Flecainide Issue

[cobbler5]

My electrophysiologist recently prescribed  flecainide to control A-fib that was breaking through on sotalol. I was also started  on Toprol at the same time. Since this combination was used, my blood pressure as been borderline to high all the time (ranging from 130s/70 to 170s/90). I also have had frequent headaches, fatigue, and some chest discomfort (heaviness, not acute pain). Nevertheless, no a-fib. I realize both medications are intended to lower blood pressure in addition to controlling the rhythm. I have normal heart structure and no history of heart attack. My blood pressure was 120s/60s on sotalol and Benicar. Is this opposite effect (higher instead of lower blood pressure) common with this medication? Thank you.

[Michael J. McWilliams, M.D.]

Just to clarify --- they stopped the sotalol and started flecainide right?  They don't have you on both medications.

Flecainide does not raise blood pressure and metoprolol is sometimes used to lower blood pressure.  If you blood pressures are high, it suggests you might need more blood pressure medication or that you are very anxious about the medication change (this can happen).  If the benicar was stopped -- it sounds like it needs to be restarted.  A generic ACE inhibitor like lisinopril is cheaper and works just as well.  The only reason to not use an ACE inhibitor is if you have a cough with the ACE inhibitor or if you like to give pharmaceutical companies lots of extra money so they can pay their CEO's.

If it stays up, you probably need more blood pressure medications.

I hope this helps.

[cobbler5]

No, I'm not taking sotalol, too. Thank you, Dr. McWilliams.  I appreciate your answer. I have an appointment with my local cardiologist in 2 weeks (EP is out of town), and I'll discuss adding back the benicar (or preferably lisinopril).