Using flecainide just once a day

[Wayne28]

Does anyone have experience taking Flecainide just once a day?  It's been working well for me to control my occasional afib episodes.  I started at 100 mg twice a day, and now just 50 mg two times per day (100 mg total per day).  I'd like to continue to cut back to the least needed and wondered if I should try 25 mg per day or could go with 50 mg once a day.  My electrophysiologist is ok with trying lower doses though I think he's not as concerned with long term dosing as I am.  Age 59. Thanks!

[Wayne28]

I had to be active in suggesting to the EP what I thought would work for me.  We're all different and I would encourage you to figure out what works best for you.  For example, do you drink caffeine or alcohol?  I can't have either of those, and for me it's a small price to pay.  Also, what do they say about your stroke risk factors?  If they're very low, as mine are, then you have less to worry about.  I've had to look at my health as a whole, not just the a fib issue, and it's really helped.  When did you first have an afib episode?

[diane100]

Did the doctor say to try for two months before lowering?  We finally found a dose that works 125 2x a day, but I am breathless with very little exertion. This will not work for me, even tho I'm not real active, this breathlessness prevents the slightest activity.  Afraid if I drop the 25mg 2x a day, and take either 100 in morning and 125 in evening, that the Afib will come back and will be harder to control...since I read that Afib begets Afib.  However I've read of many people who take extra when Afib happens (pill in a pocket) and it works. I happen to have a doctor that doesn't prescribe that. But I get the feeling he usually doesn't play around with prescribing flecainide because he seems very nervous about it, and only does it when other pills haven't worked.

[Wayne28]

I moved down from 100mg, and tried different doses for a couple of months each: to 75 mg 2x day, then 50, then 25;  it didn't work at 25mg 2x per day, as the afib returned on a regular basis.  Back up to 50mg five months ago and that seems to be working.  I've had a few afib episodes since, during times of work stress, and an extra dose of Flecainide has cured that each time.  I've looked for studies about the long-term effects of Flecainide and haven't found any that mention negative effects.  Still, I'd like to take as little as needed, and I did notice some fatigue from 100mg 2x per day that may have been related to the Flecainide, though it's hard to know for sure.  Hope that helps...

[diane100]

     How long were you on 100mg 2x per day before dropping it to  50mg 2x per day?  I've read the once Afib is in control, the dose can be dropped.  but wondering how long a person has to have it in control before the doctor will drop the dose.  Like is there some formula for this?
     I've read that those who first had it administered in a hospital setting, once they get it under control they send you home with a maintenence dose which can be lower.

[Jerry_NJ]

I am not familiar with what forms of Flecainide exist.  In the case of beta blockers and calcium channel blocker they are available in the normal release, and are usually taken at least every 12 hours, or slow (extended, etc.) release, which are taken once a day.

I understand your desire to lower (better eliminate) dependence on medication, but as you are getting good results from Flec. a go slow approach makes sense to me.  If a slow release is available (affordable, usually cost more for the meds I have taken) trying 50 mg once a day, or normal release 25 mg twice a day seems like a reasonable discussion to have with your EP.

I was taking Propafenone (generic Rnythmol) 225 mg every 8 hours (yes, three times a day) to keep me in normal sinus rhythm following a successful electrocardioversion.  After about a year of staying in NSR (and I ran for exercise) I asked my cardiologist if I could try to get by on 225 mg every 12 hours.  He gave me the go-ahead.  About 6 months later I went back into permanent atrial fibrillation.  Related to lower dose?  I don't know.  Following another electrocardioversion I stayed on the three times a day regiment, and I still slipped back into atrial fibrillation after about 18 months of NSR.

I am currently in permanent AFib, electrocardioversion, and a mini-maze have not held NSR for me.