Atrial Fibrillation Medications: How They Work, Risks, Benefits

Medically Reviewed by Dr. K on 20 May 2022

Table of Contents:


  1. Medications That Treat Atrial Fibrillation
  2. How Medications Work
  3. Prevention of Clots and Stroke
  4. Heart Rate Control
  5. Heart Rhythm Control


Medications That Treat Atrial Fibrillation

When you have atrial fibrillation, the aim is to regulate your heart rate and, in some cases, to restore rhythm to your heart. Additionally, the doctor may want to assist you in avoiding blood clots, which can result in a stroke. Medication is the safest treatment choice for many people with AF.

Find out what medications your doctor might recommend to help you manage your AF. You'll get the most benefits from these drugs if you follow your doctor's and pharmacist's instructions to the letter.


How Medications Work


AF causes the heart to quiver or flutter due to irregular electrical signals. It may also beat too quickly. Palpitations is a term used to describe this feeling.

AF prevents blood from circulating naturally from the upper chambers of the heart (the atria) to the lower chambers (the ventricles). Blood will pool in the atria and clump together, forming clots. It's possible that one could move to your brain and cause a stroke.

Medicines have a variety of functions. They are able to:

  • Prevent blood clots. These drugs help to reduce the risk of having a stroke.

  • Slow your heart rate. Some drugs reduce the amount of contractions your ventricles make per minute. This slower pace allows them to fill up with blood before pumping it to the body.

  • Control your heart rhythm. Other medications aid in the better coordination of your atria and ventricles in the pumping of blood.

Prevention of Clots and Stroke

Blood thinning medications aid in the prevention of blood clots. Blood clots can spread to other areas of the body, causing severe medical complications including strokes. A blood clot would not dissolve with blood thinners. However, the blood clot can dissolve on its own over time. Blood thinners can also prevent the formation or growth of other clots. They will reduce the risk of having a stroke by 50% to 70%.

Certain blood thinners may be provided to you in the hospital or even at home for a limited period of time. These are the usual blood thinners that can be given intravenously (IV) or subcutaneously (subcutaneously) in the hospital:

Other blood thinners come in the form of tablets that you take on a regular basis. The following are some examples of these drugs::

Many of these medications have the potential to cause bleeding. When playing sports or engaging in activities that can cause you to hurt yourself or bleed, take extra precautions.

Precautions: Blood thinners can lead to a higher risk of bruises and excessive bleeding. If you take warfarin, for example, you'll have a blood test once a month to ensure that it's working and that you're on the right and safe dosage.

  • Contact your doctor as soon as possible if:

    • You have any unexplained bleeding or bruises.
    • You have an accident of any type.
    • Bruises and blood blisters are found frequently.
    • You feel sick, weak, dizzy, or faint.
    • You are pregnant.
    • You find stool or urine that is red, dark brown, or black.
    • Your period becomes heavier.
    • Your gums start bleeding.
    • You develop persistent headaches or abdominal pain.
    • You start to develop a pale complexion (Anaemia)
    • You become short of breath and have difficulty breathing.
    • You cough up blood or vomit blood (which may look like coffee grounds)
    • You develop a fever or an infection that's getting worse.
    • You start experiencing unusual pain or swelling.

  • Take your medication exactly as directed. Take it at the same time every day, preferably early in the evening (such as between 5 and 6 p.m.). Warfarin may be taken with or without food.

  • If you miss a dose, don't take a double dose to compensate. Consult the doctor for advice.

  • If you change from one type to another, talk to your doctor about the differences.

  • When you decide to have a procedure that might cause bleeding, tell other doctors and your dentist that you're taking one of these medications.

  • Tell any doctor who wants to prescribe you a new prescription if you're taking warfarin. Some medications and vitamins alter the way your body functions.

Clot busters, which you could get in the hospital if you have a stroke or a heart attack, are not the same as blood thinners. Clot busters, also known as fibrinolytics or thrombolytics, dissolve blood clots already present in the body.


Heart Rate Control


Beta-Blockers to Slow Your Heart Rate


The electrical signals in your heart are altered by one type of AF drug, which causes your heart rate to slow. These medications will not necessarily adjust your irregular heart rhythm, but they will make you feel better.

Blood pressure medications known as beta-blockers are a form of blood pressure medication. These are some of them:

Beta-blockers may have a variety of side effects, which are:

  • Feeling tired
  • Cold hands and feet
  • Weakness and dizziness
  • Dry mouth, eyes, and skin

Precautions: Beta-blockers are not suitable for all:

  • If you have asthma, tell your doctor. They have the potential to cause serious asthma attacks.

  • If you have diabetes, be aware that they can mask symptoms of low blood sugar, such as a racing heart. Check your blood sugar levels on a regular basis.

  • They may increase triglycerides and lower good cholesterol, however these are just temporary effects.

  • Stopping a beta-blocker abruptly may increase the risk of a heart attack or other complications.

Calcium Channel Blockers to Slow Your Heart Rate


This is a different form of blood pressure medication. They slow your heart rate by relaxing blood vessels in your heart. Here are some examples::

Calcium channel blockers can have the following side effects:

  • Feeling tired
  • Red skin
  • Swelling of the belly, ankles, or feet
  • Heartburn

Precautions: If you are taking calcium channel blockers, avoid grapefruits and grapefruit juice. They have the potential to alter the way these drugs function.


Digoxin (Digox, Lanoxin) to Control Heart Rate


This medication increases the contractions of the heart muscle and acts on the electrical system of the heart to reduce the rate at which signals travel from the atria to the ventricles. Lanoxicaps and Lanoxin are two well-known brands. Digoxin is a drug in the digitalis class.

This medication is usually taken once daily. Make an effort to take it at the same time each day. Follow the instructions on the label about how often to take it. The interval between doses and the duration of treatment will be determined by your condition.

Your doctor may advise you to check your pulse daily while on digoxin. They'll advise you on the appropriate rate of your pulse. If it is slower than that, discuss with your doctor the possibility of taking digoxin that day.

Maintain all appointments with your doctors so they can track your response to the prescription.

Digoxin can make you sleepy. Avoid driving a vehicle or operating equipment until you have determined how this medication affects you.

If you experience any of these side effects, contact your doctor immediately:

  • Nausea or vomiting 
  • Diarrhea
  • Abdominal pain
  • Loss of appetite
  • Slow heartbeat or rapid heartbeat 
  • Confusion
  • Changes in vision, for example:
    • Light flashes or flickers
    • Sensitivity to light
    • Perceiving objects to be bigger or smaller than they really are
    • Blurring
    • Changes in colour (especially a yellow or green tint to your vision)
    • Objects with haloes or borders
  • Drowsiness
  • Headache 
  • Depression
  • Fatigue

These signs can indicate that your dosage needs to be adjusted. Once you and your doctor have determined the proper dosage, you should usually experience no side effects if you take digoxin exactly as prescribed.


Heart Rhythm Control


Channel Blockers to Control Heart Rhythm


These drugs regulate your heart rhythm by decreasing the speed at which electrical signals travel through your heart. Cardioversion with medications, or chemical cardioversion, is a term that refers to this form of treatment.

If rate control medications alone have failed to help you, your doctor can prescribe one of these medications. Heart rhythm drugs are most effective if you have recently developed AF. Among the alternatives are the following:

Sodium channel blockers, which reduce the capacity of your heart to conduct electricity:

Potassium channel blockers, which act as a slowing agent for the electrical signals responsible for AF:

These medications can cause a variety of side effects, ranging from blurred vision and dry mouth to a slower heart rate.

You will need to take a blood thinner for a few weeks prior to initiating one of these medications to avoid a clot.

Medications are one treatment choice for AFib. If they are ineffective or you are unable to tolerate the side effects, you may have other options, including surgery. Consult with your doctor on all of your choices.


Referenced on 15/4/2021

  1. American Academy of Family Physicians: “Digoxin: A Medicine for Heart Problems."
  2. American College of Cardiology: “Recommended Doses of Anticoagulant/Antithrombotic Therapies for Patients with Atrial Fibrillation.”
  3. American Heart Association: “Atrial Fibrillation Medications," “Types of Blood Pressure Medications," “What is Atrial Fibrillation (AFib or AF)?"
  4. Cleveland Clinic: “Atrial Fibrillation (AFib)."
  5. Mayo Clinic: “Beta blockers,” “Calcium channel blockers.”
  6. National Heart, Lung, and Blood Institute: “How Is Atrial Fibrillation Treated?"
  7. Texas Heart Institute: “Beta-Blockers," “Calcium Channel Blockers."
  8. UpToDate: “Patient education: Atrial fibrillation (Beyond the basics)," “Cardiac arrhythmias due to digoxin toxicity."
  9. PDR.
  10. National Institutes of Health.
  12. MedlinePlus: “Digoxin Oral."
  13. “Digoxin: A Medicine for Heart Problems."
  14. “Thrombolytic Therapy.”

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