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Mixing medications

PVC
I was wondering if there is any problem mixing propafenone and digoxin with Losec and Cisapride (taken for esophagitis).
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17568 tn?1424973559
I am taking Tegretol 400 mg plus Neurontin 1800 mg for partial complex seizures.  I just started taking the Tegretol about 3 weeks ago, I have been on the Neurontin since June.
Two nights ago I may have had, according to my doctor, a vaso-vagal syndrome episode which was quite scary.  Could this be due to one or both of the medications?  thanks.
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Avatar universal
I wonder if you could tell me if my situation is normal.
i am 50 yrs old and was diagnosed with af a year ago.
Only diagnosed after visit to hospital following electric shock.
they found an irregular beat and said that in their opinion it had been there for some years, not caused by shock.
i saw my doctor who confirmed. i was put on warfarin which i understand is normal, and Cordaronne 200mg.
within a week it was amazing things which i had not been able to do for years suddenly presented no problems, the jelly feeling in my chest at bedtime disapeared, wonderful.

however after about 6 months i noticed that the effect of the drug has diminished such that now I am almost back to were i was proir to drug commencement.
should I try another drug or increase dosage, your comments will be appreciated
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Avatar universal
I have aortic valve disease for which surgery is not yet indicated, according to my physician.  I have frequent atrial fibrillation accompanied by symptoms of shortness of breath, dizziness, extreme fatigue, sometime dull chest pain, and often a feeling of oxygen deprivation similar to what I used to experience at the end of a run. Episodes last from 3 to 24 hours. After the longer ones, I am extremely tired the next day.

For some years, I was on betapace and lanoxin for the a-fib.  I have also been on coumadin for the past three months.

During my last cardiology visit, I was swiched from betapace to amiodarone for the a-fib.  On 10-6-2000, I started at two 200 mg tablets three times a day.  Starting yesterday (10-13-2000), I reduced to two 200 mg tablets two times a day.  On 10-19-2000, I reduce to one 200 mg tablet twice a day. Since then, the frequency and duration of the a-fib episodes have incresed.

For the past four days, I have had a pronounced intention tremor in both hands, making it difficult to write or use a computer mouse, among other things.  I have taken some information about other side effects of this drug off the net and am now concerned about the wisdom of continuing.

I will be contacting my cardiologist Monday, but would appreciate any other information you could offer.

--David
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Avatar universal
I was diagnosed, about one year ago, as having a-fib.  I am a 69 year old male.  I had a cardioversion about 10 months ago.  It held only a few days then went out of rythym again.  I have been on medication since- -Toprol XL (25 MG daily) and Coumadin.  With even mild exercise, I still get very tired,out of breath, and have very little stamina or energy.  I have been told by one cardiologist that,since the cardioversion only lasted a short while, I probably had an irritable focus in the atrium and should have a catherization type procedure by an ElectroPhysiologist to locate and correct it - then my heart should stay in rythym.  What is your opinion of this?  My e-mail address is ***@****.  Looking forward to your reply.  Thanks, Jack.
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Avatar universal
can you mix midol and phenazopyridine 200mg's?
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Avatar universal
My symptoms are similar to Peter's. I can set off palpitations merely by placing liquid on the back of my tongue prior to swallowing. Has anyone heard of this?
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238671 tn?1189755832
You are trying to over-analyze the situation. I do not know (and no one can know)if your swallowing is really linked to your atrial arrythmia. Actually, I think it unlikely; it is much more likely a coincidence. I do not think acid causes atrial arrythmia. What I have seen in a few cases is atrial fibrillation triggered by drinking something hot or cold; what may happen in this situation is that the esophagus which is right next to the atrium may get irritated - this would not happen if the atrium was normal. However,an EP study would be useful to either prove or disprove this connection in your case in a definitive manner. A pacemaker is generally not used to treat atrial arrhythmia anyway.
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238671 tn?1189755832
It may not hurt to try the medication for a little while and see if it helps. However, I think the more likely mechanism is the irritation by the esophagus of the left atrium, rather than vagal activity per se. Of course, I am just speculating.
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238671 tn?1189755832
I believe the primary problem is likely the atria. I really cannot guess what the likelihood of success of the procedure will be, but I do agree with repeating the EP study while you are swallowing to see if this connection is real in your case.
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Avatar universal
Thankyou again for your reply and I plan to request a follow-up EP study.  Something I mentioned earlier still leaves me baffled. First of all the swallow trigger for my arrhythmia has returned over the past 2 days(stopped taking propafenone) and now it is fully active. I check my pulse and avoid swallowing for several minutes and the entire time everything is great (normal sinus). The second I swallow the rhythm momentarily becomes chaotic.  This happens everytime I swallow.  Is this a heart problem or is the heart a victim of something else (abnormal nerve activity)? Why does it generally go away for an hour or so after I eat a meal?  What does this suggest about the mechanism?
I have strongly believed that my vagal activity is abnormally high and that swallowing stimulates this nerve to do its harmful things.  Another electrophysiologist has reviewed my test results and agrees with my thoughts.  He has suggested trying an anticholinergic drug called scopolomine to see if that resolves my symptoms.  What are your thoughts on that idea?
Peter
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Avatar universal
When you indicate an irritation of the left atrium by the esophagus what exactly could that mean?  Can you imagine the electrical activity of the atria being affected enough that atrial tach, afib etc could be the result?  I am trying to understand how an otherwise healthy electrical conduction system could be affected in such a way by acid irritation of the esophagus.  And if this in fact is the case surely there would be many others out there with a similar story.  I guess my fear is that an electrophysiologist will eventually suggest a pacemaker because nothing else makes sense. It seems the cardiac medical community does not recognize this mechanism for causing atrial arrhythmias.  Would an EP study be of any use if in fact acid irritation is the culprit?
Peter
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Avatar universal
I appreciate your answer.  We treated the esophagitis and, perhaps coincedentally, the arrhythmia went away.  Unfortunately it did return which makes me realize that despite the esophagitis ,for any arrythmia to occur, especially afib, there must be something abnormal about the electrical activity in the atria. Do you concur?  The frustrating thing about my situation is that as long as I don't swallow everything is fine.  I mean that in every sense of the word.  I can run or do anything and until I swallow the rhythm is completely normal.  The second I swallow there seems to be a sinus pause followed by a short burst of atrial tach, which unfortunately, has resulted in afib 6 times so far over the past 8 years.  During exercise the rate can go from 140 to 230 for as long as 185 beats.  Despite what you say about my situation being not that uncommon I believe that the 100% correlation with swallowing must be unique.  I have never come across anyone who has heard of this, including the electrophysiologists at the Mayo clinic that I visited last June.
I plan to have a second EP study done where hopefully this swallowing connection will be provokable.  It is my hope the the focal atrial tach that results can be located and ablated. Do you
think this likely?  I appreciate your thoughts.
Peter
Helpful - 0
238671 tn?1189755832
Yours is actually not that unique a story. Through the years I have encountered patients who related afib to swallowing (usually either very hot or cold substances). This may be due to vagal input to both the heart and esophagus. Alternatively, it may be due to the fact that the esophagus lies anatomically next to the left atrium, which gets irritated. In these cases, I have treated the afib as I otherwise would.
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Avatar universal
Sorry but I have another question.  I have written in this forum several times about my peculiar situation where I get palpatations after swallowing (everytime).  This is 100% reproducable and has entertained many friends, doctors, and nurses.  Nobody seems to understand the mechanism except for the old vagal connection.  I do have mild esophagitis which has been treated with meds.  The swallow trigger has responded positively to the meds but not with any permanent satisfaction.  I recently suffered a bout of afib which was triggered after swallowing.  I also notice that after eating a meal the swallow trigger will shut off for a while and then slowly re-establish itself.  I am 38, male and in otherwise perfect health.  I use to run marathons, raced at 5 national whitewater championships etc.  Do you have any ideas of what to look for here. Blood work is normal, echo tests are excellent and an EP study showed no observable problems (when that was done I was not experiencing any swallow triggers or arrythmias of any sort).  I fear that someone is going to suggest a pacemaker when perhaps something else is the problem.  I believe that there is something unique and bizarre causing this.  Ideas such as hiatus hernia, blood sugar problems, parasites, systemic muscle tissue disorders, canacer etc have crossed my mind.  I have also noticed some muscle twitches generally on the left side of my body in various places.  Any bizarre ideas?  I think the answer to my problem is going to require some original thinking and investigation.  I don't seem to fit the normal mold.  I am in the broad category called "lone afib".  By the way Propafenone does eliminate the swallow trigger but at a cost(side effects).
Thanks for any of your thoughts.
Peter
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238671 tn?1189755832
Propafenone can increase the level of digoxin in the blood; thus when used together, the level of digoxin needs watching. Cisapride and propafenone can in combination lead to fatal arrhythmia; I would avoid this combo.
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