If you have questions about your medications, ask your doctors and nurses. Another great resource is your pharmacist.
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Treatment for atrial fibrillation has two main goals: controlling Afib symptoms and preventing stroke. Your medical team will work with you to develop a medication plan that addresses these goals while limiting side effects.
As always, it is important to talk to your team about any concerns you have about taking medications, including costs or problems you may have had in the past remembering when to take your pills. If at any point, you experience problems with the medication – if you don’t like how it makes you feel or if you hear a news report about your medication – it’s a good idea to call your doctor before you make any changes. It’s likely that your team can adjust your dosages or make other changes so that you are more comfortable. For tools to help you with your medication plan, visit the SecondsCount Medications & Heart Health Center.
Medications for Controlling Atrial Fibrillation Symptoms
The symptoms of atrial fibrillation are caused by the irregular heartbeat. Some people find Afib episodes to be painful and frightening. Others say they are simply uncomfortable. To help, your medical team may prescribe medications aimed at controlling your heart rate and your heart rhythm. In some cases, the same medications are used to control both.
- Beta blockers are a class of medications that are commonly used for heart rate control. These medications block some of the effects of adrenaline, which tends to make the heart beat faster. Metoprolol is an example of a commonly used beta blocker.
- Calcium channel blockers are another frequently used medication for heart rate control. Diltiazem is an example of a calcium channel blocker. These drugs affect a channel in the cells of the heart that controls the flow of calcium in and out of these cells. Blocking the transport of calcium through these channels slows the rate of the heart.
- Digoxin is an older drug that is still used to assist in the overall heart rate control for people with Afib.
- Amiodarone is a medication prescribed to restore the heart to normal sinus rhythm. Or it may be used to keep the heart in normal rhythm after a procedure called electrical cardioversion, where the heart is shocked into normal rhythm. Sotalol may also be used for rhythm management.
- Propafenone and flecainide are referred to as class IC medications. Class IC medications affect sodium transport across cell membranes in the heart. These medications are reserved for rhythm control in people whose only heart problem is Afib. That is, people with known blockages in their heart arteries and people who have weakened and dysfunctional heart muscle are generally not prescribed these medications.
- Quinidine may be used for heart rhythm control.
- Dronedarone is a rhythm control medication.
Medications for Preventing Blood Clots That Can Cause Stroke
To help prevent stroke, doctors prescribe blood-thinning medications called anticoagulants. These medications prevent blood from clotting in the heart and in other parts of the body. Another word for a blood clot is thrombus.
People with atrial fibrillation are at risk for blood clots and stroke because the irregular heartbeat that occurs during an Afib episode increases the chances for blood to collect inside the heart, especially in the small left atrial appendage (LAA) sac. When blood pools for too long, it begins to clot. If a clot escapes the LAA and travels through the arteries to the brain, it is called a cardiac embolism. This is a dangerous situation that can cause a stroke. A stroke is a medical emergency that requires immediate treatment. You can learn about the symptoms of a stroke here.
The purpose of anticoagulant medications is to prevent blood from clotting and causing a stroke. One limitation of anticoagulant medications is that the blood can become too thin, which can lead to internal bleeding. For most people the risks associated with taking blood-thinner medications are less serious than the risks of having a stroke.
There are several types of anticoagulants available today.
- Warfarin (Coumadin) is the oldest and perhaps the best-known of the blood thinners. While this medication is very effective, it does have drawbacks, including the risk of severe internal bleeding. People who are taking warfarin are required to have regular blood tests, known as INR (international normalized ratio) checks. These visits are necessary to monitor the way your body is responding to the medication. The INR test allows your doctor to see how fast your blood clots and determine a healthy dose of warfarin for you. If you develop bleeding complications from taking warfarin, your doctors will need to address this problem immediately.
Fortunately, because warfarin has been in use for a long time, there is a proven method for addressing bleeding problems. If there is a problem, your doctor may give you vitamin K as an antidote to the warfarin. An antidote (in this case, the vitamin K) is a substance that reverses or decreases the harmful effect of the previous treatment (the warfarin). Vitamin K enables clotting factors in the body to work properly. Depending on the severity of the bleeding, the vitamin K may be given orally or through an IV.
Vitamin K therapy, as prescribed and monitored by your doctor in the event of an emergency, should not be confused with the use of vitamins and supplements. If you are taking warfarin and are concerned about the possibility of bleeding, talk with your doctor. Do not start taking any additional supplements to try to ward off problems, as you can do more harm than good.
The newer (or novel) anticoagulants do not require regular blood tests the way warfarin does; however, like warfarin, they carry the risk of severe bleeding. Vitamin K cannot be used as an antidote to the newer anticoagulants because they do not work the same way warfarin does. Because they have not been in use as long as warfarin, antidotes have not yet been approved to counteract all of the newer blood-thinning medications. The FDA approved an antidote for dabigatran (Pradaxa) in October 2015.
Some people prefer the newer anticoagulants over warfarin because they do not require regular blood tests. However, these medications have limitations, too. If you are taking one of the following medications, you may not take aspirin or any non-steroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs (also known as nonsteroidal anti-inflammatory agents/analgesics, or NSAIAs) include ibuprofen (Motrin) or naproxen (Aleve), among others. Many NSAIDs are taken to relieve pain, lower fever or reduce inflammation.
Many NSAIDs are available without a prescription, like aspirin is. So, even though you can get these medications over the counter, you still cannot take them if you are also taking any of the anticoagulants listed below. Ask your doctor for a complete list of medications you should not take in conjunction with your anticoagulant.
These are the newer anticoagulants that are currently available in the United States:
Once your medical team has recommended an anticoagulant for you, it is essential you take it as directed. You should not stop taking it without talking with your doctor, and you should ask your doctor before combining it with any new medications, even over-the-counter or herbal remedies. If you will need to have surgery or any medical or dental procedure, it is essential you let your doctor know about your health history and all of the medications you are taking, including anticoagulants.
What If Your Medications Don’t Seem to Be Working?
Some people discover that medications are not effective in controlling their Afib. Others find themselves unable to tolerate medications for various reasons. If you find yourself in this situation, the best step to take is to talk with your medical team about other treatment options that may be right for you. Learn about the options when medications aren’t working for your Afib.
If you would like to learn more about atrial fibrillation, including how it is diagnosed and the options for treating it, visit the SecondsCount Atrial Fibrillation Center.