Atrial Fibrillation Medications

Understand medications and why they are helpful.

For most patients, medications are the most helpful form of treatment. But many studies show that patients often stop taking medications because of side effects or a belief that they no longer need it. Discontinuing 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 of your other drugs and supplements, including over-the-counter medications and vitamins.

Print our medication log in English (PDF) or Spanish (PDF) to track your medicines.

Medications for atrial fibrillation

Doctors often prescribe medications to prevent and treat blood clots that can lead to a stroke. They may also prescribe additional drugs to control your heart rate and rhythm, and recommend medications in conjunction with other treatments.

The heart rhythm can be more difficult to control. The longer you have untreated atrial fibrillation (also called AFib or AF), the more difficult it is to reestablish a normal rhythm.

Medication options may include *blood thinners, heart rate controllers and heart rhythm controllers. The lists here are not intended to be comprehensive, and we encourage you to revisit this page often to keep up with the newest in AFib medication options.

Your doctor will use an assessment scale called the CHA₂DS₂–VASc risk to determine whether you will need medication. The components of the scale are:

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

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

Preventing clots with medication (antiplatelets and anticoagulants)

Doctors prescribe drugs such as blood thinners to prevent blood clot formation or treat an existing blood clot. Examples include:

• Warfarin
• Other Food and Drug Administration-approved anticoagulants such as dabigatran, rivaroxaban, edoxaban and apixaban (direct-acting oral anticoagulants)
• Heparin. This medication prevents blood clots or keeps them from becoming bigger. Heparin is given to some people with AFib during certain procedures and it’s not as widely prescribed as DOACs are now. This medication is taken as an injection.
• Aspirin (in rarer cases)

Overview of side effects

Antiplatelets (aspirin) can increase your risk of bleeding. Even though you can buy aspirin over the counter, it is important that you do not take more than the dose prescribed by your doctor. Report any of the symptoms listed below to your health care professional.

Anticoagulants increase the risk of bleeding. If you are prescribed warfarin, a monthly blood test is necessary to monitor and achieve optimal dosing. Read our patients' guide to taking warfarin.

The newer direct acting oral anticoagulants don’t require the monthly blood test. But it’s important to take them as directed for stroke prevention. 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 any 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 if you miss a dose.

Always talk to your health care professional about switching from one anticoagulant to another (including changing to a generic version). Even small variations of a dose can cause problems.

• Always tell your doctor, dentist and pharmacist that you take one of these medicines. This is especially important before you start taking a new medication or have any procedure that can cause bleeding.
• If you are taking warfarin, discuss any new medications with your health care professionals. Many drugs change how warfarin works in your body. Even vitamins (and some foods) could change the effect. 

It's wise to take extra care with contact sports or any other situation that might risk unnecessary trauma. Here are some things to watch for or report to your physician if you:

• 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 include:
• Atenolol
• Bisoprolol
• Carvedilol
• Metoprolol
• Nadolol
• Propranolol
• Timolol
• Calcium channel blockers These medications have multiple effects on the heart. They are used to slow the heart rate in patients with AFib and to reduce the strength of the muscle cell’s contraction. Examples of calcium channel blockers include:
• Diltiazem
• Verapamil
• Digoxin. This medication slows the rate at which electrical currents are conducted from the atria to the ventricle.

Heart rhythm-controlling medications

Once your heart rate is under control, the next consideration is to treat the abnormal heart rhythm with medications to restore it to normal. Significant side effects may occur. 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 may include:
• Flecainide (Tambocor®)
• Propafenone (Rythmol®)
• Quinidine (Various)
• Potassium channel blockers help the heart’s rhythm by slowing down the electrical signals that cause AFib. Examples may include:
• Amiodarone (Cordarone® or Pacerone®)
• Sotalol (Betapace®)
• Dofetilide
• Dronedarone (Multaq®)

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