diltiazem mr 60mg as a pip ?

[Lenlec]

Can diltiazem modified release tablets be used as a pip ?

[BobD Volunteer]

Not generally. It is not a rhythm control drug after all and calcium channel blockers are normally taken on a regular basis.

[Lenlec in reply to BobD]

Cheers bob. I need to ask if I can go back on bisoprolol then as a pip.

[BobD Volunteer in reply to Lenlec]

IMHO using anything but rhythm control drugs (flecainde, propafanone etc.) as PIP is counter productive but your choice.

[Lenlec in reply to BobD]

What’s your reasoning behind this bob ?

[BobD Volunteer in reply to Lenlec]

By keeping you heart calm you may avoid too many events or at least minimise them. beta blockers are not normally used as pip. .

[Cavalierrubie in reply to Lenlec]

I have Bisoprolol as a pip and it works for me. I have been to A/E on occasions with AF and they have given me Bisoprolol. My GP told me to use it as a pip. I start with 1.5 and then if it doesn’t subside within 30 minutes or so l up it to 2.5 This is what l am told to do and it works for me.

[valthomas15 in reply to Cavalierrubie]

And me

[Fibber222 in reply to Cavalierrubie]

I was told the same for Sotolol when I had paroxsysmal AF

[Cumbremar5 in reply to Cavalierrubie]

Me too bisoprodol 1.5 as a pip when heart rate is over 100 bpm what my doc advised.

[pusillanimous in reply to Cumbremar5]

Me too , approved by Cardio and not queried by pharmacist dispensing the prescription

[Chrissy7 in reply to BobD]

I was told I “could try” using diltiazem 30 mg as PIP but too small a dose to work effectively and was told usually a larger dose (like I was given once by IV in Emerg here for cardioversion) is necessary to stop an episode of AF.

… so can try and if its not a “big” episode coming it has helped me at times….but I choose to take it regularly now to prevent issues.

Btw it was suggested a couple of times that i add Flecianide for rythm control but I chose to stick with low dose Diltiazem and it works for me.

Question: is there a reason why you dont want to take it full time? It has few if any side effects for most of us taking it…

I was adverse to the idea at first as I dont like drugs and did awful on beta blockers - but people on here convinced me they have taken much larger doses for a much longer time without side effects…

So I just take it now….even after ablation as Im still in the blanking (healing) period.

[Buffafly]

I used diltiazem 60 as a pip for a while when I was already on 120mg and I took the extra during an episode of AF to keep my heart rate down. But my GP didn’t like that and said I must take 180 regularly instead and I couldn’t very well argue. I think meds such as bisoprolol and diltiazem take a while to work up to full effectiveness, bisoprolol definitely does and it’s inadvisable to stop it suddenly too.

[Lenlec in reply to Buffafly]

Cheers for that. The idea of a pip surely is to work asap once taken ?

[Cavalierrubie in reply to Lenlec]

Bisoprolol works immediately for me.

[Chrissy7 in reply to Lenlec]

I was told here by doctors thst it probably wouldnt…and it didnt for me… at 30 mg.

[Chrissy7 in reply to Buffafly]

Thats interesting.., I was taken off it suddenly - all at once - following my ablation as my BP dropped… and I was ok without it for a few weeks but then AF returned …so started it again. Maybe they were not concerned as Im only on 90 mg/day - a subclinical dose - but keeps me stable.

[FraserB]

When I first started on diltiazem 120 mg extended release once a day it was for afib/flutter and it took many weeks for the diltiazem to finally kick in and now it keeps under control. I asked my cardiologist could I take an extra just in case as a pip if another afib/flutter episode happens again. He was very concerned it would lower my blood pressure way too much with possible faints and was against it.

[JOY2THEWORLD49 in reply to FraserB]

Hi

I disagree as Diltiazem only works on my H/R. It is the Bisoprolol that keeps my BP in check.

We tried to leave off Bisoprolol 2.5mg no I needed it.

We tried to leave off Diltiazem120mg no I needed it.

After a year H/R dropped again from 88-96 Day to 60s. I feel more energised with that level.

I also put up B12 to 700.

cheers JOY. 74 (NZ)

[Chrissy7 in reply to JOY2THEWORLD49]

Hi Joy must have some effect on BP as mine drops on Diltiazrm 120 mg - enough to make me too tired all the time-

Why I asked to taje 30 mg - 3 x daily and have been on that dose for over a year …at some point I may need 120 mg .. but not yet…

[JOY2THEWORLD49 in reply to Chrissy7]

Hi

With experimental times Dr noted that taking Diltiazem early morning after Symthyroid 1 hour was that it works in bringing my H/R down during the day and after exertion keeps me controlled for 12 hours. Lke 7am-7pm.

BP usually rises in morning.

But taking Bisoprolol at night doesn't bring down my H/R over Might.

It doesn't matter what meds I am on the 47 avge at night or none at all dosn't interfere wity that low H/R at night. It seems strange but I've always had cold shoulders whilst sleeping! Also bed socks if necessary.

So I stand by Diltiazem 120mg AM for controlling H/R and Bisoprolol PM for 24hr control of BP. My BP was getting up to 150/96 but taking it my BP day is 110-130/69.

I guess we are all different.

BBs stop Adreline into the heart muscles. CCBs stop calcium into heart muscles.

Could it be the person with AF being stressed ADEline or not. Both relax the heart in their different ways. I like milk but changed it to A2 milk.

We all need to experience changes in our meds until we can balance them to make the Heart Specialist happy first and followed up by Doctor.

vheri JOY

[Chrissy7 in reply to JOY2THEWORLD49]

hi Joy!

glad you found what worked for you.. when we find something that works, we stand by it! It’s interesting you mentioned that calcium channel blocker. I guess it was common sense that that’s what it does but my calcium is high to the parathyroid gland, being high and vitamin D, being low at the moment, it’s a struggle being tested by endocrinologist again soon

I join the thyroid group here and they have given me a lot of information but it’s really hard to administer it from Canada because we don’t have private clinics…

I’m trying to figure it all out.

Btw, my heart rate can go down to 47 at times but it doesn’t concern me since I’ve read on here that some people are Lower and I’ve been as low as 42 before…

[JOY2THEWORLD49 in reply to Chrissy7]

Hi again

At the time Sept 2019 my stroke type Embollic, with AF I was found to have thyroid cancer (papillary). It was removed along with 12 right lymph nodes 4 mths later and 2 were affected. Lost time could have the cancer spread down to central lymph area and beyond.

Vit D is also captured by placing mushrooms and tomatoes in the sun.

I sit outside (our winter) in the moening off and on for 20mins.

Vit D breaks down the calcium for absorption.

I finally chose Synthroid as my thyroxin as

1) Locked ane Expiry date on container.

2) The dosage dependable and reliant.

3) Kiddie lock

4) Contains a condensation item.

My instructions from surgeon and Mr Gary ....... top USA thyroid surgeon is to keep TSH @ 2.0. I adjust it to be 1.0-2.0. T4 total is high as I don't fast but take it early morning.

I learnt quickly that you can only regulate TSH and your T4 total is what it is.

I take 125mg daily and had to add another 25mg tablet twice a month. But having lost 7kg I now have to take away 25mg twice a month.

Understanding your dose means you can monitor it well.

I have a 'standing' request for my TSH test.

cheers JOY

[Chrissy7 in reply to JOY2THEWORLD49]

Thanks Joy I am learning….

[Singwell]

Following as I'm about to contact my arrhythmia nurse about 'back up strategy'. I've been off all heart meds now post ablation in 2022. Just recently weaned off the Diltiazem, which was there to counter Flecainide. My EP seemed to think it a good idea to kero the 60mg Diltiazem on hand in case I needed to use Flecainide as a PiP. I'll let you know what my nurse says.

[Lenlec]

cheers all.

[Ducky2003]

I take it full time. As its only modified release available to us, it would act too slowly to work as a pip, is my understanding. You mention going back on Bisoprolol. Just curious as to why they took you off that and put you onto Diltiazem. I had a terrible time on Bisoprolol which is why they swapped me over.

[Lenlec in reply to Ducky2003]

Bisoprolol made me feel lethargic but nothing too bad. The ep suggested diltiazem every day. I don’t want to take them every day. Just as a pip is my choice. Hope this 2nd ablation today does the job

[Ducky2003 in reply to Lenlec]

Ooh, today? Hope all goes well. I think you're under UHCW as well, aren't you? They're a great team so fingers crossed 2nd time lucky 🫰

[Eirecara in reply to Lenlec]

Best wishes for today 🍀☘️

[JOY2THEWORLD49 in reply to Ducky2003]

Hi

I take both.

Why because when Diltiazem was introduced it shot down my heart rate within 2 hours by reducing my H/R by 105 beats per minute.

Bisoprolol reduced to 2.5mg Night keeps my BP in check.

But they must be separated. Hence Diltiazem AM and Bisoprolol PM.

cheri JOY. 74. (NZ)

[Chrissy7 in reply to Ducky2003]

Same here!

[fairgo45]

I take 120mg a day of diltiazam but if I have an afib event I take another one and it works ok for me

[JOY2THEWORLD49 in reply to fairgo45]

Hi

Because 360mg is the full dose.

But 180mg too much for me. Also my H/R drops every night to 47avg. Luckily my Diltiazem covers only 12 hours.

cheers JOY. 74. (NZ)

[JOY2THEWORLD49]

Hi

As my introduction to CCB Diltiazem was 180mg AM within 2 hours my rapid heart rate dropped to 51, it should work.

But I had to change the dosage down to 120mg. It went down to 88-96 but 1 year later dropped to 60s Day and always 47. avge at night.

It was a private H/Specialist who put me on it. Adding to my reduced dose of Bisoprolol 2.5PM.

I was advised by the NZ Heart Foundation that CCB and BB must be separated.

So for me CCB AM.

BB PM.

The doctor commented that Diltiazem slow release was working only for 12 hours which is great for me as my H/R is low @ 47avge at night.

cheri JOY. 74 (NZ)

[dwright12]

My dr has me on this and I still end up in ER

[mjames1]

If you mean to bring your heart rate down fast at the onset of an episode, then you would want the fast release tabs. I used Diltiazem successfully as PIP for years to bring down my HR to safe and comfortable levels while waiting to convert. Absolutely no reason for many of us to take rate control drugs on a daily basis, be it calcium channel blockers or beta blockers. If the fast release tabs are not available in your country, ask your doctor or pharmacist for alternative fast acting rate control drugs.

Jim