Diltiazem as a PIP

[Staffsgirl]

I don’t easily tolerate medications and have tried a number of BBs and CCIs as well as Digoxin. In some sort of desperation I’m trying Diltiazem again, but I’m not enjoying the side-effects. Wondering whether anyone uses it as a PIP? I’d welcome thoughts.

[mjames1]

Yes, I've used Diltiazem both as PIP and daily. I've used both the fast acting tabs and the time release tablets.

When I used it as PIP, by definition, I only took it when an afib episode started and continued taking it at set intervals until my heart rate came down to around 90-100. Then I went about my daily business until I naturally converted which was usually within 12-48 hours. My HR usually came down 90-100 within 12 hours, so I would continue taking the Diltiazem at set intervals to keep it there. Here, I used the fast release tabs which are best to use as PIP. As to side effects, since I was in afib a lot of the time, I hardly noticed the Diltiazem at all, because it was in part masked by the afib symptons.

Later on, I tried it on a daily basis, both to see if it would help with my ectopics which triggerd my aflutter and later still as a nodal blocker when I took Flecainide.

Initially, I felt side effects, but gradually they more or less went away although I developed edema (swelling) in the feet and ankles, which is common with calcium channel blockers. I seemed to have more side effects with the time release, so I switched to the fast acting tabs, even though that meant I had to take them 4 times a day.

Jim

[Staffsgirl in reply to mjames1]

Thanks for your helpful response. I really don’t like these side effects, but it’s a balancing act, isn’t it? I’ve now taken it for only two consecutive nights, and considering giving up! I only have slow release…maybe I should look into fast acting ones.

[mjames1 in reply to Staffsgirl]

You mentioned "PIP", so I assume you're in afib right now? If so, for how long? And what is your heart rate?

Jim

[Staffsgirl in reply to mjames1]

Not right now. Just trying to plan ahead! I hate all these medications and their side effects.

[mjames1 in reply to Staffsgirl]

So we're talking about two different things then.

Using Diltiazem as PIP is different from using it daily. As mentioned, when you use Diltiazem as PIP, you use the fast acting tabs and only when you go into afib.

For example, my PIP protocol was to take "x" mg of Diltiazem as soon as I went into afib. Then I would continue taking "x" mg every couple of hours until my HR got to 90-100.

The reason I probably didn't feel the side effects, is because they were so mixed up with the side effects of being in afib. And by lowering my rate they decreased the overall side effects.

What you're doing is entirely different using the time release when you're not in afib. Apples and oranges. So I don't think you can say that just because you don't like the time release on a daily basis when you're not in afib, that means you won't tolerate the fast tabs when in afib.

So you and your doctor have to decide, do you want to use Diltiazem as PIP only? On a daily basis? Or do you want to use it both as PIP and on a daily basis? It can be used all three ways.

But personally, unless the daily Diltiazem reduces your afib burden, I'd just use it as PIP. Of course, you need your doctor on board with any medication change. Are you seeing an ep or cardiologist?

Jim

[Staffsgirl in reply to mjames1]

Yes , I am simply thinking and planning ahead. As you say, apples and pears! I’m far keener on PIP than every day. A few years ago I used Bisoprolol: tried both ways, but still horrid side effects. The AF symptoms are now looming much larger, so I’m looking for some relief from them.

[mjames1 in reply to Staffsgirl]

A lot depends on your afib frequency. When I used Diltiazem as PIP, I had no more than one episode every 4-6 months. So even if side effects, they were only for a day or two, 2-3 times a year. If I had taken it daily, the side effects would be every day.

But again, the body tends to adjust to taking it daily. Like yourself, I never tolerated beta blockers like Bisoprolol and did tolerate Diltiazem better. But none of these drugs are without risks, so they should only be used under your doctor's supervision.

As to your "AF symptons...looming much larger" -- do you mean the frequency and duration of your episodes are increasing? If that's the case, it might be time to speak to your doctor about either a daily anti-arrhythmic like Flecainide, or having an ablation. Once you get the Flecainide/Ablation level, best to be under the care of an electrophysiologist (ep) as they have the experience.

Jim

[Staffsgirl in reply to mjames1]

I am under EP.

[Singwell in reply to Staffsgirl]

The fast acting are not available in the UK unless supervised in a hospital. You can get 60mg in modified release form (as opposed to prolonged release) so these might work for you. I'm currently titrating off my Diltiazem which is how I know. Talk to your pharmacist about what forms and dosage are available here in the UK and then get advice from your cardiologist or EP. That said ,not everyone gets on with Diltiazem and - as a matter of fact - I had awful withdrawal symptoms to begin with. Improved now. Sounds like you too are sensitive to pharmacological substances.

[Staffsgirl in reply to Singwell]

I am!

[mjames1 in reply to Singwell]

Hi. Please see my last post in this thread which hopefully clears things up. While I have no basis to dispute your claim, I don't see any logic in it. I am talking about Diltiazem HCL tabs, per the link I prescribed in the that post. In the US, they are freely prescribed. Dilitiazem is administered via IV in hospitals and perhaps that is what you are referring to, or some other drug?

Jim

[BorzoiGalgo in reply to Singwell]

How are the modified release labeled as compared to the prolonged release?

[Singwell in reply to BorzoiGalgo]

Hard to tell honestly because I'm titrating downwards. I understood from a cardiologist that the 'prolonged release' form have a rise time that peaks around 2 hours in. You can get a strong effect when that happens if your dose is high. Combine it with other factors e.g. you've had a prolonged AF event and your BP is dropping anyway, or you've just got off a long flight, or you're very hot and - in my case- boom into a BP hypo. Not my favourite drug by any means and it took me several hypo events to have someone work this out and change my dose. Not saying everyone responds like this.

[Spiritji]

I have permanent afib so do not have episodes.........I have been taking Diltiazem 120 mg once a day in the morning (plus the blood thinner Pradaxa) for about 10 years and I don't any side effects........my cardiologist knew I was reluctant to take any drug so he gave me this combo which seems to work well.........

[Staffsgirl in reply to Spiritji]

Thanks

[Lenlec]

I use the slow release ones

[Staffsgirl in reply to Lenlec]

As a PIP?

[Lenlec]

no 50mg twice a day. I didn’t even know about quick or slow release tbh

[Catnut]

I use it as a PIP, and find it benefits me, the only side effect I get is tiredness.

My doctor advised that I take the lowest dose of 60mg, and to half the tablet to make a 30mg dose instead if necessary, it does work for me!

[Staffsgirl]

Thanks

[JefferyW]

I use 120mg prolonged release as a PIP - and find it effective on the mercifully few occasions I’ve had to use it. My only noticeable side effect is fatigue for 24hrs - everything else is masked by the symptoms of Afib. It seems to work for me and I normally am restored to NSR within a couple of hours. My Arrythmia nurse said it’s better at controlling rate rather than rythmn but is a good alternative to beta blockers which I couldn’t tolerate.

Regards

Jeff

[Staffsgirl in reply to JefferyW]

Thanks

[Ducky2003]

As already mentioned, if you're in the UK, you will only get modified release tablets which would not work as a pip. Sorry if I missed it but what are your side effects? When I first started taking it about 7 years ago, I did have some puffy ankles for a while but that settled .

[Staffsgirl in reply to Ducky2003]

Side effects…breathless, blurred vision, leg and foot pains, cold extremities!

[Ducky2003 in reply to Staffsgirl]

Blimey. Have never had anything like that and I'm on 240mg per day. Only real issues I've had med wise was with Bisoprolol.I hope these subside or you find something that suits you better.

[Dorchen]

My EP put me on Diltiazem instead of Bisoprolol and Dixogin , it has been a miracle , the last two years on B and D were dreadful. Dizziness , brain fog, breathlessness ,anxiety , inertia , depression all gone. This AFib is different for each patient as half the the time it’s side effects from Meds or AF, some side effects we have to live with I guess

I’m in the UK and it is still not as good over here as the US with their understanding and treatment options

[Ppiman]

I used to take bisoprolol as needed but my cardiologist did say that as it takes an hour or more to have any effect, but I still found it worked. I imagine diltiazem would be similarly useful for that use?

Steve

[JOY2THEWORLD49]

Hi

Introduction to Diltiazem 180mg by a Heart Specialist Private reduced my H/R by 105!

I was slightly light headed.

It was twinked down to 120mg. I am fine with that AM

Bisoprolol 2.5mg PM for BP.

Now controlled 123/69. 60s H/R Day. Always 47 avge H/R Night.

You don't say how much Diltiazem... and what is your H/R and BP?

cheers JOY. 74. (NZ)

[JOY2THEWORLD49]

Hi again

Looking up Digoxin it has side effects nausea, somach upset and light headed and dizziness. A very old med.

It cold be you need to reduce it.

cheri Joy 74. (NZ)

Diltiazem's normal dose is 360mg but just 120mg suits me and controls H/R.

[Staffsgirl in reply to JOY2THEWORLD49]

I don’t take digoxin. Although was prescribed it by EP, it didn’t suit me. Have recently tried 120 mg diltiazem again.

[JOY2THEWORLD49 in reply to Staffsgirl]

Hi

And how was it?

Your H/R usually falls while asllep. Mine to avge 47 (on monitor) soI take my Dltiazem AM.

Dr says mine wears off within 12 hours which is good for my low H/R night.

cheers JOY. 74. (NZ)

[mjames1]

There has been some confusion stated here regarding what I call "Diltiazem fast acting tabs" and whether they are, or are not available in the UK for use out of the hospital.

The confusion is understandable because in the US alone, there are eight brands of the drug with different names and six different dosage forums. They do not make it easy with this particular drug

What I am referring to is called simply Diltiazem HCL tabs and here is a link to some of the different formulations.

dailymed.nlm.nih.gov/dailym...

In the US, this tab comes in 30mg, 60mg and higher formulations. Because it's fast acting, it also leaves the system fast, therefore it's the recommended formulation for PIP at least in the US. And because it comes and goes fast, it's usually dosed every 6 hours although sometimes dosed every 12 hours.

On the other hand, there are various other slower release formulations, by various other names that are usually dosed just once every 24 hours. This convenient dosing is more suited for those taking it on a daily basis as opposed to as a PIP.

Of course, the correct formulation for you, should be decided by your doctor, who best knows you needs. PIP Diltiazem a well as the slower release forms, may not be suitable for everyone.

Jim

[Ducky2003 in reply to mjames1]

I'm not sure what country the website above is based in but I have previously asked, my GP, EP and pharmacist about a non modified release version and all advised that there is none in the UK for general prescribing. Mine is the Hcl version but still slow release. 😊

[mjames1 in reply to Ducky2003]

It was not UK specific. I did find a UK site that talked about "standard" and "slow release" tabs. I cannot say for sure whether the standard tabs or the same as the immediate/fast release tabs avail in the US. A UK pharmacist would be the bedt resource on that. Can't seem to paste the specific URL for some reason but site was

nhs.uk

Then put "diltiazem hcl" in search bar. Then go to section "how and when to take". Then "dosage" section.

Jim