Atrial Fibrillation Medications

Understand medications and why they are helpful

For most people, medications are the best treatment. It has been reported that people may stop taking medications due to side effects or thinking they no longer need them. Stopping your 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 medications and supplements, including over-the-counter medications and vitamins.

Print our medication log in English (PDF) or Spanish (PDF) to track what you take.

Medications for atrial fibrillation

People with AFib are often prescribed medications to prevent and treat blood clots that can lead to a stroke. Other medications to control your heart rate and rhythm may also be prescribed.

The heart rhythm can be harder to control.The longer you have untreated atrial fibrillation, the harder it is to get back in a normal rhythm.

Medication options may include:

• *Blood thinners
• Heart rate controllers
• Heart rhythm controllers

These lists are not meant to be comprehensive. We encourage you to revisit this page often. Also, talk with your health care professional to keep up with the newest AFib medication options.

Your health care professional may use an assessment scale called the CHA₂DS₂–VASc risk to help decide if you need medication. The factors of the scale are:

• Congestive heart failure
• Hypertension (high blood pressure)
• Age (75 or older)
• Diabetes
• Stroke (prior stroke)
• Vascular disease (prior heart attack, peripheral artery disease or aortic plaque)
• Age (65-74)
• Sex (female)

The more factors you have may result in increased use of medications to control your AFib.

Preventing clots with medication (antiplatelets and anticoagulants)

Health care professionals prescribe medications such as blood thinners to prevent blood clots or treat an existing blood clot. Examples:

• Food and Drug Administration-approved direct-acting oral anticoagulants  (DOAC s) such as:
  • Dabigatran
  • Rivaroxaban
  • Edoxaban
  • Apixaban
• Heparin. This medication prevents blood clots or stops them from becoming bigger. Heparin is given to some people with AFib during certain procedures.  It’s not as widely prescribed as DOACs are now. Heparin is injected.
• Warfarin
• Aspirin (in rarer cases)

Overview of side effects

Antiplatelets (aspirin) can increase your risk of bleeding. You can buy aspirin over the counter. But, do not take more than the dose prescribed. Report any of the symptoms listed below to your health care professional.

Anticoagulants increase the risk of bleeding. If you are prescribed warfarin, you need a monthly blood test to check for the best dose. Read our patients' guide to taking warfarin.

The newer DOACs don’t require a monthly blood test. But it’s important to take them as directed to prevent stroke. View and print: What are Direct-Acting Oral Anticoagulants? (PDF)

Important precautions when taking anti-clotting medications

• Call your health care professional right away if you have unusual bleeding or bruising.
• If you forget to take your daily anticoagulant dose, don't take an extra one to catch up. Follow your health care professional's directions about what to do.

Always talk to your health care professional about switching from one blood thinner to another. This includes changing to a generic version. Even small changes in a dose can cause problems.

• Always tell your health care professionals, including dentist and pharmacist, that you take these medications. This is especially important before you take a new medication or have a procedure that can cause bleeding.
• If you are taking warfarin, discuss any new medications with your health care professionals. Many medications change how warfarin works in your body. Vitamins and some foods could also change the effect.

Take extra care with contact sports or any situation that might risk trauma. Here are some things to watch for or report to your health care professional:

• Have an accident of any kind
• Often find bruises or blood blisters
• Feel sick, weak, faint or dizzy
• Think you are pregnant
• Notice red, dark brown or black urine or stools
• Bleed more during your periods
• Notice bleeding gums
• Have a headache or stomachache that won’t go away

Heart rate-controlling medications

• Beta blockers. These drugs slow the heart rate. Most people can function and feel better if their heart rate is controlled. Read more about beta blockers. Examples of beta blockers:
• Atenolol
• Bisoprolol
• Carvedilol
• Metoprolol
• Nadolol
• Propranolol
• Timolol
• Calcium channel blockers. These medications slow the heart rate in people with AFib and weaken the heart’s contraction. Examples of calcium channel blockers:
• Diltiazem
• Verapamil
• Digoxin. This medication slows down the electrical signals from the upper to the lower chambers of the heart.

Heart rhythm-controlling medications

Once your heart rate is controlled, the next step might be treating the abnormal heart rhythm with medications. You may have serious side effects. Your health care professional will most likely want to monitor your progress closely. There are two types of channel blockers for controlling the heart’s rhythm:

• Sodium channel blockers help the heart's rhythm by slowing its ability to conduct electricity. Examples:
• Flecainide
• Propafenone
• Potassium channel blockers help the heart’s rhythm by slowing the electrical signals that cause AFib. Examples:
• Amiodarone
• Sotalol
• Dofetilide
• Dronedarone

Treatment options for AFib also include non-surgical and surgical methods. Discuss your best options with your health care professional.