Transition from Sotalol to Dronederone

[BobRBob]

I have been on Sotalol for over a year to control my a-fib. Recently, I've started to have breakthroughs and my cardiologist has prescribed Dronederone (Multaq) in place of the Sotalol. He has also referred me to an EP to investigate an ablation. My question relates to the transition from Solalol to Dronederone. My cardiologist told me to just switch from one drug to the other with no taper and no overlap. I'm wondering if anyone here has done this transition. The Sotalol is a beta blocker and it comes with a warning to not suddenly stop taking it. Of course, this warning assumes no alternate drug therapy in it's place but I'm still concerned that I may develop tachycardia or some other condition upon withdrawal of the Sotalol even though I've switched to the Dronederone. My pharmacist agrees that this is the correct approach but I'm a little afraid at this point to just do it. Has anyone here had this experience? Dronederone is not a beta blocker.

[Jerry_NJ]

I'm surprised you haven't gotten a knowledgeable response.  That being the case I'll give you my experience with  beta blockers (I do not have any experience with Sotalol or Multag).  

I have gone in step fashion from 200 mg a day to 100 mg and to 50 mg.  All of Toprol XL (or generic).  My cardiologist had no problem having me make sudden changes.  

Assuming you are protected from blood clots, you might want to consider taking  a half dose of Sotalol for a couple of days before dropping it completely in favor of Multaq.  Or, better, discuss with your doctor.

[BobRBob]

Thanks Jerry. My doctor says there is no need for tapering the Sotalol as long as the Multaq is started with no delay as soon as the Sotalol is stopped. We shall see. I took my last Sotalol last night and my first Multaq this morning about an hour ago. So far, I'm still in a-fib (it started last night about 6pm). I'm really not feeling much from the Multaq so far. Just a bit of minor heart pounding that may have happened anyway as a result of eating breakfast. We shall see. I'm hoping to convert back to NSR sometime today then see if it holds with the new drug.

[BobRBob]

It's 6:30 now and I'm about to take my second Multaq. My heart has remained in a-fib all day today but it's quite mild and not too uncomfortable. Talked to my cardio and he said the drug takes 3 days to reach therapeutic levels. Hopefully, my heart will convert to NSR on it's own before then. I expected more rebound tachy from stopping the Sotalol but there really hasn't been much of anything happening except for the a-fib. We'll see how this goes tonight.

[Jerry_NJ]

Sounds like you are on your way.  From my perspective you are "lucky" to be able to get a conversion on just medication.  I have never used Multaq or Sotalol or any of the strong stuff, my cardiologist no longer believes any of them will convert me.  I had a history of betting converted with the shock treatment, then that too would not put me in NSR for more than a week, and that was with taking a strong dose of Rythmol.  

Anyway, seems you are safely off of Sotalol.

[BobRBob]

Update as of 9:30 AM Friday. My heart converted during the night. I woke up at 2am in NSR. So that's a good thing. I couldn't go back to sleep at first but drifted off around 4am or so. Awoke suddenly with elevated heart rate and butterflies in stomach. I felt sort of anxious and agitated until about 8am or so. It's subsided now and my heart remains in NSR but my heart rate is a little higher than normal for me. I think I'm getting a bit of rebound from the sudden withdrawal off the Sotalol. Not a great feeling but tolerable for now. I think I'll call my cardio and ask him if I should re-instate the Sotalol at a reduced dose, then taper. I would do this only if the anxiety and tachycardia gets worse.

[BobRBob]

One other thing... Still no noticeable side effects from the Multaq. Listed effects are mostly nausea, the runs, bradycardia. None of that yet.

[LindaTX]

Is Sotalol related to or in the same family as Multaq?   Like Rhythmol and Flecainide are in the same family.  Curious because I just came out of an ablation and went off Sotalol cold turkey because it was making me feel worse on it than I felt off it.

[BobRBob]

No, Sotalol is a beta blocker and anti-arrhythmic drug. Multaq is a very different chemical and is not a beta-blocker. Multaq (Dronederone) is actually similar in molecular structure to Amioderone but without the Iodine which makes the Ami so toxic.

Update on my crossover to Multaq...

It is now Sunday morning and I am still in normal rhythm (yay!). So far, the only side effect from the Multaq seems to be some heart racing and pounding for an hour or so after dosing. I've also noticed some anxiety and very slight teeth chattering in the morning the past 3 days as well, most likely an effect of the withdrawal from the Sotalol. Both were a bit better this morning so I'm hoping this will stop happening as I adjust to the Multaq and my body completely re-adjusts to the sudden removal of the beta blockade. I don't know how long this takes. Linda, how long were you on Sotalol before stopping? I was on it for over a year so my body was very used to it. With a half life of about 12 hours, the Sotalol is now virtually gone from my system.

[BobRBob]

Monday afternoon and still in normal rhythm. Still no noticeable side effects from the Multaq. Hard to believe given how awful the Sotalol was. Teeth chattering and nervousness has subsided so I guess I'm safely off the Sotalol...

[LindaTX]

Glad you are still in NSR....that means a lot! :)  I was only on Sotalol for a few days after I got out of the hospital.  It was keeping me at 103-108 bpm.  I finally converted into NSR and went to 72bpm immediately so I was worried about continuing the Sotalol because I hated to see my resting heart rate up so high.

I'm willing to do what I need to do but I don't feel like I'm getting any real clear direction from my EP's office.  After talking with them today they said they did get my EKG that was faxed to them LAST Wed.  They are supposed to call me back after talking to the Dr. about whatever med they want me on.  My normal resting rate is in the 60's so I reall miss that.

[BobRBob]

Great that you've converted Linda. Glad to hear it. Hopefully, this means your ablation is successful and you're healing. I have an appointment in December with an EP to investigate an ablation. I'm scared but it may be the only way.

I went into a-fib yesterday around 5pm but converted back at 10:30pm. One thing I noticed is the a-fib is smoother and less bothersome on this drug than it was on the Sotalol. I'm still hopeful though that this drug will stabilize and hold me in normal rhythm for extended periods. I've started to notice slightly cold hands today. Nothing too bad but noticeable.

[LindaTX]

Just got a call from my EP's office.  Instead of Sotalol, they want me go on Rhythmol 3 times a day....which is what I took a yr ago.  So hopefully it will keep my rhythm regular until I can discontinue it in a couple of months.  Yeah, don't rule out an ablation....a-fib is a progressive condition.  I didn't want an ablation but with my history i thought the time was right .  Only time will tell...there are no real guarantees.

[LindaTX]

I went out of rhythm into a-flutter last Fri and I'm still in it.  I called the Dr's office but no call back yet.  I need something other than this rhythmol because it is clearly not working.  I'm thinking my options will be digoxin, sotalol or Multaq.  Can't imagine they will come up with something other than one of these.  How are you doing on the Multaq?  

[BobRBob]

Hi Linda. Sorry to hear your quest for NSR has been delayed. Mine, too, is uncertain at this point. I have been in a-fib for 3 days now and just came home from the ER where they gave me a Metoprolol 12.5Mg BID. This is to complement the rate control already offered by the Multaq. This is disappointing (although I still may convert back) but one thing I have noticed with the Multaq is that the a-fib is not as symptomatic as it was before. Basically, I can't really feel much. Still hoping for a conversion but I guess we'll have to see...

[LindaTX]

Hi, I did convert to normal in the middle ofthe night last night...after I'd taken my first dose of Multaq about 6 hrs earlier. I can only hope it will hold me in normal rhythm.  I'm not sorry I had the ablation, the meds just weren't working for me anymore after 12 yrs.  I think eventually they all become pro-arrhythmic. I think it's good that you are going to look into having an ablation.  Only time will tell with me but i figure I needed to give it a shot.  I did have one of the best Dr's to do mine so shop around for someone who has done a lot of them.  I guess "practice makes perfect" when it comes to ablations. For me, the actual ablation was a piece of cake.  I was completely out for the whole thing.  It'll be 3 wks tomorrow for me and it's been dealing with the a-flutter afterward that has kicked my butt.  They say it takes 3-6 months for the inflamation and agitation to subside.

So they didn't convert you back with meds at the ER? Maybe the metoprolol will be just the ticket along with the Multaq.  I've got plenty of that in my medicine cabinet.  Keep me updated.

[BobRBob]

No, they said I had been in a-fib too long to risk an electro-conversion as I'm not on Warfarin. I have the option of starting Warfarin now and getting converted in 3 weeks if I'm still in a-fib by then. I also wonder if there's any point. Won't I just go back into a-fib the next day or whatever? I don't understand how I could go so quickly from total control with Sotalol to no control on any of the drugs tried in a few weeks. The Metoprolol seems ok at the low dose I'm on although I'm not clear yet on what it's doing. My heart rate was too high in a-fib on the Dronederone alone when active. It would run at 120 or so just walking around. The Metoprolol is supposed to lower my active rate to something more reasonable. Hope it works. I'm getting a Holter monitor tomorrow to assess the situation over a 48 hour period. My blood pressure is good - nice and low for most of the day and night. I learned that watching the bedside monitor in the hospital overnight and most of the day yesterday as there wasn't much else to do. That's good to know.

As I said before, my a-fib is hardly detectable at rest at this point. The Dronederone has a very calming effect and smooths it out vs the lumpy and bumpy shirt shakers that I was having while still on the Sotalol. I guess this means the drug is doing something good.

As for shopping around for a good EP, I'm really not sure how to approach that in Canada. Our health care system is so different from the US. There is no marketplace for services and no easy information available about individual doctors and their success records. I really have to trust my cardiologist to make an informed referral. If anyone reading this has any advice to me on how to research the issue I'm all ears and thanks in advance.

And here's to a successful outcome for both you and Pete. I am following and watching your progress with much interest and wish you both the best in your quest for healthy hearts!

[BobRBob]

Linda, regarding your ablation, what sedative did they use to knock you out?

[LindaTX]

One time when I was approaching 4 days in a-fib, my electrophysiologist sat me down and said I could go on coumadin right then or I could sit back and wait for a stroke.  Taking coumadin has been easy and I do feel more protected from having a stroke. I can't remember how long you've been dealing with a-fib but you may have reached to end of the road wih the anti-arrhythmic drugs.  Eventually they all stop working. I used them for probably 11 yrs all total.  Ok, I think these are what they used to sedate me. Isuprel, Protamine, and I think I saw Propofol (the Michael Jackson drug). My last year of this journey I was having weekly episodes of 24-36 hrs but I was not on any meds at all.

I was only in sinus rhythm for 24 hrs and then back into perpetual a-flutter. I'll stick to the Multaq and see what happens, maybe it hasn't taken full effect yet.  But I don't think i could take another marathon episode of this crap.

[BobRBob]

Linda, what was your CHADS2 score when your EP told you to go on Coumadin? My score is zero which is why I'm just on Asprin. Hopefully, this is safe. I really do worry about the risk of stroke but there are risks with Coumadin as well so it's a balancing act. Maybe I should tell my Cardio that I want to go onto Coumadin. Are there any side effects? Seems all these drugs do something bad while doing their thing.

[LindaTX]

I personally have not had any side effects on coumadin (warfarin).  My chad score was 1 but I'm pretty sure it was because of the a-fib episodes.  If they are longer than 24 hrs they say it's very possible for clots to form. I was against going on coumadin...I've been on it 1&1/2 yrs now. I guess it depends on how long and how often your episodes are.  Like I said, my Dr was pretty insistent. On those meds I quoted, I had the hospital send me what is supposed to be a full copy of my medical records from the ablation, I hope it includes everything.  I have to say it doesn't seem real detailed.

[BobRBob]

After almost 6 days in a-fib, I converted back to NSR yesterday in the afternoon. Hope it holds. We'll see. I'll enjoy it while it lasts.

[LindaTX]

OMG...I am so happy you finally did convert.  That certainly makes life more liveable.  But that is so dangerous being in a-fib that long without a blood-thinner. If you get any stroke-like symptoms you better head to the ER right away.  Don't take any chances.

Hey, I'm actually still in NSR this morning.  So glad!  Hope it holds....forever.   I had been taking some nsaids for inflamation and I haven't since I've been in normal rhythm.  You don't think ibuprophen or some of the others could have any connection? Probably not but I may stay off them for awhile.

[jwalter7]

Patients using NSAIDs for 2 to 4 weeks had a 76% higher risk of developing AF compared with those who hadn't taken these pain medications, researchers found.

[jwalter7]

Patients using NSAIDs for 2 to 4 weeks had a 76% higher risk of developing AF compared with those who hadn't taken these pain medications, researchers found.

[bobf132]

Interesting transition - I am on Sotalol but with breakthru every other week my Cardio EP has instructed me to stop Sotalol for three days then start Multaq - afraid after 3 days I'll surly be in afib so waiting till after the holidays - pharmacist also agreed w the 3 day stop

[Gustav_NL]

I used Amiodarone previously , it worked perfect on me stopping my AFIB and AFLUTTER over 3 months. Had to stop because of Iodine related side effects. I recently started Multaq , after stopping Sotalol I immediately had tachycardia and AFIB + AFLUTTER.This is the third day I am using Multaq , I feel it tries to restore NSR but I am still experiencing AFLUTTER.
With Sotalol and Digoxine , I knew my way how to control my arrhythmia.. I am a bit blind now..