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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for irregular heart rate and dizziness

Hello, I am taking Flecainide 50 mg twice daily for a month. I was having dizziness for a few months. After ruling many things out, we found that I am having too many heart beats. The doctor thought once we slowed the beats down, I would not be dizzy. I have still had dizziness. It felt like it was leveling out a bit, but now it is bothering me again. They told me to make another appointment which is over a month away. I can t believe the doctor said not to take it if it bothers me. I would be afraid to stop taking it since it has slowed the rapid beats down. Do you think it might help if I cut them in half taking 25 mg. twice daily? I also take klonopin 0.5 mg. daily and hydroxyzine which I only started when I was dizzy months ago. I am tired of being dizzy. For 20 years the klonopin has kept me in check.
Mon, 5 Oct 2015
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Cardiologist 's  Response
Hello. Thank you for your question and welcome to HCM. I carefully read your query.

Flecainide is an antiarrhythmic from class I-A of this broad drug family. While very effective in treating various arrhythmias, mainly supraventricular, this class of drugs mandate careful monitoring of heart rate while on them. The reason is that, by delaying impulse conduction, they also tend to prolong the Q-T segment (seen in EKG), and pose the heart to other arrhythmias, sometimes dangerous and life-threatening ventricular arrhythmias. This is the controversial side effect of this class: the proarrhythmic effect. It is safe to discontinue flecainide, but once arrhythmia was diagnosed, it should be treated at least with another class of drugs. The other drugs of choice would be amiodarone, propafenone and sotalol. I would recommend you to discuss with a cardiologist about the switching to one of these drugs, regulating frequency and dosage of the new drug. About the above mentioned side effect, amiodarone and propafenone are significantly safer than flecainide. If your heart is damaged by an ischemic attack to the heart (remote or recent heart attack or myocardial infarction) then I would prefer amiodarone.

I hope I was helpful. Take care.

Best regards,
Dr. Meriton
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