Common Medications for Atrial Fibrillation (AFib)

Healthline

Written: James Roland           Medically reviewed: Alan Carter, PhamD, Nov 22, 2021

• Medication overview
• Heart rate drugs
• Heart rhythm drugs
• Blood thinners
• Side effects
• When to get care
• Working with your doctor
• Summary

Atrial fibrillation (AFib) is the most common type of arrhythmia, or abnormal heart
rhythm. According to the Centers for Disease Control and Prevention (CDC), it’s
estimated that AFib will affect 12.1 million people in the United States by 2030.

AFib means that the heart’s upper chambers (known as the atria), beat out of synch
with the lower chambers (known as the ventricles). When this happens, not all blood
gets pumped out of the heart. This can cause blood to pool within the atria, which raises
the risk of blood clots forming. If one of these clots breaks free and travels toward the
brain, it can restrict blood flow to the brain, causing a stroke.

A person with AFib may have brief, sporadic episodes of an abnormal heart rhythm or
experience it on a continuous basis.

Fortunately, there are many treatments for AFib. Some cases of AFib may require
medication and surgery or other procedures to help stop the arrhythmia, while others
can be managed with medication and a heart-healthy lifestyle.

How medications help

AFib medications can help manage this abnormal heart rhythm condition in a few
different ways.

Certain AFib medications can help restore a normal heart rhythm and rate. They don’t
cure AFib, but they can help control symptoms and reduce the frequency and severity
of future AFib episodes. Some of these drugs also treat high blood pressure, which is
common in people with AFib.

If you have AFib, you may be prescribed medications known as blood thinners. These
medications can help prevent blood clots and may lower your risk of a stroke.
The severity of your condition and other measures of heart health will determine which
medications your doctor prescribes.

Heart rate medications
If your heart rate is too fast or too chaotic, this means that your heart doesn’t work as
efficiently as it should. Over time, an abnormal heart rate can weaken your heart. This
can increase your risk of heart failure.
When treating AFib, your doctor will want to make sure your heart rate is under control.

This will make it easier to manage your heart’s rhythm, too.

There are a few major types of drugs designed to control your heart rate, including:

• beta-blockers
• calcium channel blockers
• digitalis glycosides

Let’s look at each one in more detail.
Beta-blockers
Beta-blockers are a class of medication that can help lower your heart rate. They do
this by blocking the effects of epinephrine, also known as adrenaline.

Beta-blockers are often given to people with AFib. These drugs can also treat high blood
pressure, anxiety, migraine, and other issues.

Examples of beta-blockers include:

• acebutolol (Sectral)
• atenolol (Tenormin)
• betaxolol (Kerlone)
• labetalol (Trandate)
• bisoprolol (Zebeta)
• carvedilol (Coreg)
• metoprolol tartrate (Lopressor)
• metoprolol succinate (Toprol-XL)
• nebivolol (Bystolic)
• penbutolol (Levatol)
• propranolol
• sotalol hydrochloride (Betapace)
• timolol
• nadolol (Corgard)
• pindolol (Visken)

Calcium channel blockers
Calcium channel blockers can also slow down your heart rate. These drugs help relax
the smooth muscle lining of the arteries and can also keep the heart from absorbing
calcium. Calcium can strengthen the heart’s contractions.

As a result of these actions, calcium channel blockers help relax the heart muscle and
widen the arteries.

Only two calcium channel blockers are centrally acting. This means that they help lower
your heart rate. They’re often used to treat AFib. These drugs include:

• verapamil hydrochloride (Calan SR, Verelan)
• diltiazem hydrochloride (Cardizem CD, Dilacor XR)

Other calcium channel blockers are peripherally acting. They also relax blood vessels,
but they aren’t helpful for AFib heart rate issues.

Digitalis glycosides
A drug known as digoxin (Digitek, Lanoxin) belongs to a class of medications called
digitalis glycosides.

This drug helps strengthen heart contractions. Doctors often prescribe it as a regular
part of heart failure treatment. Digoxin also helps slow the speed of electrical activity
from the atria to the ventricles. This action helps control your heart rate.

Heart rhythm medications

AFib is an electrical problem. Your heart’s rhythm is controlled by electrical currents that
follow a set path throughout the heart.

With AFib, the electrical currents no longer follow that pattern. Instead, chaotic electrical
signals run throughout the atria. This makes the heart quiver and beat erratically.
Drugs that are specifically used to treat problems with heart rhythm are called
antiarrhythmic drugs. They help prevent recurring AFib episodes. There are two basic
types:

• sodium channel blockers
• potassium channel blockers

Sodium channel blockers
Sodium channel blockers help control heart rhythm by reducing how fast your heart
muscle conducts electricity. They focus on electrical activity in the sodium channels of
the heart cells.
Examples of these drugs include:

• disopyramide
• mexiletine
• quinidine
• procainamide
• propafenone (Rythmol)
• flecainide (Tambocor)

Potassium channel blockers
Like sodium channel blockers, potassium channel blockers also help control heart
rhythm. They slow down electrical conduction in the heart. They do so by interfering
with conduction that occurs through the potassium channels in the heart cells.
Examples of these drugs include:

• amiodarone (Cordarone, Pacerone)
• dronedarone (Multaq)
• sotalol (Betapace)

Dronedarone (Multaq) is a new drug that is only used to prevent AFib in people who’ve
had it in the past. People with permanent AFib should not use this drug.
Sotalol (Betapace) is both a beta-blocker and a potassium channel blocker. That means
it controls both heart rate and heart rhythm.

Blood thinners to prevent clots and stroke.

AFib can interfere with the normal, healthy flow of blood throughout your heart. The
irregular beat of the atria allows blood to pool rather than move into the ventricles and
out to the lungs or the rest of the body.

Blood that pools can easily become a blood clot. Once that clot leaves the heart it can
become lodged in an artery supplying blood to the brain. If it blocks circulation, that clot
can cause a stroke—the disruption of blood flow to brain tissue.

An estimated 1 in 7 strokes are caused by AFib, according to the Centers for Disease
Control and Prevention.

There are two main types of blood thinners — medications that either slow down or
interfere with the blood clotting process. They include:

• antiplatelet drugs
• anticoagulant drugs

Blood thinners raise your risk of bleeding complications. If your doctor gives you one of
these drugs, they’ll watch you closely for side effects during treatment.

Antiplatelet drugs

These drugs work by interfering with the action of platelets in your bloodstream.
Platelets are blood cells that help stop bleeding by binding together and forming a clot.

Antiplatelet drugs include:

• anagrelide (Agrylin)
• aspirin
• clopidogrel (Plavix)
• prasugrel (Effient)
• ticagrelor (Brilinta)
• tirofiban (Aggrestat)
• vorapaxar (Zontivity)
• dipyridamole (Persantine)

Anticoagulants
These drugs work by extending the time it takes for your blood to clot. If your doctor
gives you this drug, they’ll monitor you closely to make sure the dosage is right for you.
It can be tricky to keep your blood at the correct thinning level, so your doctor needs to
check often that your dosage is accurate.

Anticoagulants known as non-vitamin K oral anticoagulants (NOACs) are now
recommended over warfarin for most people. Examples of these drugs include:

• dabigatran (Pradaxa)
• edoxaban (Savaysa)
• rivaroxaban (Xarelto)
• apixaban (Eliquis)

Warfarin (Coumadin) is still recommended for people who have moderate to severe
mitral stenosis or have an artificial heart valve.

Anticoagulants come as oral or injectable drugs. The injectable forms are often given in
the hospital by a healthcare provider. You may eventually be able to give the injections
to yourself and continue to take them at home. In some cases, you may only take them
at home.

These injectable drugs are given subcutaneously (under the skin). Injectable
anticoagulants include:

• enoxaparin (Lovenox)
• dalteparin (Fragmin)
• fondaparinux (Arixtra)

Medication side effects

Different medications for AFib have different potential side effects. For example,
antiarrhythmic drugs that treat irregular heart rhythms can actually cause those
symptoms to happen more often.
Some possible side effects of calcium channel blockers include:

• tachycardia (fast resting heart rate)
• headache
• dizziness
• fatigue
• nausea
• constipation
• swelling of your feet and/or legs

Some of the most common side effects of beta-blockers include:

• feeling tired
• feeling dizzy or lightheaded
• cold hands and feet
• nausea
• difficulty sleeping

The most common side effects from blood thinners are episodes of excessive bleeding.
This may include:

• prolonged bleeding from a cut or scrape
• heavy periods
• bleeding gums
• blood in urine or stool
• nosebleeds without an obvious cause

Blood thinners may also cause excessive bruising just under the skin and internal
bleeding complications. If you suffer an injury, such as a fall, be aware that weakness
or numbness on one side of the body or a sudden headache or change in vision or
hearing may indicate internal bleeding.

Treat these symptoms as an emergency and get to a hospital. People who take blood
thinners are advised to wear a medical alert bracelet detailing their heart condition and
the medications they take.

Don’t stop taking a medication without consulting your healthcare professional. Your
doctor can discuss other options with you. You might not have the same side effects
with a different drug, even if it serves a similar purpose.

You can ask your doctor if you may be at higher risk for any particular side effects based
on your health history and other medications you take.

Your doctor should have a complete list of all of the medications you take to ensure that
there aren’t any negative interactions between the different drugs.
Be sure to tell your healthcare professional about any vitamins, supplements, or natural
remedies you take, too, since these substances may also interact with your AFib
medications.

When to see a doctor
Having AFib means working closely with your doctor to manage your condition. You
may have a cardiologist or a specialist in abnormal heart rhythms known as an
electrophysiologist.

Your particular condition and overall health will determine how often you need to see
your doctor for scheduled checkups. However, there may be times between your
regular visits, that you may need medical attention.

For example, if you start to experience noticeable AFib symptoms, it could mean that
your condition is becoming more serious or that your current medication is no longer
working as effectively as it should.

Make an appointment with your doctor if you start to experience medication side effects,
have symptoms that bother you, or have symptoms that last for more than a few days.
More severe symptoms and side effects include:

• a racing heart
• an erratic heart rate
• chest pain
• shortness of breath or trouble breathing
• weakness on one side of the body

If you experience any of these symptoms, be sure to call 911 or get to a hospital right
away.

Working with your doctor
There are many medications used to treat AFib. They each work in different ways. Your
doctor will recommend a particular medication based on your:

• age
• overall health
• medical history
• other drugs you’re taking
• the side effects you’re able to tolerate
• other conditions you may have

You may need to try more than one kind of drug or various doses to find the medication
and the dosage best suited to control your AFib safely and effectively.

If a drug isn’t working or is causing intolerable side effects, your doctor can prescribe a different
medication or change your dosage.

It’s important to work with your physician and to take your medications exactly as
prescribed. If you have any questions about your medications, be sure to talk with your
doctor to get the answers you need.

To maximize the effectiveness of your medications, your doctor may also recommend
lifestyle changes that include:

• a heart-healthy eating plan, such as the Mediterranean diet or the DASH diet
• safe, regular exercise that’s well suited to your strength and abilities.
• healthy options for stress management
• getting sufficient sleep every night
• managing your weight or losing weight if you’re overweight.
• keeping your blood pressure, cholesterol, and blood sugar under control

The bottom line

Medications are a cornerstone of AFib treatment. Some of the most common AFib
medications include drugs that can:

• control your heart rate
• control your heart rhythm
• prevent blood clots

It’s important to work with your doctor to find the medication that works best for you. It
may take some time to find the drugs and dosages that work most effectively, with the
fewest side effects.

Let your doctor know if you have concerning side effects so they can work to find a
different, more suitable option for you.