Diltiazem with Apixaban

[FraserB]

Because of afib/flutter diagnosis I've been prescribed diltiazem (rate) and apixaban (stroke). The last 6 months I've been having stomach pain (comes and goes) and every month I get a subconjunctival eye hemmorrage (without pain). I've looked at my diet and lifestyle and nothing different. When renewing my latest prescription the pharmacist told me something neither doctor nor cardiologist mentioned and said to have my GP monitor if any unusual bleeding. He said diltiazem is an inhibitor of CYP3A4 which may increase blood levels of apixaban a potential bleeding risk. Now wondering if stomach pains and eyes are related? My main concern is stroke so if I can avoid this I'll be happy. Though I've now made an appointment to see GP to see what he says.

My question is had anyone had similar side effects from diltiazem and apixaban combination?

[Buffafly]

Interesting, I have read that diltiazem increases the effect of Apixaban though my GP doesn’t seem aware of it. I asked if I could take a half dose of Apixaban because I felt I was bleeding too easily and I have had stomach problems. I am well under 60kg and coming up for 80 so I thought it was reasonable but she refused, sticking by the rules, so I’ve cut my Apixaban dose down to 7.5 mg per day by taking a whole and a half tablet and I do think I’m better for it. I’ll be interested to hear what your GP says.

[FraserB in reply to Buffafly]

Thanks for your reply Buffafly. After the pharmacist mentioned the interaction I also did some reading but it's mostly coughing up blood, or tarry stools. Somehow stomach pains and broken eye blood vessels every month aren't the worst I guess, but I think it could indicate a potential for it to be building up in the system? I'll get back with what my doctor has to say but you've made a good point that they stick by the rules and do see the consequences of stroke.

[Ducky2003]

I've taken both together for about 7 years without any problems I'm aware of.My pharmacist is usually pretty good with alerting me to any potential issues, as he has with other meds, but has never mentioned anything about this combo.

[FraserB in reply to Ducky2003]

Thanks Ducky, it's good to hear you haven't had any issues with diltiazem and apixaban combination. Our of curiosity I phoned a different pharmacy and ran this by him. He mentioned some people metabolize the same drug(s) differently along with their own genetics. And he did mention to definitely see my GP about it.

[Ducky2003 in reply to FraserB]

Interesting. I may mention it to my pharmacist next time I'm in. Certainly haven't had the issues you seem to be having. Hope you get sorted. 😊.

[Ppiman]

No, but that is interesting. Thanks for posting.

Steve

[Bagrat]

Several drugs have a possibility of interacting because they are CYP3A4 inhibitors. I was put on tamoxifen and apparently that is a CYP34 inhibitor too but oncologist was happy, I had mentioned other meds. I think the instruction is "close monitoring" so a chat with GP sounds a good thing.

[Offcut]

Diltiazem was given to me some years back as it was explained it was better for me and would not stop my lung medicine being more efficient? However, I did not do well with it at all my heart rate would not go below 150 bpm and I was feeling very unwell! I was going to Hospital daily and having Intravenous Digoxin to get my heart rate down. It all came to a head when my Heart and Lung Consultants went into an office with me outside rowing not very quietly at all!

The problem did not get that much better as the Heart consultant would not take me off it and the Lung Consultant told me he will get me off it? In the end something happened and I was taken off Diltiazem. I took about a week to get to "my normal" I was at that time on Warfarin and did suffer bleeding when brushing my teeth more than any other time? I now have a marker stating I have a bad reaction to Diltiazem!

Be Well

[FraserB in reply to Offcut]

Hi Offcut, your experience with diltiazem sounds extremely difficult and it did not suit your body well. Usually diltiazem lowers the rate. Thankfully the digoxin worked to get it down but you had to go through much difficulty to get an alternative treatment.

[Debjimmay]

Hi! I have taken the same combination of medication for a couple years and have had no side effects. I’m not sure if you’re able to recommend an app on here, but I have an app called “Drugs.com”. With this app you can download all your medication and it will tell you if it will interact anything you’re taking. I love this app and use it all the time!

[Buffafly in reply to Debjimmay]

The BNF does the same thing, together with cautions about using drugs in the elderly. I’m not keen on Drugs.com because I find the site a bit alarmist, not distinguishing clearly between vanishingly rare and common.

[Debjimmay in reply to Buffafly]

Hi Buffafly. I agree with you on the Drugs.com being a bit on the alarmist side. How do I find the BNF app that you’re referring to? I tried searching for it, but I couldn’t find it. I’m in the US if that makes a difference. Thank you.

[baba in reply to Debjimmay]

I think the “British National Formulary” (BNF) is only available in Britain

[Debjimmay in reply to baba]

Oh ok. Thank you for letting me know.

[Buffafly in reply to Debjimmay]

Try this bnf.nice.org.uk/

[Bagrat in reply to Debjimmay]

I use that too. There is a uk version and us I think

[Cookie24 in reply to Debjimmay]

Yes , drugs.com is very detailed. There is both consumer and professional info. I have taken Diltiazem and Eliquis for 7 years and ok.

[FraserB in reply to Cookie24]

Good to hear diltiazem and eliquis work okay for you. I would prefer to stay on the diltiazem and apixaban. My stomach pain seems to be between meals and I'll also wake up with a lot of pain. So maybe always have a full stomach? For the last 6 months I've have had eye hemmorrage(s) --never had them before the meds. I guess I can live with it but tired of everyone I meet saying "are you feeling well"? I guess my face looks like I'm ill or someone "socked" me in the eyes. I will see if my GP can help with all this. As a family member said "better than having stroke dear". So true.

[Buffafly in reply to FraserB]

As the pain is when your stomach is empty definitely see your GP!

[Cookie24]

Other sites for drug interactions are epocrates and Medscape.

[JOY2THEWORLD49]

Hi

I take Diltiazem 120mg AM and PRADAXA late AM and late PM.

Not had any problems.

Perhaps the 1/2 dose of PRADAXA is bettder for you. From 70 years I take 110mg x 2 daily.

Take care. also PRADAXA with juice as it breaks it down quicker.

cheri JOY. 75 (NZ)