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Patient education: Medicines for atrial fibrillation (The Basics)

Patient education: Medicines for atrial fibrillation (The Basics)

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

Feel as though your heart is racing, pounding, skipping beats, or beating out of sync

Have mild chest "tightness," pain, or discomfort

Feel lightheaded, dizzy, or like you might pass out

Have trouble breathing, especially when you exercise

Why do I need medicines to treat atrial fibrillation? — Having atrial fibrillation 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 atrial fibrillation can help lower the risk of these problems. Some medicines can also help reduce your symptoms.

Which medicines might I need? — There are 3 main types of medicines for treating atrial fibrillation (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 names: Cala SR, Verelan, Verelan PM). They work by slowing down the speed of your heartbeat. 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) 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 for it. If you take warfarin, you will need regular blood tests to check how well it is working. There are other differences among the medicines, too (table 2).

Most people with atrial fibrillation take heart "rate control" medicines. Other people with atrial fibrillation 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 atrial fibrillation also take an anticoagulant medicine to help prevent a stroke. 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 atrial fibrillation

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? — To keep safe, it's important to 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. So 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 hand-out 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 a medicine for blood clots (The Basics)
Patient education: Taking medicines for blood clots (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)

This topic retrieved from UpToDate on: Jan 02, 2023.
This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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