomatic on my home treadmill after a dose increase and captured an ekg showing Wide QRS on my Kardia. EP then lowered the dose and wouldn't let me go back to higher dose without another exercise stress test.

As to "by the book", in addition to what I've described, some are also tested during exercise after they start taking the drug. My ep was not going to do that until I sent him my home treadmill ekg. Looking back, he should have. Flecainide is not to be taken lightly.


Jim



Edited 1 time(s). Last edit at 10/24/2023 08:46PM by mjamesone.

Quote
mjamesone
From what I've read on various forums, the majority now require some pre-testing.

If you say so. Just telling what I know from personal experience and the hundreds of people we hear from here. I'm not voicing any opinions on what should or shouldn't be done, only relating what I think is common practice, at least in the US.