Heart Rate Control Medications
Often, if you are in AFib, your heart rate may be elevated. Medications that are used to control heart rate may not convert the heart rhythm back into sinus rhythm, but they may restore the heart rate to a standard rate.
Examples of heart rate control medications include:
Digoxin typically works to control the heart rate at rest but doesn't do a great job of managing the heart rate during activity. Digoxin is used more often with people who have heart failure along with AFib.
Physicians don't prescribe digoxin as often as in the past because recent studies have shown that it seems to increase the risk of death in people without heart failure and is less effective than other medications.
Digoxin doesn't work well when you're exercising or if you are experiencing severe emotional stress.
Side effects of digitalis include:
- Breast enlargement
- Fast, irregular heart rate
- Changes in your vision
- Unusual bruising or bleeding
Calcium Channel Blockers
Calcium channel blockers provide rapid rate control and help to decrease heart rate both at rest and during exercise. Diltiazem and verapamil are two drugs in this category that are effective for initial rate control.
When a person comes to the hospital in fast AFib with significant symptoms, they receive one of these medications through an IV. One of the downsides of calcium channel blockers is that they don't work as well as beta-blockers for controlling heart rate.
Some types of calcium channel blockers are:
- Calan SR
- Procardia XL
- Cardizem CD
- Dilacor XR
Avoid calcium channel blockers if you have heart failure or hypotension (low blood pressure). Other side effects of calcium channel blockers include:
- Heart Failure
- Ankle swelling
Beta-blockers are a class of medicines used to ease the workload of the heart muscle by reducing the release of adrenaline. Beta-blockers are one of the most common choices for treating a fib because of their high rate of effectiveness in decreasing rapid heart rates.
Examples of beta-blockers used for AFib treatment are:
- Toprol XL
Beta-blockers can cause hypotension, along with these other side effects:
- Symptoms that resemble asthma
- Heart failure
- Cold hands and feet
- Trouble sleeping
- Problems with sexual function
- A heart rate that is too slow
- Women who want to get pregnant will need to talk with their physician
- People that have diabetes and take insulin need to keep a close eye on their blood sugar levels
Anticoagulants (Blood Thinners)
Anticoagulants are especially important to take if your physician prescribes them. Remember how we discussed that huge risk of AFib is sustaining a stroke? Taking anticoagulants can keep the blood thin, meaning that the clot may not form in the first place.
The most common anticoagulant is warfarin (Coumadin, Jantoven). Coumadin is a very effective and powerful medication. However, the downside is that the drug requires frequent monitoring – it can be challenging to get the dosing accurate.
There are also a couple of newer anticoagulants:
- Dabigatran (Pradaxa) is as effective as warfarin but does not require frequent monitoring. However, you cannot take it if you need anticoagulation due to mechanical heart valves.
- Rivaroxaban (Xarelto) is another option that is also as effective as warfarin. Xarelto is a short-term option to use after catheter ablation.
- Apixaban (Eliquis) is a third option for anticoagulation.
Side effects that can occur when taking anticoagulants include:
- Bleeding into the gums
- Dark brown, red, or black urine or feces
- Bruising or bleeding more easily than usual
- Increased bleeding during menstrual cycles
- Severe stomach ache or a headache that will not resolve
If you use nutritional supplements or any vitamins regularly, you will need to visit with your physician to see if they cause any harmful interactions with the anticoagulant you take.