Cardiologist has offered diltiazem vs metoprolol upon my asking for a possible better result. Have read posts on forum about side effects, effectiveness, etc. But have following question.
Reported possible side effects that are most concerning for me are fluid retention and edema (swelling ankles/feet). Anyone experienced ?
Any info/advice is appreciated !
Some of us can't take calcium channel blockers due to oedema . That is true. AF means trying lots of diffrent things before you find the right balance. We are all different.
I’ve taken 120 mg for years and it has never been a problem for me and we don’t get many posts from members about it either. Some have said the swelling subsides when you raise your feet so if it becomes a problem, maybe try taking it in the evening before you go to bed. Obviously drugs effect different people in different ways, but I changed to Diltiazem from Bisoprolol and am very pleased that I did……..
Hi Flapjack
I take120mg Diltiazem. 360mg is the normal dose am with Bisoprolol pm.
I would never take it at night as my hbeat average per night is 48.
This is important when I take it. First 2 hours brings down h.rate drastically and is wise to monitor as one starts on it.
I started changed meds at weekend day Saturday. Surprisingly my private specialist put in his reort that I could have the dosage of Diltiazem increased from 180mg to 360mg!
Imagine what that dosage would have done to me.
cheers JOY. 73yr. NZ
In NZ Diltiazem is only available in 120mg and 180mg in the smaller doses.
Different in UK. It's a modified release tablet, lowest dose 60mg. I take 240mg per day, 120mg am and 12mg pm.
I have been on Diltazem for 7 years 180mg slow release and have had no problems. I was prescribed it because I had been on Digoxin and had to come off this because of side effects. A year before I had been diagnosed with heart failure and AF so fluid retention was one of my problems. When I was prescribed Diltiazem (my HF problems were under control) the doctor did mention about fluid retention when taking Diltiazem but decided to go ahead and see what happened. It caused no problems with fluid retention so have remained on it.So you can only take it and if it does cause you to retain fluid, stop and find another medication.
Cassie
I don’t notice anything with feet and legs but I can’t get my rings on .. snd I think it’s due to diltiazem …
Ankle oedema is a common, often troublesome adverse effect for patients who are receiving calcium channel blocker (CCB) therapy. its treatment with diuretic is not effective as it is due to changes in capillary pressure leading to leakage into interstitial areas, rather than due to water retention. Adding anangiotensin II receptor blocker (ARB)in addition to usage of compression stockings helps to reduce swelling considerablly.Am taking 180 mg Dilzem in combo with 4 mg of Atacand( ARB)/day and already have good results. Warning: you have to talk to your doctor before taking this combo to make sure that your blood pressure does not go down too much.
I take Diltiazem and though I have had episodes of swollen ankles they were generally a result of being overtired or hot weather. Also get cold feet when sitting but compression stockings/cuddly boot slippers help and it encourages one to get up and move around regularly. I feel it’s a small price to pay as it’s very effective for me and even better with a bp med added recently. I had a surgical tooth extraction two weeks ago and it went horribly wrong afterwards, now on very strong antibiotics. I expected to go into AF any minute but not a flicker 💖
I do better on diltiazem than on beta blockers, including metoprolol and have not had fluid retention and edema. But we all react differently to these drugs.
Jim
I have taken Diltiazen 120 mg's once a day for about 10 years and I have never had any swelling ever...........I was reluctant to go on any drugs so my cardiologist prescribed for rate not rhythm and I also take pradaxa .........no side effects from that either
I've also been on diltiazam for years 120mg a day no problem with swelling and until about 6 months ago I was also on metoprolol but my heart rate slowed right down into the 30s so i stopped that and my heart rate soon went back into 60s .I suppose we're all Guinea pigs up to a point but in my case I'm better off without Metoprolol if I have any afib episodes I just take an extra diltiazam with cardiologist approvement of course
No issues with oedema for me. Initially on 200mg slow release I had problems occasionally with sudden BP drops. This would be after a long AF episode. I'm now on 120 and doing better. I'm planning to switch to normal release 60mg twice a day. Others who've had similar issues reported an improvement after switching to the normal release. Apparently 2 aspects of prolonged release are: it uploads and then peaks after about 3 hours - which can cause a spike in its impact - and its 'half life' is longer - so effects take longer to die away. Had this info from my EP.
Hi
Please not understanding what your ES said.
I had a rapid, persistent AF day Metropolol 186, changed to Bisoprolol 156 still uncontrolled.
started on Diltriazem 180mg a.m and Bisoprolol 7.5 a.m and 2.5 pm.
With drastic drop in pulse with assistance from Healthline doctor at week day told me to reduce Bisoprolol as I dropped 100bpm.
Then drop again on wednesday so I talked to Heart Foundation to a nurse. She knew Cardiac Specialist and rung him re dropping my dosage to 120mg. The nurse asked me to separate the Bisoprolol and have it at night.
So I ended up with 120mg Diltriazem a.m and 2.5mg Bisoprolol at p.m
BEST.
My Diltiazem 120mg slow release works within 2 hours.
As my pulse at night drops to 48.
Now day avge is 77 with a BP 123/72.
cheers JOY
So that's working well for you. Shows we're all doesn't it? The thrust of what my EP said is that the impact of the drug is slightly different between the prolonged release and normal. That's all. In my case that was problematic after a long run of AF.
I was told only modified release were available in the UK outside hospital 🤔.
We are all different with meds, the only way is to try it. I did not suffer with swelling of feet/ ankles. I was on it for ten months.
My legs have been swelling up for awhile now but I never thought it could be the diltiazem until I started reading the side effects. Dr told me to wear compression socks which have help a lot. I do a test on my veins just to make sure it is t that and it is the meds.
I have taken Adizem slow release 120 mg for 5 years and not had any side effects I am aware of.
Hello mav7 I originally was on bisoprolol but didn't get on with that, also I carry an epipen and it is also unsuitable for that drug , so changed to diltiazam maybe 4-5 years ago, had no problems at all since, I also take daily small 50mg dose of flecainide. Apart from very occasional blip, it's kept everything under control (so far). Best of luck
Also switched to Diltiazem, no side effects,great QOL.Are u on any other meds for any other conditions?
My wife gets occasional swollen ankles and swollen hands, but chalks it up to her diabetes meds.
HiI have had Diliazem 120mg since December in a.m. and Bisoprolol 2.5 p.m
No oedema on a regular basis.
Had ankles up as I drove for 5 plus hrs from my place in NZ to Auckland.
Raised feet at night.
Ankles went down in 4 days.
Drink plenty and raise as necessary.
I had 'lightheadedness' problems with 180mg Diliazem as within 2 hours my average daily rate plummeted from 156 (on Bisoprolol uncontrolled) to 51.
I was immediately prescibed 120mg.
Controlled my rapid persistent AF is now 77 day 48 night with blood pressure 123/72.
If you want control try the Diliazem 120mg is my suggestion. Mine has not been changed since December 2021.
On Metoprolol which I was given first in hospital after a stroke. did not control @ 186bpm day! This drug made me breathless, tired with no energy to do anything by exertion.
The stroke was caused by AF which was caused by Thyroid papillary cancer. Removal of thyroid and 12 lymph nodes (2 were affected ) 4 months later. Lots of arguments about waiting 6 months.
Take care,
JOY 73. NZ
I had many negative side effects on Metoprolol and asked for something different for two months. New cardiologist ( don't always see same doctors at VA,) and he suggested I try diltiazem, 120 mg, once a day. The next day I felt better. I didn't feel completely lethargic. The Dizziness took a few days to go away, and my heart rate was better controlled.
I am quite happy with the move to Diltiazem.
My blood pressure is not as low on it, but I am able to function on it better. I can walk across the room without getting out of breath.
Thank you for writing what you did it sounds like you were having issues that I do being breathless walking across the room I never thought about metropolol and my doctor did not mention any drug issues that he thought might be causing problems. I am having an echocardiogram done tomorrow because they think I have fluid around my heart but if that’s not the case I will now ask him about metropolol and the side effects. I never had problems though until my procedure two months ago wow I can’t believe and saying two months ago 😱
I had an echocardiogram Monday and spoke with PN last night. She wants the doctor to go through the results but thought that it looked good. The problem is I still feel so unwell especially the breathing. So last night she took me off Metropolol The only thing I am still on is the blood thinner. She said if I should happen to have a breakthrough event use Multaq though my doctor had removed me from that on Monday the sixth. I told her I have been hearing about metropolol and I’m glad she’s taking me off of it to see if it is creating more problems than helping. I wonder, if you have an ablation that is successful can these meds cause you to feel unwell because you no longer need them? Today will be my first day trying less so I will let y’all know how it works. We all know about side effects maybe we need to pay more attention once we have a procedure. As I mentioned previously I had the vein of Marshall ablation and my doctor is actually the pioneer of the latest procedure of it. I feel good about him I have faith and it is worth taking the chance to possibly be off meds and get a break from a fib 😊
Hi Dawn
May I ask is your AFib paroxysmal or persistent and was the ablation successful ?
And the metoprolol was just to keep you in NSR ? What is your current heart rate ?
Sorry for the interrogation. 
I am on metoprolol for persistent AFib and considering other medications/procedures.
Hi. It was persistent and also flutter on top of that. I had been on, Metropolol and my blood thinner since diagnosed. They put me on amiodarone after my first ablation and I did not handle it well with constant rash and sickness that made me spend most of my time curled up in a ball but I had to stay on it at least four months. My doctor actually took me off at a little less than the four months and put me on Multaq. It has been 2 years I have to say my meds did not bother me. I had a second ablation the first was cryo-only lasted six months the second was RF and lasted 15 Months. remained on the same meds without problems until this past fall. I began getting a fib again and then got hit with Covid this Spring which I believe made things much worse. I have been barely able to shuffle let alone walk and have had crushing pain in my chest and breathlessness. I could not even stand to wash dishes for any length of time. I had my third procedure two months ago. This one was more aggressive in fact my doctor is a pioneer of it it is called the vein of Marshall. It had three entries and they use ethanol. You can look it up and see his name Dr. Valderrabano. The first week I thought I felt good and then once I got active or tried everything came back again or so I thought.
I saw Dr. V on the sixth and discovered I am NSR and he was thrilled. I was not because I still have the same issues and could barely make it from my car to his office. So the procedure has been a success at least for now and it is a long haul not a short term fix. It could take six months to a year normally however he took me off of Multaq and ordered an echo. He thought I might have fluid or inflammation. I just spoke with his PN last night she has removed me from metropolol immediately. Without committing to anything about the medication it was clear I was to get off it. Which kind of supports what I have been reading here from people. Today will be my first day without it. I also have to pick up an anti-inflammatory. She is waiting for the doctor to read the results to make sure she did not miss anything because she is baffled with all of my symptoms still. I need to go get a full panel blood work up Monday. I have a funny feeling this is all going to go back to Covid and inflammation
I can tell that my heart is quiet so I believe the procedure was successful and I have a copy of my EKG from the day I was with the doctor. It appears what’s going on now is separate from a fib.
Sorry for the novel in answer to your interrogation LOL questions are not interrogation and I am trying to completely answer you to show you my path. I had been told originally that six months to a year I could be off all medication. It is happening sooner which could be a great thing. We all know every medicine has a side effect some seem worse than the actual illness.
Please let me know how you are handling yours let all of us know so we can share and at least put ideas in our mind of things to ask our doctors. We are all different as you know but thanks to people here I was persistent to try to get answers and still working on it. Hopefully it’s as simple as coming off Metropolol
Actually, I’m on both, was on Diltizam for quite a while, the Dr added metaprolol, not sure why. Anyway, have had no swelling or other issues from Diltizam, but I believe Metaprolol has caused me to gain weight, especially belly fat. When I asked about it, (2) doctors said that was not the cause🫤
Metoprolol is listed as side effect causing weight gain which I have experienced. However, exercise has been reduced.
I started on Metoprolol May 2021, I gained 24 pounds, and after I had my Ablation, I asked the doctor to take me off the Metoprolol, but he said not yet, on Drug.com, Metoprolol interactive with each and every medication I was taking all moderate except for one it was major. I just went to my cardiologist a few days ago and took another EKG. Looked at it tell me the same as last time, which is good as far as I'm concerned. He doesn't like the results but he knows there's nothing could be done about it without a heart transplant.But I was happy to get off Metoprolol. Hopefully I could start losing some weight?
But it's so easy to put on and so hard to take off. QUAYCONG
Side effects are things that might happen, not things that will happen. While someone else may experience adverse effects, that does not mean that you will. I would take the med, and if any adverse effects happened, call doc and ask to switch to different med.
Not for me, no side effects. It’s been life changing for me. I was a zombie on Metoprolol. Now I feel like myself again. If you do start retaining water add apple cider vinegar into your diet. It’s a very effective diuretic. Mix with water, 2-4 tablespoons daily.
I’m on Diltiazem 60mg morning and evening as my resting rate is too low for beta blockers (35-45 at night, 45-50 in the day). No problems at all.
I hate metopolol. I took it & couldn’t function at all. I’m on Diltiazem now, been months with Hydrochlorocide; still not 100%, need further care but at least I can take the dog for short walks. Long ones make me breathless; I moved to West Coast of US, one reason was to get better care than in the East & I see Diltiazem & Hydrochlorocide as bandaid measure but I’ll never take Metopolol. We need to remember every body can respond differently.
I take 360mg Diltiazem every morning. No major issues. Occasional ankle swelling, but I also have lupus, which causes that for too, sometimes. Good luck with your decision!
Certainly appreciate everyone's answers - very helpful !
I take 180 extended release diltiazem and have never had an issue with fluid retention or swollen feet and ankles. I couldn't tolerate beta blockers (made me feel exhausted at any exertion), but love my diltiazem!
Diltiazim was prescribed to me when I go into afib I should take a 120mg capsule but after about a year I realized it did nothing for me except lower my heart rate which is already low at 50bpm, so an emergency room Dr. told me to stop taking it. Now my heart rate is 50-55bpm constantly and once in a while drops in the 49 range. I notice when in afib and monitering my heart rate it drops down for a second to 44-43 but then goes back up. If I were still taking diltiazim who knows how much lower it would go. I personally do not like it but the main thing is to let the Dr. tell you what he thinks and then go from there and monitor so you'll know how it affects you. Good Luck
I have been on both at different times. The metoprolol works far better for me. Both lowered my pulse rate adequately, but the Diltiazem caused extreme swelling in my feet, and general bloating elsewhere, to the point of malaise. Definitely not for me. No such problems with the Metoprolol. My doctor said preference for one or the other was common.
Hi. I have been on metropolol for the past two years since day one and have had no issues. Of course everyone is different it’s some thing you have to watch for. Best of luck
Looks as though you've received enough answers, but I'll add mine:
I was prescribed between 120 and 240 mgs of diltiazem a day depending on symptoms, but it appears that my ablation has been successful for now. But I'm still taking 120 mg. until the doc. tells me to stop.
I've noticed no issues with fluid retention or swelling legs and feet. My girlfriend pays a lot more attention to my legs than I do and she thinks they've stayed the same size and gotten more defined with our running schedule, so I probably haven't experienced the side effects you mentioned. For me, diltiazem has been one of the least problematic medications that any doc has ever prescribed.
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