Hi, my first post but have been a member and avid reader of all your posts (which have been very informative) since joining in Feb 22 when diagnosed with AFib.
Question - does anyone have experience of taking Diltiazem alongside Flecainide, and if so, has that been ok in terms of QoL and side effects? I’ve been taking Flecainide for a year or so, 100mg twice daily and been fine, so am worried about the severe side effects possible for the Diltiazem.
Brief history for me - when diagnosed I was given Bisoprolol, 1.25,2.5 then 5mg, by then I’d been in AFib for 3 weeks or so before returning to NSR. Side effects worsened over time, so at my consultant appointment 3 months later it was agreed to reduce down to 2.5mg and add digoxin 125mcg. Had gone back into AFib a couple of weeks before then and took a few more before returning to NSR. Bisoprolol side effects not improved any. Couple more episodes before next appointment and changing to Flecainide. Side effects improved after that.
All well till late June 2023 when had a short AF episode. At consultant appointment end August asked to reduce Flecainide, agreed at 100mg am and 50mg evening, but he added bisoprolol back in. As expected side effects back and not easing so stopped taking and advised consultant. He then added the Diltiazem, have been putting off taking it for the past week after reading the warnings leaflet!
sorry for long post, but if you have any advice it would be much appreciated. Also is it best taken morning or evening?
Diane
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Bobbins58
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I'm assuming you are dropping the bisoprolol and now taking just Flecainide and Diltiazem?
If so, there had been a very recent thread with the identical question, but I'll paraphrase my answer here.
Flecainde and Diltiazem is a very common combination. The Diltiazem serves the same safety function as bisoprolol, acting as a nodal blocking agent.
Not crazy about the drug, however tolerate it better than bisoprolol. Things to look out for are edema (swelling) in ankles and feet and a lower exercise heart rate, but probably not as bad as when you were on bisoprolol.
Side effects are a very individual thing and yours may be different or none at all, but I wouldn't be concerned about the combination, again a very common one. So... if your doctor and pharmacist gave you the green light, I would throw that warning leaflet in the trash. Taking Flecainide without a nodal blocker would have more risks!
Thanks Jim, yes ditched the Bisoprolol. I suppose as with most of these drugs it’s a case of try it and see, I’m reassured that the combination is a tried and tested one though.
Hello Diane, I’m happy to share my own experiences but on the basis that we are all different, what happens with me maybe very different to what happens with you. After a cardioversion back in 2014, I remained in sinus rhythm for about a year before AF re-appeared. Prior to the CV I was in persistent AF, but the first episode after self reverted without any medical intervention and although I was put on the list for an ablation, the waiting period was likely to be in excess of 7 months so I was prescribed a daily maintenance dose of 2 x 50mg Flecainide which I took with Diltiazem and I was not aware of any problems. Some time after my first ablation after the maintenance dose was stopped, I had some AF episodes and my EP prescribed taking Flecainide as a PiP dose of 300 mg (maximum daily dose permitted) again without any real problems other than some slight tingling around my lips. After 2 ablations I rarely need to take Flecainide but for me, it does not cause any problems with Diltiazem, hope this helps…..
I was put on 200mgs Flecainide with no other drug at age 60 after having 2 episodes a week for a month. My cardiologist was quite sparing with explaining this regime, simply saying the usual accompanying drug would make me feel unwell.
My individual circumstances Lone PAF, active lifestyle, 115/63 BP and HR mid 50's.
So 10 yrs+ down the line and questioning him twice (last time he said 'less risk of rapid HR the older you get') I have been fine with great QOL. I do take care to have a brisk walk x2 per day of 1 mile as I feel this helps in keeping the heart beat strong.
Despite reading posts here and the occasional published study, I can't recall any reliable statistic about this situation so I guess you just have to follow your own medic's advice. I am not the only one taking just Flec but in the minority for sure.
Thanks, that’s interesting as I too was quite happy just on Flecainide and like you realised from other posts that it was a minority. However, different consultant this time, they have different views so looks like I’ll have to give the Diltiazem a try.
I was switched from bisoprolol to diltiazem for a short while a couple of years back. I only took it for a couple of days and then had a severe reaction to it with my heart rhythm and rate all over the place. I felt so ill and finished up in hospital. It's important to appreciate that I had been diagnosed with AF for a few years but had always been asymptomatic
The diltiazem was stopped and I went back to bisoprolol. I had two or three attacks with diminishing symptoms over the next month or so but, since then, I've gone back to being asymptomatic.
I should also mention that I was taking amlodipeine, another calcium channel blocker at the time and that may also have contributed.
Just to note there are 5 different brands of Diltiazem (Adizem, Angitil, Tildiem, Viazem, Zemtard) all are slightly different, your gp will prescribe one of these. When I was put on Diltiazem in 2015 it was by a cardio and he carefully chose which one because I have AF and Heart failure so had to be careful with fluid retention which Diltaizem can cause. I was given Viazem and had no problems (I was also on Biso). About 18 months ago there was a problem with Viazem production so none available, I was then given Zemtard. This was awful, I felt really unwell and fluid started to build up had to stop them after 5 days. I was then given ADizem which I tolerated but not happy on it. Went back to Viazem when available and all okay. Which brand have you been prescribed.
I have persistent AF diagnosed 12 moths ago. Was taking Bisoprolol for heart rate for 4 months and then in Feb cardiologist added Flecainide 50mg twice a day to see if it helped me cardiovert to NSR.
Bisoprolol made me feel like death so eventually cardiologist changed to Diltiazem in June as Bis dropped my BP way too low.
Also stopped Flecainide in Oct as it had zero effect on my heart rhythm, though I know for some, especially those with paroxysmal AF it can put them into normal rhythm, for me with my persistent, it did nothing .
So I am now in Diltiazem alone. Felt slightly better (than on Bisoprolol) but recently felt dreadful and had to increase my dose. All that said, as other folk have said, everyone’s individual circumstances are different, certainly entrenched, persistent AF for me seems to create lots of challenges.
I hope therefore that the combination of Flecainide and Diltiazem helps pop you back into normal rhythm. I have not experienced any swelling, but I keep very well hydrated..
Thanks, I think the Flecainide is keeping me mostly in NSR, so I’ll give the Diltiazem a go to see if it does anything. The consultant did say that it’s to prevent the one to one transference across the AV node, which I understood as helping prevent AF at lower heart rates, but I might have that wrong!
I was wondering how you went with the Flecainide and Diltiazem? I have been prescribed this combination and have been taking Sotalol which worked for about 12months but unfortunately my AFib episodes have recently come back.
I would be interested how you found the combination, has it worked and any side effects?
I seem to have settled ok with the diltiazem in addition to flecainide. No episodes at the reduced flec dosage, the difficulty I find with multiple medications is working which, if any are causing side effects and also, are they side effects or just normal! Good luck with yours.
I space my pills out like Synthoid 125mg awake 5 , 6 , 7am OR. Drink of water.
Then Diltiazem 1 hour later again no food.120mg AM for reduced H/R Day.
BB Bisoprolol 2.5 PM for BP control.
Always I drop down to 47 average at rest at night.
Just had operation which dropped out PRADAXA 110mg x twice daily.
Right shoulder repair. It's helping my right hand fingers. Hopefully I am back to knitting.
Pain under wraps.
Back to sleep. I had 2 panacetamol 500mg and 2 tramadol 50mg at 5pm and I sleep through the night.
I think the statin 10mg Avorastatin which has properties of an anti-inflammatory. effect.
No flecainide for me as I have an abnormal heart structure. Also no ablation and cardioversion after stroke with AF 4 days later a shadow on my Thyroid having a Carotid Arteries scan. Yes, Papillary Cancel which was removed 4 mth post Stroke.
Thanks, I don’t really need it for reduced heart rate day or night as I tend to be generally around 60 unless exercising or in AF, so I might have to try and see whether it works best at night or morning for me.
Hope your shoulder heals quickly and you can get back to knitting, not good when things stop your enjoyment.
I was thinking that a 30 mg Diltiazen may 'skip' you over the high H/R times.
It's interesting that I take 120mg (180mg too much) for 24 hour and yet it does not bring down the 47 average night.
When I was introduced to CCB by a new private heart specialist on 180mg Diltiazem my heart per minute by 105 within 2 hours.
Between the shock of the immediate big drop, at the Sunday I talked to our Healthline and I was to sort it out with a Dr there.
On the following Wednesday I talked a nurse at NZ Heart Foundation. She had worked with Dr Brandon Wong. A very caring Dr. I even got a Christnas Card from him last year.
I feel that careful use of a CCB is worth while trial as it saved me from sky high H/R Day of 187 bpm even though I was on Metopolol getting pauses at night. And it was rapid persistent! Looking back there was so much stress on my heart.
Problems were
1. No follow up for a person struggling with high H/R with a stroke.
2. BB did not reduce my H/R.
3. Drs would simply put up my BB meds.
4. Reducing H/R was wonderful, no more over sweating, no energy, little fatigue, walking further and less stopping. That time was no quality of life.
Do read CCBs and BBs and see their individual blocking powers.
There is research being done now on whether BBs are helpful as a first line med for AF sufferers.
I would have been better on a firstline H/R reduction which overflows a slowing down of irregular heart beat. Think of your heart beating too fast and irregular each minute of the day or AF times. Control is more important than rhythm. If I have control of H/R I. also have control of irregularity.
I would pick up a paint brush do a 5 minute paint and collapse into bed. No quality of life.
Luckily I don't feel the rapid irregular heart beat. I do have a 'bad' rib cage.
I feel that a caring heart specialist is of the most important to closely monitor you. But take your own record of events with you. Be included in any conversation.
I hope you get a balance of meds to suit your health needs.
You state not to take Diltiazem with food. I have always taken it with food and have just checked with the instructions in my pack of Viazem and it states to take with food or just before!
I'll ring the chemist as I don't get the manufacture of these Pharmac Safe bright bluey green capsules.
I know that after starting on 180mg (too high) the manufacure was changed to ACCORD because of COVID but changed back to MedSafe manufacturer. Meanwhile the 30 and 60mg meds were stopped here. I dropped 105hbm within 2 hours. I became light headed. Tweaked to 120mg AM.
I think I went online to see about 'how to take it'.
As I said Diltiazem for H/R and as night average is 47 I take it in AM 1 hour after Synthroid 125mg as I had Thyroid removed in Ca Thyroidectomy.
My Diltiazem 120mg is manufactured by CLINECH an my Chemist who is also a herbalist says no to food with Diltiazem.
After Diltiazem it reads HCL CD. Hydrochoride Acid and Controlled Dose. I've asked her to put expiry date on my 3month supply. She said why (bought in bulk I guess), I said because I am the client.
When I gave in my pills at the Private Hospital they said that Atorastatin was out of date as well as PolyGel.
Hi. Have been on Adizem XL 120 for 8 years since diagnosis of PAF, two ablations and a DC cardioversion later I’m now up to 300mg Adizem daily. Just started (3 weeks ago) flecainide, no adverse reactions so far and my heart feels more stable, less bouncy and fluttery. Was on bisoprolol initially, but it was the spawn of the devil and made me feel like a zombie, so am now on a isosorbide monocitrate (Elantan LA 25) which seems to stop the micro angina. Plus Dilitazem and paracetamol. Oh yes, any asthma medication as well. I rattle on bumpy roads…………
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