Flecainide again sorry

[Bagrat]

Two questions really. I am now on 50mg twice a day. No breakthrough episodes since reduction but still get occasional times when I just have to lie down for about 20 minutes as overwhelmingly fatigued. Am either increasingly unfit or flec is contributing to tachycardia on walking up hill with slight breathlessness. I live at the top of a hill. The questions - does anyone take 25 of flec twicea day? Does anyone take uneven doses i.e. 25 am and 50 pm. I did uneven doses when reducing I know. Sometimes I wish I was just happy with the status quo which is really good compared with many or most on this forum

[jeanjeannie50]

Morning Bagrat, that could have been my post with all you've written. If you remember I went 6 months without any AF last year (unheard of as only went 4-6 weeks before for years). If you remember I had a tooth that had been extracted, as my dentist said there was a root infection he could see on an x-ray, other dentists had tried unsuccessfully over the years to get to the base of the root without success.

About 5 months after having no AF I thought I'd gradually start reducing my Flecainide dose week by week. All was going well and I'd got down to 12.5mg of Flecainide when my AF came back in October. To say I was disappointed and cross with myself for reducing Flec is an understatement, because I'd been feeling like a normal person and it was wonderful.

I also had a message from my doctors surgery around August to say that my thyroid had now become so underactive I needed medication. I had known for years that Amiodarone had damaged it and had regular tests. Like you I had been getting episodes of feeling tired, especially in the afternoons and if I did too much. I thought it was my age when I wanted to take a nap in the afternoon, but since taking thyroid medication I realise how it was my thyroid causing the tiredness not my heart.

Since October I've been in constant AF and have become one of those people who have it, with little effect on stamina. Yes, I can puff a bit going up hills but I no longer have to go home and take an afternoon nap because of the hills.

I'm just wondering if you've had a thyroid blood test and if not whether it's an underactive one that's causing your tiredness as it was mine?

Jean

[Bagrat in reply to jeanjeannie50]

Thank you. I think I had thyroid function checked about a year ago but will check. Yes I do remember your trials with the tooth.

[secondtry]

Hi Bagrat, well done seems like you have reduced Flec with no major issues. My cardio does not favour uneven doses when I discussed reductions with him, even though it seemed logical to me certainly on an initial reduction given that evening/night were my worst times and mornings fine.

[Hidden]

I often took uneven doses when I was taking 150mgs of flecainide twice a day. Just to cut it down a bit I'd only take 100mg in the morning. At that time I would wake with AF and if I was OK first thing, I was OK all day. Once or twice in the last few years I have managed to set it off bending down while gardening.

[Hidden]

Anti-arrhythmic drugs doses are very personal. I suggest not to try to change the doses on your own, because you can run into very serious problems. Take note of your symptoms and bring them with you for the next appointment with your doctor. Anti-arrhythmic drugs only work if you maintain a steady blood level at all times, think of it as building a shield or fence around you to keep the AF beast at bay. When you don’t have AF episodes or just feel better, it means that the shield is adequate. Keep in mind that the anti-arrhythmic medicine does not kill the AF beast, only provides you with a shield or fence to keep it out of your territory. Again, for the protection to be adequate, it requires that you keep taking the same dose at all times. So, never change it by yourself, because you will be inviting the AF beast to come in.

[ILowe]

A steady blood level for them to work best. That may be true for some drugs, and for some people, but not all. A few weeks ago I decided to diminish my evening dose of flecainide. It was peaking around midnight. Heart rate then quite low. I often woke with tacycardia. ok only 100 but at least 30 more than resting. I suspect it is due to too high level of flec for the need. It could also have been part of the sleep routines for the heart.

The morning is the opposite. It is normal for irregularities to start on waking as you review the day and anxiety creeps in. The standard way the body dampens irregularities is... sustained fast heart rate. So the flec needs to act quickly and in strength during an active day.

Hence 50mg morning and 25mg evening. It works.

If I do not want to risk riding out the tachycardia I take PIP of a small amount of bisoprolol.

[Bagrat]

Thanks for your replies. I would never change without medical advice. I have only ever had episodes during the night. We each have our own mysteries!!