Neurological Side Effects After Dropping Dose

I started taking flecainide, 100 mg twice a day, 10 years ago for a-fib & never had a problem with it. In recent years I had more than my share of breakthrough a-fib episodes which my cardiologist told me was not unusual. After having 3 major episodes in July which necessitated ER visits, & being tried on 3 other heart medications which caused severe side effects, I was sent to an electrophysiologist who suggested an ablation but in the meantime increased my flecainide dose to 150 mg twice a day. No long after starting this dose, I developed Parkinson-like symptoms in my hands. He then brought my dose back down to 100 mg twice a day while I waited for the ablation to take place. During this time (2 weeks) I continued to have tremors in my hands but they were very mild. After my ablation, he decided to cut my dose down to 50 mg twice a day. A week later, during a 4-day time frame, I began having vision disturbances & one day had an episode of stroke-like symptoms on my left side which righted themselves within a short period of time. I called the electrophysiologist's office & was told by one nurse that it was "probably the flecainide" & she suggested I cut it back to 50 mg once a day for 3 days & then call back to say how things were going. When I called back, I spoke with another nurse who said she didn't think the flecainide had anything to do with my symptoms at all but she left the dosage at 50 mg once a day. Since then I've continued to experience weakness & tingling in my left arm & some shaking in my upper extremities off & on which I would consider to be mild. I saw my PCP who is sending me for a brain MRI & an echocardiogram as she suspects I may have had a small stroke.

My question is this: I took flecainide 100 mg twice a day for 10 years without any side effects. When the electrophysiologist increased the dose to 150 mg twice a day, I had side effects. When he cut it back to my normal dose, I still experienced side effects but to a milder degree. At 50 mg twice a day I experienced the vision disturbances, stroke-like symptoms, & some shaking. At 50 mg once a day I am experiencing weakness & tingling in my left arm off & on as well as mild shaking in my upper extremities at times. Could the increase in my dosage of flecainide, which lasted about a month, still be affecting me even after cutting it back to my normal dosage & then lowering it even further? Wouldn't the "extra flecainide" that was in my system during that month of higher dosage be out of my system by now?

Thank you for any insight into this.

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Hello, Sajehill! How are you?

I'm not a doctor, so I can't say with complete certainty, you'll need to be checked out for anyone to be able to do that…

But, it's likely that the abrupt dosage changes, up and down, have both played roles in what's happened. It takes 3 to 5 days for a steady plasma level of it to be achieve and that's going to apply to either way your dosage goes, which means you can experience increased side effects for about 2 weeks after raising the dosage and withdrawal/rebound symptoms for about 2 weeks, when lowering the dose. The reason I'm saying 2 weeks if because of the length of time it takes to hit the steady spot in plasma that I stated, then it's general overall effects once it's there.

Learn more Flecainide details here.

When are you having the MRI and echo?

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You may have a dystonia. I took flecainide for 5 years and now have oralmandibular dystonia. It is very difficult to speak and I have to take botox shots every 3 months. I am a teacher and this disease or disorder has turned my life upside down. I have damage to the basal ganglia which controls movement. You may need to see a neurologist to have the dystonia diagnosed. I did not know that this medication would cause this horrible disease. I am now on another medication that I have been told needs to be discontinued after a short period because it can cause lung disorders. I will eventually have to get the a-fib procedure.

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