Rhythm Control Strategy Medications

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

Medications used to maintain the heart in normal sinus rhythm are call “Antiarrhythmic medications”. Take these medicines exactly as prescribed even if you feel fine, since they are being used to prevent further spells of afib.

In this Some of these meds require careful monitoring


Also known as Pacerone or Cordarone, is acknowledged to be the most effective medication to maintain a normal rhythm; but it requires your health care provider monitor your liver, thyroid, lungs, and muscle function and your eyes for side effects. Using this medication to treat AFib is called “off-label” because it was not specifically approved by the FDA to treat AFib.

  • Common Dose: 200 mg once or twice a day.
  • Common Side Effects: Dizziness, vision problems, seeing halos around lights. Loss of coordination, feeling weak or tired. Abnormal liver function tests.
  • Special Consideration: Liver, thyroid, lungs and muscle function need to be monitored by your health care provider as well as periodic eye exam. Avoid sunlight or tanning bed exposure. Use sunscreen when going outdoors.


Also called Betapace. It is a type of medicine called a beta blocker that also has an antiarrhythmic action. In order to start this medicine, patients are typically admitted to the hospital for a few days to monitor for side effects.

  • Common Dose: 80mg twice a day then gradually adjust to 120 – 160 mg twice a day. May be taken with or without food.
  • Common Side Effects: Fatigue, slow heart rate and headache. Other side effects include nausea and vomiting, insomnia, shortness of breath or abnormal ECG.
  • Special Consideration: Dizziness or lightheadedness may be worsened if taken with alcohol. Do not suddenly stop taking Sotalol. Contact your physician if you are not tolerating this medication.


Also called Tikosyn. It is an antiarrhythmic drug used to treat an irregular heart rhythm. It is also commonly started in the hospital to monitor for side effects and kidney function when beginning this medicine.

  • Common Dose: 125mcg -500mg twice a day based on kidney function. May be taken with or without food.
  • Common Side Effects: Dizziness, headache, fainting or fast heartbeat.
  • Special Consideration: Grapefruit or grapefruit juice may interfere with Tikosyn.

Flecainide or Propafenone

Also called Tambocar and Rythmol. It is used to manage AFib if the heart muscle pumping function is normal and the patient does not have coronary artery disease. These medicines are often prescribed as a “pill in the pocket” and taken at the onset of AFib instead of every day.

  • Common Dose: It comes in 50mg, 100mg or 150mg.
  • Common Side Effects: Blurred vision or seeing spots. Stomach pain, belching or constipation.
  • Special Consideration: If you experience difficulty breathing, dizziness, fainting or lightheadedness, fast irregular heartbeat, or tightness in chest call the doctor right away.


Also called Multaq is often used to treat the heart rhythm problems like AFib and AFlutter.

  • Common Dose: 400mg twice a day with meal.
  • Common Side Effects: Nausea or diarrhea may occur. Unpleasant tastes in the mouth.
  • Special Consideration: Should not be used for patients with severe heart failure. Avoid grapefruit or grapefruit juice.


Dr Jose Osorio
Miami, FL


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