Tips for Taking Atrial Fibrillation Drugs

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Atrial fibrillation (afib) is the most common heart rhythm abnormality among Americans. If you have afib, the upper chambers of your heart beat rapidly and irregularly. This can cause symptoms like shortness of breath, dizziness, palpitations, chest pain, and fatigue. Although an abnormal heart rhythm is not life-threatening, it can lead to dangerous problems like stroke and heart failure.

Your doctor will probably prescribe drugs to restore a stable heartbeat, to relieve your symptoms and lower your risk of stroke and heart failure. There are many options, and the best ones for you depend on your symptoms and your overall health.

Here are some tips that apply to taking all atrial fibrillation drugs:

  • Always let your healthcare provider know about any side effects.

  • Never stop, change, or add medications on your own.

  • Never skip or double a dose of medication.

  • Never take any over-the-counter medications, including vitamin and herbal supplements and cold remedies, without checking with your healthcare provider.

Tips for Drugs That Lower Your Risk of Stroke

One of the biggest dangers for people with afib is stroke, which can happen when a blood clot forms in your heart and travels to your brain. Most people with atrial fibrillation need to take a blood-thinning medication to prevent blood clots. If you take warfarin (Coumadin), here are guidelines for taking it:

  • The dose needs to be adjusted frequently to keep your blood at the right clotting time. Your blood can become too thick or too thin, which could increase your risk of stroke. You will probably need to get a blood test monthly to make sure that your blood does not become too thick or too thin. Don't skip any of these blood tests.

  • One of the main side effects is increased bleeding. Let your healthcare provider know about any easy bruising or abnormal bleeding. For life-threatening bleeding, you will be given a drug that reverses the effects of warfarin.

  • Internal bleeding may cause your urine or stool to be red, brown or black.

  • Other side effects to tell your healthcare provider about include headache, dizziness and weakness.

  • Many medications, including antibiotics and vitamins, can interact with warfarin.

  • Vitamin K, found in leafy green vegetables and other foods, may also interfere with blood-thinning drugs. Ask your healthcare provider if there are any foods you should avoid.

Besides warfarin, many people are able to take newer blood-thinning medicines, known as new oral anticoagulants (NOACs). This includes apixaban (Eliquis), dabigatran (Pradaxa), and rivaroxaban (Xarelto). These drugs are as effective—maybe even more effective—as warfarin at preventing stroke. But they don’t have the same precautions:

  • NOACs have a consistent effect on blood thinning. There’s no need for frequent lab monitoring or dose changes. But you will need an annual blood test to check your kidney function.

  • Bleeding is still a risk. Tell your provider about any abnormal bruising or bleeding, or changes in your urine or stool. Unlike warfarin, NOACs do not currently have specific reversal agents in the case of bleeding.

  • NOACs can interact with other medicines, so always consult your doctor or pharmacist.

  • Vitamin K does not affect NOACs. The only food requirement is to take rivaroxaban (Xarelto) with food.

  • Swallow NOACs whole and keep dabigatran (Pradaxa) in its original packaging until you’re ready to take it. Don’t store it in a pill organizer.

Although the benefits of taking blood-thinning medications (NOACs or warfarin) with afib outweigh the risks of not taking them, it’s important to discuss all your medication options with your doctor.

Tips for Taking Heart Rate Control Drugs

Atrial fibrillation can cause your heart to beat 100 times per minute or more. Targeted drugs can get your heart rate down to about 80 beats per minute. This reduces your risk of heart failure. Possibilities include drugs known as beta-blockers, calcium channel blockers, and digoxin. Here are some guidelines for taking heart rate control drugs:

  • Be aware that these medications can interact with many other drugs, including over-the-counter medications.

  • Side effects of beta-blockers may include drowsiness, weakness, cold hands, and dry mouth.

  • Grapefruit juice may interfere with the absorption of calcium channel blockers. Ask your doctor if you should not drink it.

  • Side effects of calcium channel blockers include flushing, fatigue, ankle swelling, and heartburn.

  • Avoid drinking caffeine when taking digoxin.

  • Side effects of digoxin include confusion, weakness, upset stomach, and changes in vision.

Tips for Taking Heart Rhythm Control Drugs

If other treatments have not worked and you are still having atrial fibrillation symptoms, you may need one of the many drugs available to control your heart rhythm.

  • When you start one of these drugs, you may need to be in the hospital. This is so your healthcare provider can monitor you while your heart rhythm is reset.

  • These drugs do not work for everyone, and they may stop working after you have been taking them for a while. You may need to try several to find the right one for you.

  • There are many possible interactions with these drugs and many possible side effects. Discuss these risks with your healthcare provider, and make sure you understand them. If not, ask questions.

  • Some side effects to watch out for are worsening of allergy symptoms and increased sensitivity to sunlight.

Key Takeaways

  • Atrial fibrillation medications can reduce your symptoms and your risk of stroke and heart failure.

  • There are many drug choices available, and you may need to try several combinations to find the most effective treatment for you.

  • Drug interactions and side effects are common. Discuss these with your healthcare provider.

  • Always check with your healthcare provider before taking any other drugs, including over-the-counter medications.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Apr 29

  1. Shea, JB and Sears SF. A Patient's Guide to Living With Atrial Fibrillation. Circulation. 2008;117:e240-343. 

  2. Atrial Fibrillation. Cleveland Clinic.

  3. Atrial Fibrillation Medications. American Heart Association.

  4. Beta-Blockers. Texas Heart Institute.

  5. Calcium Channel Blockers. Texas Heart Institute.

  6. Digitalis Medicines. Texas Heart Institute.

  7. Antiarrhythmics. Texas Heart Institute. 

  8. Lane DA, Wood K. A Patient’s Guide to Taking the Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) for Atrial Fibrillation. Circulation. 2015;131(16):e412–e415.

  9. Sarich TC, Seltzer JH, Berkowitz SD, et al. Novel Oral Anticoagulants and Reversal Agents: Considerations for Clinical Development. American Heart Journal. 2015;169(6):751-757.

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