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When and Why to Take Medicine for AFib

For many people with atrial fibrillation (AFib), medications are the best way to treat the condition. Drugs can prevent blood clots, reset your heart’s rhythm, control your heart rate, and lower your odds for a stroke. If you haven’t had untreated AFib for a long time, your doctor may be able to get your heart rate back to normal with these medicines.

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Anticoagulant Blood Thinners

Because AFib makes your heartbeat irregular, blood can pool in your heart’s chambers. That means clots could form, which raises your odds of a stroke. Anticoagulants are drugs that help prevent clots. They keep your body from making proteins that play a role in how clots form. Your doctor will probably prescribe one to cut your stroke risk. Warfarin is a common choice. Others are dabigatran, rivaroxaban, edoxaban, and apixaban -- a group called DOACs.

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Anticoagulants: Side Effects and Risks

These drugs work very well to prevent strokes. But they raise your chances for bleeding, which could be severe. If you take warfarin, you’ll need to have regular blood tests to make sure the dose you’re getting is right. You’ll also need to watch your diet carefully. DOACs don’t require a blood test. But if you have a mechanical heart valve, you can’t take them.

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Antiplatelet Blood Thinners

These drugs, such as aspirin and clopidogrel, also can prevent blood clots in people with AFib. They may also bust up an existing clot. They may not work as well as anticoagulants. But your doctor may prescribe them if you can’t take those other blood thinners.

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Antiplatelets: Side Effects and Risks

These blood thinners also can raise your risk of bleeding. If you notice blood in your stool, bleeding gums, heavy periods, weakness, or dizziness, let your doctor know right away. You can buy aspirin over the counter, but never take more than your doctor prescribes.

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Beta-Blockers

These are medications that your doctor may prescribe to help you restore your heart rate -- the number of beats per minute -- to normal. They’re blood pressure medicines that can slow down your heart if it beats too fast.  Options include atenolol, bisoprolol, carvedilol, metoprolol, nadolol, propranolol, and timolol.

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Beta-Blockers: Side Effects

Because they slow down your heart rate, beta-blockers may help you feel better overall. But they can cause side effects like low blood pressure, insomnia, cold hands or feet, asthma symptoms, or erection problems in men. They also may make you feel tired or depressed. Let your doctor know if you're pregnant or want to try to conceive while on beta-blockers.

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Calcium Channel Blockers

These blood pressure drugs, such as diltiazem and verapamil, relax your blood vessels and keep your heart from working so hard. The muscle cells of the heart and arteries use calcium to create a stronger, harder contraction. Calcium channel blockers work by stopping the flow of calcium into those cells, which slows that speedy heart rate in AFib. They can control your irregular heartbeat, lower high blood pressure, and ease chest pain.

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Calcium Channel Blockers: Side Effects

These drugs can cause constipation, dizziness, headaches, heart palpitations, or swollen ankles or feet. If you have low blood pressure or heart failure, calcium channel blockers may not be a good choice to treat your AFib.

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Digoxin

This is a type of drug called a cardiac glycoside. It helps slow down your heart rate. AFib makes your heart fill with a different amount of blood each time it beats. That means your blood delivers an uneven amount of oxygen throughout your body. Digoxin improves how your heart fills with blood, which may ease AFib symptoms like feeling dizzy or lightheaded. It can also improve blood circulation and lower swelling in your ankles or hands.

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Digoxin: Side Effects

The drug can make your heartbeat stronger and steadier. But it does have many possible side effects, such as nausea, vomiting, fainting, and heart palpitations. Your doctor will probably try beta-blockers or calcium channel blockers to control your heart rate before she prescribes digoxin. You may also take it along with those other drugs.

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Antiarrhythmics

After drugs slow your heart rate, your doctor may prescribe others to steady its rhythm. Your heart uses electric signals to control its pattern of beats. One type of antiarrhythmic, sodium channel blockers, such as flecainide, propafenone, and quinidine, slow down how your heart conducts electricity. Another type, potassium channel blockers, such as amiodarone, sotalol, and dofetilide, slow down the electric signals that lead to AFib.

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Antiarrhythmics: Side Effects

These drugs don’t work well for everyone, and they may cause some serious side effects. They could cause new heart rhythm problems or make the one you have worse. Those risks mean that your doctor may only prescribe them for severe AFib or if other drugs haven’t helped. Your doctor will want to watch you closely while you take these drugs.

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What’s New in AFib Treatment?

Scientists are researching new blood thinner drugs that can prevent strokes with fewer blood tests. One type, oral factor Xa inhibitors, are anticoagulants that may better prevent clots or cause fewer side effects. Thrombin inhibitors may cause less bleeding risk. Researchers are also trying to find medicines that target the causes of AFib rather than just its symptoms.

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Sources | Medically Reviewed on 04/16/2018 Reviewed by Suzanne R. Steinbaum, MD on April 16, 2018

SOURCES:

Medscape: “Atrial Fibrillation Medication.”

Mayo Clinic: “Atrial fibrillation,” “Calcium Channel Blockers.”

American Heart Association: “Atrial Fibrillation Medications,” “Types of Blood Pressure Medications,” “A Patient’s Guide to Taking Warfarin.”

StopAFib.org: “Anticoagulant Medication for Atrial Fibrillation,” “Rate Control Medication for Atrial Fibrillation,” “Rhythm Control Medication for Atrial Fibrillation.”

SecondsCount.org: “When Atrial Fibrillation Medications Don’t Work.”

American College of Cardiology: “Aspirin vs. Anticoagulant Use in AFib Patients at Risk for Stroke.”

Heart Rhythm Society: “Electrical System.”

British Heart Foundation: “Digoxin.”

Atrial Fibrillation Association UK: “Chapter 9: New Treatments in Development.”

Reviewed by Suzanne R. Steinbaum, MD on April 16, 2018

This tool does not provide medical advice. See additional information.

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