Newbie

Hi, Fitted with dual chamber pm 2weeks ago. On Flecianide 50mg twice daily. Digoxin 250mg once daily, eliquis 5mg twice daily. Still having tachy Brady mainly tachycardia episodes. Wanting to know if anyone else out there is on these medications and if so did they work for you and did you have to stay on them long term?  With Thanks


6 Comments

Flecainide and Digoxin

by Gemita - 2020-01-29 05:00:13

Hello Nellie, I am in UK but have family in Brisbane area and Toowoomba.

I have been on both Flecainide and Digoxin (and at the same time too). I was on both meds for two years before getting my pacemaker.  Firstly it is important to remember that it might take a little time for your pacemaker and you to settle down together and for any medication to work.   It took me three months approx before I started noticing real benefits from being paced.  We are all individual, with different health problems and I have found that pharmacological treatment can be very trial and error until we find what works best for us.  It is a real learning process.  This is particularly true when it comes to treating arrhythmias like AF/tachycardia.

I expect you were told that a pacemaker will prevent your heart rate from falling below your PM minimum set level (which will address your bradycardia) but it cannot slow or treat a fast heart rate which is why we still unfortunately need to take either rate or rhythm control medication (or both).  I personally did not like Digoxin.  It seemed to make my arrhythmias worse (there was a noticeable increase in frequency, duration and speed of heart rate).  My doctors agreed that is was pro-arrhythmic for me (especially combined with Flecainide).   For a while I took Flecainide with beta blocker Bisoprolol which I found a better combination until I was able to drop Flecainide. I am now only taking Bisoprolol and together with my pacemaker, I am managing very well.

With Digoxin it is important to get blood levels of the med checked periodically to make sure that a safe level is being maintained since it can build up in the blood stream and cause toxic symptoms, especially in patients with poor clearance of the drug, eg those with poor kidney function.  I was told Digoxin was a useful medication to try since it could help reduce heart rate without causing too much of a fall in blood pressure - as say a beta blocker might do.  I have suffered from extremely low blood pressure and heart rates most of my life until I developed arrhythmias that can really take off, so I need a rate control medication to calm everything down.

Flecainide is generally well tolerated, especially at lower doses ( 2 x 50 mg is low). They checked for coronary artery disease before giving me Flecainide to make sure it was safe for me to take.  The only side effect I had from Flecainide was a slight increase in blurring of vision (but I have vision problems even without Flecainide).  I stopped Flecainide soon after getting my pacemaker since I found I was better off without it.  I now only take Beta blocker Bisoprolol and my pacemaker is really helping control my arrhythmias by pacing me at 70 bpm.  That has been my personal experience Nellie..  I wish you all the very best for a speedy resolve to any initial hurdles you might have to overcome.  It will get better

Flecainide and digoxin.

by Selwyn - 2020-01-29 13:40:15

Welcome to the Club, Nellie.

I tried at first to take beta blockers for the rate control of atrial fibrillation and could not exercise ( I was very short of breath). I went onto Flecainide 100mg twice daily.  Your doctors could certainly increase the dose. Your pacemaker stops some of the more problematic arrhythmias associated with Flecainide, though not all. In my case the Flecainide caused atrial flutter. I had a flutter ablation and continued with the Flecainide. This still did not control my AF so I was given verapramil  ( caution advised) for the rate. I still had flutter and fast AF and ended up having an atrial fibrillation ablation x2.   I am well now  and not on any antiarrhythmic drugs.

The use of digoxin is seen to be quite old fashioned and not without complications. You are on quite a high dose. It is rather poisonous stuff and is only occasionally used these days for some heart failure and atrial fibrillation

( see https://cks.nice.org.uk/atrial-fibrillation#!prescribingInfoSub:10 )

Flecainide is not without it's long term problems.

( see https://www.drugs.com/sfx/flecainide-side-effects.html).

I was particularly concerned as to the effect on my lungs. I should think I took Flecainide for perahps 6 years or more.  I was able to exercise with the drug. 

Hope this helps answer your posting.

Kind regards,

Flecanide and Digoxin

by Nellie - 2020-01-29 23:19:56

Thank you so much Gemita and Selwyn for your comments. I am having a review next week as my doctor was talking about a further ablation (I have already had 2). Yes not keen on staying on these drugs.  Was on Bisoprolol before I started having AF, Tachy Brady and extra ectopic beat which resulted in PM. Hoping I can go back on that again as tolerated it well. 
Appreciate your time guys. 

Nellie

by Gemita - 2020-01-30 05:04:08

Yes Bisoprolol, being a cardio-selective beta blocker I was told, would be safer to take long term than an anti arrhythmic med like Flecainide.  I am actually on a very low dose and still my arrhythmias are holding, quite incredible really after all the nonsense I had to go through before my pacemaker.  For me, the pacemaker has made all the difference Nellie by outpacing, if that is the correct term, many of my arrhythmias.  I have definitely benefitted from a constant higher heart rate.

Good luck with your review next week.  I am sorry if the feedback you have received on Flecainide and Digoxin has been rather negative so far but we have to tell you truthfully how it is.  I know many people who have done really well on both these meds and have been on them for many years without deteriorating symptoms and with excellent control of their arrhythmias.  They just didnt work for me

Digoxin and Flecainide

by AgentX86 - 2020-01-30 10:39:18

AFAIK, digoxin is no longer used in the US. There are safer, though perhaps more expensive drugs available.  As pointed out here, it's quite an old drug and has more than its share of problems.

Flecainide is commonly used without problems, until it doesn't. It tends to become a proarrhythmic at some point. None of the antiarrhythmics are safe drugs. All can cause serious problems in a large percentage of the population if taken long enough. Their toxicity is roughly proportional to their effectiveness.

Drugs

by marylandpm - 2020-01-30 19:17:27

 I only lasted 4 days on flecainide before I got very sick. Then tried Multaq for 4 months before I thought my lungs were full of mucus.  I had two ablations that worked for about a year. When my Afib got bad enough I started taking Dofetilide/ tikosyn.  I have been Afib / flutter free now since starting this, over a year now. 

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