How to wean off Flecainide Acetate?
Patient: I am 64 years of age. Height = 5ft 10in Weight = 125lbs. I was first diagnosed with lone atrial fibrillation in 1996 and prescribed a dosage of Flecainide Acetate at 50 mg twice daily. My episodes of Atrial Fibrillation were extremely rare and usually short in duration. The Flecainide did not prevent them entirely. Recently I changed my GP who examined both me and my complete medical history. He was extremely surprised that I had been continuously prescribed the medication without review and advised me to stop taking the medication immediately as he did not feel my condition justified continued use. This was one moth ago and I have suffered no symptoms. I am also very health conscious and eat a very healthy vegetarian diet. I am non smoking and do not drink alchohol (apart from a glass of wine with some meals). I run between 30 - 40 miles a week (have done since my teenage years) and also brisk walk with my wife several times a week. What do you advise about stopping taking the Flecainide Acetate? Doctor: Lone atrial fibrillation has two concerns, symptoms and the risk of stroke. You report no risk factors for stroke but this is an important part of the conversation with your doctor on a yearly basis. Limiting symptoms often requires nothing. Atrial fibrillation will not go away. It will reoccur, usually in brief episodes. Episodes may occur once or twice a year at first. Over time, episodes will get longer and come more frequently. As they do, medicine is used to abort or prevent them. For someone like you in whom they remain rare, keeping medicine with you in case symptoms occur is the current preference. It is called pill in the pocket. Flecainide is actually the preferred drug. The dose is different for pill in the pocket as opposed to daily dosing. The original recommendation was not a bad one. Flecainide has no cumulative harm and is effective. You may want to revisit the issue with the prescribing doctor and ask about pill in the pocket.