Rate Control Strategy Medications

If you have afib, you should learn about 3 different medication classes that may be used in your therapy:

These medications are used to slow down the heart during atrial fibrillation. Most of these meds are also blood pressure medications. It is important to understand that these medications will not convert the heart into normal rhythm. Anti-arrhythmic drugs are used to convert or maintain the heart in normal sinus rhythm.

The most commonly used rate control medications are:

  1. Beta blockers:

    1. They are also blood pressure medications
    2. Common side effect: fatigue
    3. Commonly used beta blockers: Acebutolol, Atenolol (Tenormin), Bisoprolol, Metoprolol (Lopressor, Toprol XL), Nadolol (Corgard), Nebivolol (Bystolic) and Propranolol (Inderal LA, InnoPran XL).
  2. Calcium channel blockers

    1. They are also blood pressure medications. Not all medications in this class can be used as rate control agents
    2. Common side effects: fatigue and constipation
    3. Commonly used calcium channel blockers: diltiazem (cardizem) and verapamil
  3. Digoxin

Calcium Channel Blocker: Diltiazem

Also called Cardizem or Tiazac, it is a type of medicine called a calcium channel blocker. It can also be used to treat high blood pressure or angina (chest pain). It helps keep the heart from beating too fast, but it does not put the heart into a normal rhythm.

  • Common Dose: 60 – 120 mg twice daily or 120 – 360mg slow release once a day.
  • Common Side Effects: Dizziness, lightheadedness, weakness, tired feeling, nausea, or upset stomach.
  • Special Consideration: Grapefruit or grapefruit juice may interact with Cardizem. It can cause an individual to sunburn more easily. Wear protective clothing or use sunscreen when going outdoors.

Beta Blocker: Metoprolol

Also called Lopressor or Toprol XL, is a type of medicine called a beta blocker. There are many beta blockers but this is the most commonly prescribed. It helps keep the heart from beating too fast, but it does not put the heart into a normal rhythm.

  • Common Dose: 25mg, 50mg, 100mg or 200mg. It is usually taken once or twice a day.
  • Common Side Effects: Feeling tired when first start taking Metoprolol. Dizziness or lightheadedness, dry mouth, gas or bloating.
  • Special Consideration: Tell your doctor if you have asthma, chronic bronchitis or emphysema. It may also cause your blood sugar level to be higher.


Also called Lanoxin or Digitek, is a medicine commonly used to treat AFib or Atrial flutter. This medication is used to increase the strength of the heart’s squeeze and improve symptoms.

  • Common Dose: 0.125mg, 0.25mg, or 0.5mg It is usually taken once daily.
  • Common Side Effects: Slower heart rate. Feeling dizziness or drowsiness, depression or headache.
  • Special Consideration: Itching or hives, swelling in your face or hand, swelling or tingling in your mouth or throat or chest pain. Call your doctor right away.


Dr Jose Osorio
Miami FL

Read more about Afib:

AFib & Newer Blood Thinners

Rhythm Control


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