How to control side effects of flecainide/metoprolol?

You can take up to 200 mg of Flecainide daily if you are under 160 lbs of body mass (with some variance of course, but it's a general guideline). Over that weight, titrate up to the allowable limit per your EP/cardiologist's instructions. Generally, you would up the dosage in discrete steps, say 25 mg/day, but not incrementally each day. IOW, you try an additional 25 mg for at least two days to see if that nips the PVCs. If no improvement, you add an additional 25 for a total of 'new 50 mg', again for at least two full days. Taking larger doses for only one day, and then adding, is not going to show definitively that the increased dosage will work. Give each increase time for your heart to adjust.

As always, make adjustments to any medication with consultation of a professional competent in the field. Take my suggestion, and that's all it is, for what it's worth.

I'm a lot younger than you and have experienced both light-headedness and fatigue at times even without medication. If I need to, I move more slowly. I don't know of any other work-arounds.

Hey Scolio
Thanks for comment. I’ve tried every combination to see what best result is. Taking 3X/day seems to produice least side effects, but still have them everyday.

Dr. difficult to contact. I am adjusting dosages myself. Think the % of daily metoprolol to flecainide is about 1 to 8 ? Supposedly the use of both mitigates some of the side effects of each taken individually. Any thoughts on this?

I can only speak for myself, but I did not do well taking too much metoprolol. I found myself with a heart rate near 30 BPM when my daily total went past 125 mg. This was immediately after a spike near 148 BPM. In fact, that was after a first failed ablation. I went on Amiodarone and dropped the metoprolol cold...no further dosage as soon as the ER physician ordered Amiodarone.

Try cutting the dosage of metoprolol by 50% for a couple of days (you should consult your care giver first, though). See what happens. You may find that the Flecainide does all you need from medications.

The arrhythmia, if it happens, is not lethal...not for several weeks or months...UNLESS the heart rate exceeds 100 and seems to want to remain that high. Never go more than 24 hours with a heart rate higher than 100.

Thanks “gloaming”. I only take 25 mg. of metoprolol and 150 mg of flecainide daily. Yet still have lightheadedness and fatigue. Had ablasion that didn’t work. Sounds like amiodarone alone is working for you.

Before and after my cardiogram procedure (a procedure to treat AFIB) I was put on Flecainide. . I recently discontinued taking it but am experiencing severe muscle weakness in all my joints and arthritis in both hands. Has anyone had the same experience?

I have been on Flecanide for a year now .
Why did you stop taking the medicine?
Since you stopped you have this problem????

I developed the muscle/joint problem soon after being put on Flecainide.It has been noted that this is a possible side effect.

Hello @r0secrane. I combined your discussion with an existing discussion titled, "How to control side effects of flecainide/metoprolol?" - https://connect.mayoclinic.org/discussion/how-to-control-side-effects-of-flecainidemetoprolol/.

@gia talked about experiencing side effects on flecainide as well and may be able to share some of their experiences as well.

@r0secrane, has an alternative been discussed with you in regards to treatment? What did your provider say as to how to proceed forward with the symptoms you experienced as a result of taking flecainide?