Atrial Fibrillation Medications

Understand medications and why they are helpful. Medications can be a commitment for life and health!

Medications, for most patients, are the most helpful form of treatment. However, many studies show that patients often stop taking medications because of side effects or their own belief that they no longer need it. Discontinuing medications can be very dangerous!

If you have been prescribed heart medications, taking and tracking your medications is one of the best things you can do for your health.

Tell your health care team about all your other drugs and supplements, including over-the-counter medications and vitamins.

Download our printable medication log (PDF) to track your medicines. Also available in Spanish (PDF).

Medications for atrial fibrillation (AF or AFib)

Medications are often prescribed to prevent and treat blood clots which can lead to a stroke. Additional drugs may be prescribed to control heart rate and rhythm. These medications may also be used in conjunction with other treatments. The heart rhythm can be more difficult to control. The longer you have untreated AFib, the less likely it is that normal rhythm can be reestablished.

Medication options may include *blood thinners, rate controllers, and rhythm controllers. Lists included here are not intended to be comprehensive, and we encourage you to revisit our page often to keep up with the newest in AFib medication options.

Preventing clots with medication (antiplatelets and anticoagulants)

Drugs such as blood thinners are given to patients to prevent blood clot formation or to treat an existing blood clot. Examples include:

• Warfarin
• Other FDA approved anticoagulants such as dabigatran, rivaroxaban, edoxaban and apixaban (Direct-acting oral anticoagulants or DOACs)
• Aspirin (in rarer cases)

Overview of side effects

Antiplatelets (aspirin) can increase your risk of bleeding. Even though aspirin can be purchased over the counter, it is important that you do not take more than the dose prescribed by your doctor. Report any of the symptoms stated below to your healthcare provider.

Anticoagulants increase risk of bleeding. If you are prescribed warfarin, there is a monthly blood test that is necessary to monitor and achieve optimal dosing. Read our patient's guide to taking warfarin.

The newer oral anticoagulants — DOACs — (dabigatran, rivaroxaban, edoxaban and apixaban) do not require the monthly blood test, but care must be taken to take them as directed so that you receive the maximum benefit for stroke prevention. Download our sheet: What are Direct-Acting Oral Anticoagulants (DOACs)? (PDF)

Important precautions when taking anti-clotting medications

• Call your healthcare provider right away if you have any unusual bleeding or bruising
• If you forget to take your daily anticoagulant dose, don't take an extra one to catch up! Follow your healthcare provider's directions about what to do if you miss a dose.

Always talk to your healthcare provider about switching from one anticoagulant to another (including changing to a generic version). Even small variations in the amount of the dose of a medication can cause problems.

• Always tell your doctor, dentist and pharmacist that you take one of these medicines. This is especially important before you start taking a new medication or have any procedure that can cause bleeding.
• If you are taking warfarin, discuss any new medications with your healthcare providers. Many drugs change the effects of these agents on the body. Even vitamins (and some foods) could change the effect.

It is also wise to take extra care with contact sports or any other situation that might risk unnecessary trauma. Here are some things to watch for or report to your physician:

• If you have an accident of any kind
• If you often find bruises or blood blisters
• If you feel sick, weak, faint or dizzy
• If you think you are pregnant
• If you notice red, dark brown or black urine or stools
• If you bleed more with periods
• Bleeding gums
• Bad headache or stomach ache that won't go away

Heart rate controlling medications

• Beta blockers. These are drugs used to slow the heart rate. Most people can function and feel better if their heart rate is controlled. Read more about beta blockers.
• Some examples may include:
• Atenolol
• Bisoprolol
• Carvedilol
• Metoprolol
• Nadolol
• Propranolol
• Timolol
• Calcium channel blockers. These medications have multiple effects on the heart. They are used to slow the heart rate in patients with AFib and to reduce the strength of the muscle cell’s contraction.
• Some examples are:
• Diltiazem
• Verapamil
• Digoxin. This medication slows the rate at which electrical currents are conducted from the atria to the ventricle.

Heart rhythm controlling medications

Once your heart rate is under control, the next management consideration is usually treating the abnormal heart rhythm with medications to restore the heart rhythm to normal (also known as chemical/pharmacological cardioversion). Significant side effects may occur, and your healthcare provider will most likely want to monitor progress closely.

• Sodium channel blockers which help the heart's rhythm by slowing the heart's ability to conduct electricity.
• Examples may include:
• Flecainide (Tambocor®)
• Propafenone (Rythmol®)
• Quinidine (Various)
• Potassium channel blockers help the heart’s rhythm by slowing down the electrical signals that cause AFib.
• Examples may include:
• Amiodarone (Cordarone® or Pacerone®)
• Sotalol (Betapace®)
• Dofetilide
• Dronedarone (Multaq®)

Treatment options for AF also include non-surgical and surgical approaches. You and your healthcare provider will need to discuss the best options for you.