What should be done if a patient with atrial fibrillation is not taking their prescribed medications, including Flecainide (flecainide), Metoprolol (metoprolol), and Eliquis (apixaban)?

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From the Guidelines

If a patient with atrial fibrillation is not taking their prescribed medications (Flecainide, Metoprolol, and Eliquis), they should contact their healthcare provider immediately to discuss the situation. The patient should not suddenly restart these medications without medical guidance, as improper resumption could cause dangerous heart rhythm problems or other complications. Their doctor may need to perform an evaluation, possibly including an ECG, before determining how to safely resume treatment. The doctor might recommend a gradual reintroduction of medications or a modified regimen based on how long the patient has been off the medications. This is critically important because Flecainide helps control heart rhythm, Metoprolol helps control heart rate, and Eliquis (apixaban) prevents blood clots that could lead to stroke. Patients with atrial fibrillation who stop anticoagulation therapy like Eliquis face a significantly increased risk of stroke, as stated in the 2024 ESC guidelines for the management of atrial fibrillation 1. The doctor should also address any reasons for medication non-adherence, such as side effects, cost concerns, or misunderstanding about the importance of these medications, to develop a sustainable treatment plan moving forward. Key considerations in managing atrial fibrillation include optimal treatment according to the AF-CARE pathway, which includes comorbidity and risk factor management, avoiding stroke and thromboembolism, reducing symptoms by rate and rhythm control, and evaluation and dynamic reassessment, as outlined in the 2024 ESC guidelines 1. The choice of anticoagulant, such as Eliquis, is also crucial, with DOACs preferred over VKAs except in specific cases, and the dose of anticoagulant should be adjusted according to the patient's individual risk factors, as recommended in the guidelines 1. Overall, the management of atrial fibrillation requires a comprehensive and patient-centered approach, taking into account the individual patient's needs and risk factors, and prioritizing morbidity, mortality, and quality of life as outcomes.

From the FDA Drug Label

Do not stop taking it without first talking with your doctor. If you are taking apixaban tablets for atrial fibrillation, stopping apixaban tablets may increase your risk of having a stroke. The patient should be advised to resume taking their prescribed medications, including Flecainide, Metoprolol, and Eliquis, as directed by their doctor to minimize the risk of stroke and other complications associated with atrial fibrillation 2.

  • The patient should contact their doctor immediately to discuss the best course of action.
  • The doctor may need to assess the patient's current condition and adjust their treatment plan as necessary.
  • It is essential to follow the doctor's instructions and take the medications as prescribed to ensure the patient's safety and well-being.

From the Research

Medication Non-Adherence in Atrial Fibrillation

  • Medication non-adherence is a significant issue in the management of atrial fibrillation, as seen in the case of a patient not taking their prescribed medications, including Flecainide, Metoprolol, and Eliquis 3, 4, 5.
  • The combination of Flecainide and Metoprolol has been shown to reduce atrial fibrillation clinical recurrences and improve tolerability at 1-year follow-up in persistent symptomatic atrial fibrillation 3.
  • Medication adherence is crucial in preventing atrial fibrillation recurrences, and non-adherence can lead to increased morbidity and mortality 4, 5.
  • The American Heart Association emphasizes the importance of medication adherence in cardiovascular diseases, including atrial fibrillation, and suggests policy and structural changes to support patients in adherence 4.

Factors Influencing Medication Adherence

  • Intentional and non-intentional non-adherence can occur due to various factors, including forgetfulness, running out of medication, and lack of understanding of the treatment regimen 4, 5.
  • Interaction with a health professional is essential in understanding the reason for non-adherence and promoting adherence 5.
  • A psychosocial perspective can inform the development of interventions to optimize adherence, taking into account the interactions between an individual and a specific disease/treatment, within a social and environmental context 6.

Effective Interventions for Medication Adherence

  • Tailored interventions addressing specific perceptions and practicalities influencing individuals' motivation and ability to adhere can be more effective 6.
  • The use of reminders, education, and support from healthcare professionals can improve medication adherence in patients with atrial fibrillation 4, 5.
  • The effectiveness and safety of Apixaban, a direct oral anticoagulant, have been compared with Rivaroxaban in patients with atrial fibrillation, showing a lower rate of ischemic stroke or systemic embolism and bleeding with Apixaban 7.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Flecainide-metoprolol combination reduces atrial fibrillation clinical recurrences and improves tolerability at 1-year follow-up in persistent symptomatic atrial fibrillation.

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2016

5
Research

Medication adherence: understanding the issues and finding solutions.

British journal of community nursing, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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