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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Should I be concerned about taking Propafenone and Eliquis together?

Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6612 Questions

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Posted on Thu, 7 Feb 2019 in Hypertension and Heart Disease
Question: One week ago, after having a rapid heart beat for 14 hours ... of 155 beats per minute...i went to emergency room.... ( it happend 4 months ago but stopped after I took 120 mg of diltiazem). In the ER i got an Intervenus doze of diltiazem and it began coming down , finally reaching normal sinus rythm. The exams showed i had "atrial flutter." I was put on the following drugs and released the next day. No problems since. 1. Propafanone (Rythmol) 150 mg three times a day... anti- arrythmic drug 2. Diltiazem 180 mg once a day... 3. Eliquis 2 times a day... blood thinner.... Im concerned about taking the propafanone and Eliquis. The reason why i am concerned is that when i had the first episode 4 months ago, the cardiologist simply put me on one 120 mg of diltiazem daily and called it " supra ventricular tachycardia" and did not put me on the anti arrythmic drug or blood thinner. He did not call it " atrial flutter." I had used that cardiologist for the last 5 years but had recently decided to use a heart specialty hospital where the previous cardiologist doesnt service. So the new cardiologist put me on the anti arrythmic and Eliquis etc. I woukd like to ask : what treatment do you think is more appropriate?? Should i be concerned about taking propafanone and Eliquis??
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello,

I would explain your uncertainties as follows:
- It seems that you are actually suffering from recurrent episodes of atrial flutter. You raised a question about atrial flutter or paroxysmal supraventricular tachycardia (PSVT), you are right!

They are different and distinct forms of cardiac arrhythmia:
- Both of them are located completely or almost within the atria chambers of the heart
- Generally are more benign compared to ventricular arrhythmias;
- They also are very similar regarding the mechanisms of triggering and arrhythmia maintenance (abnormal electrical impulse travels inside a macro-circuit within the myocardium, but the locations of these arrhythmic loops differ between atrial flutter and paroxysmal supra-ventricular tachycardia);
- They differ also from the higher atrial frequency of atrial flutter compared to PSVT.

A simple resting ECG may differentiate whether atrial flutter or PSVT: atrial frequencies (P/f waves frequency) in the range of 240 to 440 goes in favor of atrial flutter; much lower frequencies may help defining PSVT.

You can upload an ECG recording (photo) here for a direct review and a second professional opinion. Nevertheless, the good thing of all this story is that whichever be the exact arrhythmia, the therapeutic options are almost the same.


Now, let me explain you that your actual therapy seems rational:
- The first episode of your arrhythmia was successfully treated with Diltiazem, which is a calcium channel blocker that may show beneficial in terminating an acute episode but may not be sufficient at maintaining a normal sinus rhythm.
- That's why your doctor has added an anti-arrhythmic drug (Propafenone) in top of Ditiazem.
- Propafenone, a class IC anti-arrhythmic medication is preferable in the maintaining therapy for supra-ventricular arrhythmia (atrial flutter/fibrillation; PSVT, etc.)
- The combination of Diltiazem and Propafenone is preferable also for another reason: Diltiazem may slow impulse conduction through the atrio-ventricular node in case atrial flutter with a fast ventricular response occurs (a potential complication of Propafenone therapy).
- Returning to anti-coagulation, Eliquis seems rational, as it doesn't require any lab anti-coagulation test. Eliquis tends to prevent thrombo-embolic events, a potential complication of atrial flutter/fibrillation.
- Even the combination of Diltiazem or Propafenone with Eliquis has proved to be safe; no adverse effects are shown by these combinations.

So, to summarize all the above, I would say that your treatment strategy seems okay!

What you need to discuss with your doctor would be an opportunity of investigating any potential detectable causes of the arrhythmia.

Several medical tests are recommended:
- A cardiac ultrasound (as a structural heart disorder should be first sought)
- Chest X ray study
- Pulmonary function tests
- Thyroid hormone levels
- Liver and renal function tests
- Blood electrolytes level, etc.

In case your actual therapy doesn't show successful at preventing further arrhythmia recurrences, then you may discuss with your attending cardiologist on the possibility of optimizing the treatment by switching to another anti-arrhythmic drug or performing cardiac ablation, which has been shown highly successful in eradicating the arrhythmia loop (circuit) inside the myocardium, thus stopping definitely the arrhythmia.

Hope to have clarified your uncertainties! In case of any further questions, feel free to ask me again.

Regards,
Dr. Iliri Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ilir Sharka 4 hours later
Thanks so much Dr. !!!!!
One of the side effects I am experiencing with propafenone is a metallic taste in my mouth, almost constantly. I really don't want to have that forever. Is there a good alternative???
Second--- I have been taking Advil for a torn medial meniscus in the left knee... I take about 600 mg a day for pain. Is that ok to continue ibuprofen with the new heart drugs I have??
doctor
Answered by Dr. Ilir Sharka 16 minutes later
Brief Answer:
Opinion as follows:

Detailed Answer:

Hello,

As you are experiencing such an adverse effect from Propafenone, then you should discuss with your prescribing doctor on the opportunity of switching to another class Ic anti-arrhythmic drug such as Flecainide, which has a more benign profile regarding taste alterations.

With your actual Propafenone daily dose (150 mg x 3/day), your daily Flecainide dose would be 100 mg x 2/day.

Regarding concomitant Ibuprofen use, no additional important adverse effects has been shown.

Nevertheless, you have to be careful and check your liver and renal function tests, as well as complete blood count, just to be sure that no adverse effects arise from Ibuprofen use.

I recommend you not to use Ibuprofen for prolonged periods of time.

Hope I have answered your query.

Regards,
Dr. Iliri Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Raju A.T
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