Patient education: Medicines for atrial fibrillation (The Basics)

What is atrial fibrillation? — Atrial fibrillation, or "A-fib," is the most common heart rhythm problem (figure 1). The condition puts you at risk of stroke, heart attack, and other problems. If you have A-fib, you might:

●Feel as though your heart is racing, pounding, skipping beats, or beating out of sync ("palpitations")

●Have mild chest "tightness," pain, or discomfort

●Feel lightheaded, tired, dizzy, or like you might pass out

●Have trouble breathing, especially when you exercise

Symptoms of A-fib can come and go. Some people do not notice symptoms.

Why do I need medicines to treat A-fib? — Having A-fib puts you at risk for a stroke and other problems, including heart attack and heart failure. The medicines your doctor or nurse prescribes to treat A-fib can help lower the risk of these problems. Some medicines can also help reduce your symptoms.

In addition to medicines, you might get other treatments for A-fib, too.

Which medicines might I need? — There are 3 main types of medicines for treating A-fib (table 1). They include:

●Heart rate control medicines – These medicines include "beta blockers" like metoprolol (brand names: Lopressor, Toprol XL) and carvedilol (brand name: Coreg), and "calcium channel blockers" like diltiazem (brand name: Cardizem) or verapamil (brand name: Verelan). They work by slowing down how often your heart beats. Digoxin (sample brand names: Digitek, Lanoxin) is another medicine that might be used to slow down your heart rate.

●Heart rhythm control medicines – These medicines include amiodarone (brand names: Cordarone, Pacerone), dofetilide (brand name: Tikosyn), flecainide, and sotalol (brand name: Betapace). They work by helping the heart switch back to and stay in a normal rhythm.

●Medicines to help prevent blood clots and lower the risk of a stroke – These medicines are called "anticoagulants" or "blood thinners," although they do not actually thin the blood. They include apixaban (brand name: Eliquis), dabigatran (brand name: Pradaxa), edoxaban (brand names: Savaysa, Lixiana), rivaroxaban (brand name: Xarelto), and warfarin (brand name: Jantoven). Warfarin is also sometimes called "Coumadin," which is an old brand name. If you take warfarin, you need regular blood tests to check how well it is working. There are other differences among the medicines, too (table 2).

Most people with A-fib take heart "rate control" medicines. Other people with A-fib take rhythm control medicines instead. The "rhythm control" medicines can be a better choice for people who still have symptoms when taking heart rate control medicines. Some people take both kinds of medicines.

Many people with A-fib also take an anticoagulant medicine to help prevent a stroke. A-fib can cause a blood clot to form inside the heart. A stroke is when a blood clot travels from the heart to the brain. Taking an anticoagulant medicine can prevent about 6 out of 10 strokes. There is a small risk of having a bleeding problem when taking one of these medicines.

Your doctor or nurse will decide which medicines are best for you depending on:

●Your age

●Your symptoms and how often they occur

●Your other health problems, if you have any

●If you already had a stroke

●How long you have had A-fib

Your doctor will probably need to adjust the doses of your medicines. Sometimes, people need to try several different medicines to find one that works best for them.

What can I do to be safe? — Too much caffeine (coffee, tea, energy drinks) or alcohol can make A-fib symptoms worse. This can also affect how your medicines work. Limit caffeine to no more than 2 servings a day. Limit alcohol, too.

Take your medicines exactly as your doctor tells you, so you get the correct amount of each medicine. Using pill boxes and reminders can help (picture 1 and table 3).

Your doctor and pharmacist need to know all of the medicines you take. This includes any over-the-counter medicines, vitamins, and herbs. It's a good idea to keep a list of the names and doses and bring it with you each time you visit any doctor. You can find an example of a list at this website: www.fda.gov/drugs/resources-you-drugs/my-medicine-record. If your medicines cause troublesome side effects, or if you can't afford your medicines, talk to your doctor or nurse. There are often ways to deal with these problems. The first step is to let your doctor or nurse know.

For more detailed information about your medicines, ask your doctor or nurse for the patient handout from Lexicomp available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

More on this topic

Patient education: Atrial fibrillation (The Basics)
Patient education: Heart failure (The Basics)
Patient education: Stroke (The Basics)
Patient education: Coping with high drug prices (The Basics)
Patient education: Choosing an oral medicine for blood clots (The Basics)
Patient education: Taking oral medicines for blood clots (The Basics)
Patient education: Digoxin toxicity (The Basics)

Patient education: Atrial fibrillation (Beyond the Basics)
Patient education: Stroke symptoms and diagnosis (Beyond the Basics)
Patient education: Coping with high prescription drug prices in the United States (Beyond the Basics)
Patient education: Warfarin (Beyond the Basics)