Hi, everybody:

I would like to know if these two medications, Tambocor and Inderal, can cause heart attacks and/or strokes, whether or not they are taken together.

The amounts and dosages of these two medications I take are:
-Tambocor (flecaïnide) extended release 200 mg: one capsule daily
-Inderal (propranolol) immediate release 40 mg: one tablet twice daily

I also take other medications (Duragesic, MSIR, Tylenol, Keppra, Klonopin, etc.) but my question is about these two medications specifically (Tambocor and Inderal).

Thanks for your information.

According to drug checker:

http://www.drugs.com/interactions-ch...1266,1094-2330

In general drugs like Tambocor do carry some risk for certain people:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000466/

Do not change doses, or suddenly discontinue either medication without medical supervision. This is very important.

Hi, mrsD and others:

Thanks for the links and information.

Quote: "MONITOR: Beta-blockers and flecainide may have additive negative inotropic effects. Areas under the curve were increased for both drugs and negative inotropic effects occurred when flecainide and propranolol were given to normal subjects. A case of bradycardia, atrioventricular block and cardiac arrest has been reported after sotalol was added to flecainide; however, causality was not definitely determined."

I cannot find the word "inotropic" in my dictionary and, as a result, I do not know what this word means. If there was a health care professional here (doctor, nurse...) who could give me not only the definition of this word, but also the meaning of "Areas under the curve were increased for both drugs."

There is information about a cardiac arrest, bradycardia (slow heart beat), and block (?) with the mix of flecaïnide and sotalol. I wish so hard this would not apply to me because I do not take sotalol, but propranolol.

My cardiologist prescribed the flecaïnide for me, but he does not know I take the propranolol. The propranolol was prescribed for me, after the flecaïnide, by my primary care physician. This doctor does know I take flecaïnide.

I feel caught between a rock and a hard place. On the one hand, the mix of these medications might be dangerous, even deadly; on the other hand, I need these medications for the control of my intense RSD pain, because the fentanyl patches and morphine capsules do not seem to be as effective as they used to be. I really do not know what to do. I am almost 100% sure my primary care physician will not increase the dosage of the fentanyl patches. There is no qualified pain management doctor where I live.

Quote: "MANAGEMENT: Careful monitoring of the patient's hemodynamic status is recommended during concomitant administration. The same precaution should be observed when beta blocker ophthalmic solutions are used, since they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. Patients should be advised to promptly report symptoms such as dizziness, slow or irregular heartbeats, syncope, or palpitations."

Another word I do not find in my dictionary is "hemodynamic". What are exactly "palpitations"? I know this word is commonly heard, but I am not sure I understood it right.

Quote: "Do not change doses, or suddenly discontinue either medication without medical supervision. This is very important." Thanks for warning me, mrsD. I really appreciate the information.

inotropic:
http://www.thefreedictionary.com/inotropic

Affecting the heart muscle and its ability to contract.

Hemodynamic means blood flow. Drugs that reduce contraction of the heart, or slow the beats result in slower blood flow over all.

Sotalol was the betablocker that was reported in that interaction.
It is similar to the one you take. (all beta blockers are similar, with some being cardioselective and others not...propranolol is not considered cardioselective, meaning it affects larger areas of the body as well as the heart.)

You should notify the cardiologist ASAP that another doctor is also prescribing drug(s) for you, as this may impact the heart.
A patient should always keep all doctors in the loop regarding addition or subtraction of drugs.

Bradycardia is a slowing of the heart beat.

Suffice it to say, at this point you should be talking to your cardiologist and follow his/her recommendations IMO.

Hi, mrsD:

Thanks for giving me the link to the free medical dictionary and thanks for the medical words definitions. I thought the definitions of these words could be found in a medical dictionary, but I did not have access to such a dictionary, in a paper version or in an online version.

Quote: "Hemodynamic means blood flow. Drugs that reduce contraction of the heart, or slow the beats result in slower blood flow over all." I hope I will not get a blood clot because of slower blood flow.

In the past, my father had a blood clot in one of his legs; this clot moved to his brain and caused him to have a stroke, which affected his talking. Now, another blod clot has just returned in one of his legs again.

I hope the same thing will not happen to me. I am thinking of what would become of my two-year-old baby boy if I had a blood clot that moved to my brain and killed or disabled me enough so that I could not take care of a child. I do not want CPS stealing him.

When you say that propranolol is not a cardio-selective beta-blocker and that it "affects larger areas of the body as well as the heart", what could propranolol do to these areas of the body other than the heart?

I thought about notifying my cardiologist that I am taking propranolol besides taking flecaïnide, but I am so afraid my cardiologist will call my primary care doctor to tell him not to prescribe the propranolol for me anymore. I already had such a hard time convincing my primary care physician to prescribe a beta-blocker for my RSD pain.

What would happen with my RSD pain without either the flecaïnide or the propranolol? Like I said, my Duragesic and MSIR do not seem to be as effective as they used to be (due to tolerance?), so I am relying on the flecaïnide and the propranolol to boost and potentiate the pain killing effects of Duragesic and MSIR. I am already taking my Duragesic at a dosage of 125 mcg (one 100 mcg patch and one 25 mcg patch every 72 hours), so I do not think my primary care doctor will be willing to increase the dosage of my Duragesic to 150 mcg, especially considering the fact that this doctor has already been, in the past, harassed several times by the public health insurance company, which was complaining about the Duragesic costing them too much money.

So I do not know what to do. If you are a RSD pain patient or if you have seen the McGill Pain Scale, you will understand how painful of a syndrome RSD is. If my Duragesic and MSIR continue losing some effect, they will end up becoming totally ineffective, which would be a catastrophe for me. I cannot live with a pain of 10+ 24 hours a day, 365 days a year.

I wish there would be a medication that could protect my heart while I am taking the flecaïnide and the propranolol. This medication only exists in my dreams!

Thanks for caring so much because you took the time to give me all this information. I really appreciate your caring.

Selective betablockers cause less brain involvement. Example is atenolol. It was designed for controlling blood pressure mostly, and anxiety.

The non-selective ones, go into the brain, and typically cause depression and amnesia. Propranolol for example is being looked at for Post Traumatic Stress disorder. It is not surprising therefore that propranolol was chosen for you, because it works all over the body, and not mostly on the heart. But it still affects the heart like the selective ones do.

I cannot answer your RSD question. That is for the experts. sorry.

I really think you should talk to your cardiologist. He/she would understand what to do for you better than an internist.