My doc has agreed to lower my Diltiazam but did not give an exact process, rather says I could reduce the 30mg. As I could tolerate. I’ve been trying 30mg every 8 hours but have experienced A-fib for past three days lasting about 2 hours. A-fib once weekly is my norm.
I must include the fact that I had been on a strict a-fib diet and was without AF episode for 23 days ! Ecstatic- thought I was on to something BUT THEN, I hosted a luncheon, ate sugary foods and began with one of my three episodes before I got up from the table! So I’m thinking it’s the sugar, but three days is troublesome and of course the poor food choices coincided with my lowering Diltiazam.
Goodness, sorry to be so long winded!
My original question: has anyone successfully reduced their 120mg. ER Diltiazam dose.
Thank you.
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Only reduced post ablation. I was on 200 mg extended release. I stopped over a few days. I was on capsules so could not cut them up so I just went onto a capsule every other day for 2 days then stopped .I had no issues but was not in afib as it was over 3 months after my ablation so may not be that relevant to you.
I did not like diltiazem so could not wait to stop but it was good at rate control.
I guess the bigger question is whether or not the Diltiazem is making any difference in the frequency of your afib episodes. For me and many it never has.
While it does have some antiarrhythmic properties, with afib it seems most effective for rate control, as opposed to keeping you out of afib.
This doesn't mean you should stop taking it but definitely discuss with your doctor.
As to the process of reducing your dose, I used to just cut my 60 mg fast acing tabs in halves or quarters , depending on the dosage I wanted, using a pill cutter.
Which diet are you on? I've been on the FODMAP diet which helps, but in spite of it, my episodes became more frequent and longer, which can often be the progression of afib no matter how careful you are with diet and lifestyle.
After qualifying with a nuclear stress test, I was recently put on a class 1c antiarrhythmic, Flecainide, 50mg, twice daily, with instructions to take more should I go into afib.
Seems to be working, but then again more drugs to tolerate, as it needs to be taken with either a calcium channel blocker like diltiazem, or a beta blocker -- not for their antiarrhythmic properties, but to protect the AV node while taking Flecainide.
Apart from the last few weeks before my post ablation EP review I only ever took diltiazem as rate control with Flecainide as anti arrhythmic. ( I stopped flecainide a few weeks befire the review, presumably so my EP coukd establish whether I went back into AFib before the meeting).
Its 4 years since the ablation I gave up the drugs May 15 2018.I had to take flecainide all the time because I was always high rate afib, and initially I could come out of afib spontaneously or with a bit if hospital assistance in 24 to 36 hours then on my 3rd attack I discovered if I went running when I got Afib 8 to 10 minutes later I cardioverted. However on my 12th attack that did not work, and neither did anything the hospital did, so i was 8 days in afib, 5 of them in hospital at 165 to 195 resting. I was eventually cardioverted in the hospital CCU with intravenous flecainide. So the doctors said I had to take flecainide daily NOT AS A PIP, as they said I was too difficult to cardiovert. Consequently I had to take diltiazem daily to control the flecainide. Eventually it failed to do that. 9 days after my afib ablation I developed reentrant atrial flutter , which was new to me. The Diltiazem controlled the rate at 140 bpm. As I had no evidence of flutter previously my EP advised it was promoted by the flecainide. Very bad timing as if the flutter had developed 10 days earlier they could have sorted it with the Afib ablation .As it was I had a second ablation one month after the first to get shut of the flutter.
Good question. On Diltiazam as rate control and to lower BP.Diltiazam not as effective in either case as a beta blocker but I simply couldn’t tolerate the beta blockers.
Diet, basically FODMAP.
I know I am likely looking at an anti arrhythmic and/or ablation in the future ( maybe sooner rather than later) ; I just am not mentally prepared for either as I am kind of new to AF ( although have had ectopics- PVC’s/PAC’s over the past 2-3 years.
Why did you need rate control when you were not in a fib? Or maybe I misunderstood you.
Before I started flecainide, I only used dilitiazem for rate control when I went into afib. Then I stopped the diltiazem when I converted to NSR.
Everyone is different, but it generally took between 60-120mg of diltiazem fast tabs to bring my resting hr below 100. But my moving around (ambulatory) HR was still high. I found that a little bit of a beta blocker (6.25 mg metoprolol tartrate) would bring down my ambulatory rate, so I could go about my daily business until I converted. That is only one quarter of a tab but I guess I'm pretty sensitive to the drug.
Your situation is very interesting and one I’ll discuss with the doc.I do have paroxysmal A- fib along with hypertension. So the Diltiazam was to lower BP and control rate when in A-fib.
My BP seems to be better after some weight loss thus the attempt to get off Diltiazam and to use more as a PIP when in AFIB which you mentioned.
Do you take Flec as PIP or daily?
I would like to avoid anti arrhythmic if possible.
Curious: did a cardiologist or EP prescribe your meds?
So then you were on diltiazem all the time, whether in afib or not. I understand that many doctors do this but my ep was ok with me just using diltiazem as a pill in the pocket (PIP) when I went into afib. This made my quality of life a lot better because I did not have to deal with the side effects of diltiazem except when in afib, which happened at first once every few years, then it was every few months.
It went something like this.
When I went into afib, depending on my heart rate, I would take either 30 or 60mg of fast acting diltiazem tabs. Wait an hour or two and then take more if my resting HR was still above 100. Once my HR was stabalized I would take another 30mg or so every 6-8 hours to maintain the rate. The maximum 24 hour dose I was allowed was 480mg but I rarely got to even half of that. For me, the diltiazem was very effective in getting my resting rate under control, but I needed a small dose of beta blocker to get my ambulatory (moving around) HR under control. Then as soon as I went into NSR (usually between 6 hours and 3 days) I stopped the diltiazem and beta blocker.
During that period, I also took a blood thinner only at the onset of an episode, and discontinued when I returned to NSR. I understand that thinners-when-needed is a controversial approach here, but my ep allowed it, and I am certainly not suggesting it to anyone. You speak to your doctor, look at the stroke odds vs the downsides of a thinner and make up your own mind. Currently I'm on thinners every day, afib or not, because my afib frequency increased plus I'm on daily flecainide.
Once my episodes started happening weekly, and extending as long as 14 days, I realized that the Diltiazem PIP approach was no longer working. At that point I went on daily Flecanide, and have been for the last five weeks. The jury isn't in yet on how long I'll stay on it but my guess is that it will be an intermediate step and eventually I'll have an ablation. But certainly better being in afib for 30-90 minutes with the flecainide versus 3-14 days without it. On the other hand, I have to take 120mg of slow release diltiazem every day as a nodal blocker, and I do have side effects from the diltiazem I'm trying to adjust to.
Specific to your question, everything I did was a shared decision between me and my doctors. There was some experimentation with dosage, and drug combinations on my part, but they were in the loop. So you really need a very good cardio or ep who believes in shared decision making, or you will just get cookie cutter treatment, which may or may not work best for everyone.
Like yourself, I also wanted to avoid daily anti arrhythmics, but when I started going into afib every week with episodes lasting days, it made the most sense. It was either staying in afib with rate control, which at some point might become permanent, having an ablation which I wasn't ready for, or going my current route.
You mentioned diltiazem for blood pressure. It might work for some, but there are much better calcium channel blockers for blood pressure without the side effects. Amlodipine for example. And then of course there are other classes of bp meds like the ace inhibitors.
You also mentioned losing weight. How overweight were/are you? Some studies suggest losing 10% of your weight alone can significantly lower the incidence of afib. I'm trying to lose another 5 pounds myself to put me in that zone. Once I get there, I might try reducingmy Flecainide dose, or even using it as PIP alone (not daily) but at this point of the journey, I'm probably deceiving myself that I could go off daily flecainide and not pop right back into afib. lol
Such a great post! Thank you for taking the time to explain your journey.I have lost 10% of my weight but ideally I would like to lose 10- 15 more.
I am fortunate that my cardiologist believes in shared decision making . I realize I need to do more research on the topic to better present my needs/views.
He defines himself as more conservative towards ablation than his younger EP partners but will refer to an EP whenever I’m ready or when my A-fib episodes increase or become more problematic
Glad it was helpful. If you have more weight to lose, as long as it won't put you underweight, I think that would be your most important next step. Curious, what country are you in? I'm in the U.S.
I was on 180 mg diltiazem ER daily. I walked into my ablation and haven't taken a single dose since. That was over two years ago. No side effects from quitting cold turkey.
Thank you. Doing great. I was diagnosed with AF at 50. I was an otherwise fit and active women going about my business when AF struck. Docs blamed stress or heredity, as my Dad has AF and was diagnosed at age 40. Meds including diltiazem did not seem to control my AF. After about 1.5 years of being in and out of the ER and trying every med and their terrible side effects, I had had enough. I insisted on a consult for cryoablation and was found to be an excellent candidate. So glad I did it. I would do it again in a heartbeat (pun intended).
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