flecainide/atenolol revisited

Don, you mentioned that the flecainide/atenolol combination
is known for producing tiredness. I appreciate your generous
response, but am wondering if there is any more you would
say about what you have heard about the combination.

4 Comments

Flecainide & Beta Blockers

by donr - 2014-01-06 03:01:43

I changed the topic a bit to address the combination more in general.

I take the pair Flecainide/Acebutolol in combination w/ my PM to knock down the qty of PVC's I have. At the time I started the combo, I was up to about 30-50% PVC's & it was debilitating. I already had the PM for Bradycardia & some minor A-Fib that showed up after I got the PM.

I'd like to go back to the beginning - you are old enough to recognize this line: "Well, I was one of 7 boys..." However I'll start a bit later when I developed Hypertension very suddenly in 1992. The first med they tried on me was Tenormin (Atenolol). I was told at that time that "You'll adapt to its side effects." Yeah, & pigs will fly, too! I just felt like crap all the time. The DR. switched me to Nifedipine XR, which I DID adapt to & continued on that for several yrs. So I vaguely remember what Atenolol did TO me, more than FOR me. At that time I had no idea what any of these drugs were or how they affected you.

Fast Fwd to Feb 2003, when I had my PM planted. I was on a witch's brew of Meds to control the HBP, including Acebutolol. I was taking it 200mg, BiD & kinda floating along w/o much ill effect.

Suddenly came the PVC storm & it was Flecainide added as an anti-arrhythmic Med, plus a prescribed 800 mg per day of Acebutolol (200mg Qid). We started out at 50 mg Flecainide 1X per day & increased it to Tid. That's when I recognized the Zombie Effect. It was so bad that even I recognized something was wrong.

The Combo absolutely killed all the PVC's, but at a terrible price I paid in side effects.

If you read the side effects of the two meds, you find that they have some in common. The Flecainide is an anti-arrhythmic, so I needed that to kill PVC's. Unfortunately, it also slows the HR, as does the Acebutolol - hence the PM is really needed. Drowsiness is also a common side effect for both - Double Whammy - just about as bad as Evil Eye Fleagle.

I nagged the crap out of my Cardio & EP, so much so that they are now totally crapless! They finally allowed me to cut back on the two till I found a level of PVC's that I could tolerate & balance that against all the side effects. Now I am at Acebutolol 200mg TiD & Flecainide 50 mg Bid.

Now that is all FIRST PERSON, so I can testify to it in court - no hearsay.

From what I have read elsewhere & heard in here, the entire family of Beta Blockers has SIMILAR side effects, so my discussion is a good place to start when examining the med combos containing any Beta Blocker w/ Flecainide.

IF you are sentenced to taking those meds, I strongly suggest starting on one for a couple weeks to find out what it does to/for you before adding in the second.

One final, BIG, BTW: Flecainide has some nasty side effects w/ the heart's electrical system. It can cause elongated Q-T times, which are extremely serious. My cardio has me on a quarterly ECG to see if I have developed that problem. None yet!

Dunno if this helps, but it is what it is!

Don

Flecainide

by Theknotguy - 2014-01-06 10:01:52

Be careful with the Flecainide. They had me on that. Everything was going along great. Moved 2000 pounds of wood on Thursday. Walked 3 1/2 miles with dogs on Friday. At the end of 3 1/2 miles I collapsed on the trail. Heart rate was 20 when EMT's got there, then heart stopped completely in ambulance. Had at least three people doing CPR and couldn't get my heart re-started until they put in temporary PM. They waited 4 days to see if I would live, then put in permanent PM.

Best guess of doctors was an "undetermined" event. Something about a bad a-fib session. So when Flecainide defects to the opposing side it goes all the way.

There may be other mitigating circumstances, I had a mild flu, was a little dehydrated, and was a little overheated. But I feel the Flecainide had a part in the events.

So my personal feeling is that you be careful with the Flecainide.

Theknotguy

Atenolol & tiredness

by golden_snitch - 2014-01-07 03:01:15

Hi!

Flecainide's pro-arrhythmic effect doesn't cause brady, but severe ventricular tachy. It also doesn't slow the sinus node down, and only slows the AV-node down a little bit, but less than a betablocker would. So, Thenotguy, I'd not think that the Flecainide had a part in your events. But this feeling is just based on my knowledge of the effects it can have.

Levente, Atenolol and Metoprolol are the betablockers I do not tolerate at all. They make me really tired and drowsy. I also had bad headaches from Atenolol. I have taken both alone, not in any combination, so I know for sure that these side effects are linked to these meds, and not something else. I have also taken Flecainide quite often, and it NEVER made my drowsy; in fact, I didn't have any side effects from Flecainide.

So, my guess is that it's probably the Atenolol that's causing your tiredness. Not 100% sure, but based on my experience Flecainide doesn't cause tiredness. One could find out either if you switch the betablocker - I tolerate Nebivolol really well - or if you take only one drug for a while, if that's possible. But of course you need to discuss this with your doctor first.

Good luck!

Inga

Flecainide side effects

by donr - 2014-01-07 12:01:09

Levente: Note that Inga & I have a difference of opinion about the side effects of Flecainide..

Realize that we all react differently to any drug, that's why the list of side effects is so long.

Since Inga & I BOTH took the drug & reacted differently to it, you get a difference in perception.

Decreased HR is NOT a common side effect of Flecainide - not listed at all on three of the sites I visited to verify my original comment to you BEFORE I wrote it. Inga has taken me to task at least twice on this statement - & she is correct - if you read her source material. I got to the Mayo Clinic (#4 in the Google list that came up for me) site & they list it, but at #28 in order.

If you are into reading side effects, you will find that most sites have VERBATIM the list as declared by the mfgr - even the US NIH site. I do not know who is the originator for these lists.

Inga has the advantage over me in that she took Flecainide alone, as opposed to in combination w/ other meds, so her evaluation is 100% valid. I started on it when ALREADY on Acebutolol, so my experience is a bit more clouded.

When I was trying to kill the Zombie Effect, I did it by first decreasing the Flecainide & observing the reaction. Did that for something like two weeks & went to see my Cardio for a download to see what my PM showed to compare it w/ what I observed. Part of the sluggishness had gone & I acted more human (observed). The PM showed a MINOR increase in PVC's; nothing different on my ECG. Then I reduced the Acebutolol. Big time difference in the Zombie Effect; very little difference in what the PM showed for PVC's & Zero effect seen in an ECG. So that's where I stand today.

Unfortunately, we did not check my meds induced HR w/o the PM on either day, so I do not know what the relative proportions of any effect on that can be traced to either med.

We also react to the attitudes of our respective Dr's. My EP is very cautious in some respects of the side effects of Flecainide - like he is a fanatic about checking my ECG for QT elongation. Last year he saw one small anomaly in my quarterly ECG & I was sentenced to the first available chemical stress test to check something out - that meant the next day. He still prescribes it w/ impunity, however. My Cardio, for whom the EP is an associate, will NOT prescribe it under any circumstance. Fortunately, they can work together in harmony, because my Cardio, who I see regularly, has never said or done anything contrary to what his EP associate is doing. I never feel like I have to walk on eggs when discussing w/ either of them what the other has said or done.

I do not know how Inga feels, but it does not disturb me when she disagrees w/ me in the same or different threads. I respect her judgement & experience, which is more extensive & expansive than mine. In short - the lady is well-read, never incorrect & expresses her opinions in a tactful, definable manner, backed up by references.

Don

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