Safe interaction of meds

[Maggi79]

Hi everyone..I was prescribed apixaban and diltiazem...just checked interactions and says not to be taken together unless closely monitored which I'm not Any advice?

Thank you Maggi

[Buffafly]

Where did you read that? Diltiazem can increase the effect of Apixaban slightly but I presume the strength of dose has a bearing. All you need is your regular blood tests which you should be having while on Apixaban. I take both but I meet the criteria for a lower dose of Apixaban - 80 and under 60kg so I only take 2.5 mg twice a day.

[CDreamer]

What is meant by ‘closely monitored’ and where did you read that?

Surely you have regular blood tests? If you are concerned talk to your pharmacist at your surgery.

[FraserB]

I'm taking the same medication and I had a pharmacist tell me that depending on your diltiazem dose that it can increase the levels of apixaban in your bloodstream by affecting its metabolism. Pharmacolgy has labelled diltiazem as a moderate inhibitor (not strong) and can interact with your apixaban by slowing its breakdown with more remaining in your system. Though thankfully it's not a strong inhibitor only a moderate one and you can still take the two the same day but you'll hear the words "have your doctor closely monitor" which means what we already know about anticoagulants and that is watch for unusual bruising (not just the odd spot now and then), gums bleeding a lot, or blood in urine, etc, and that's when you should contact your doctor if any of these occur. Diltiazem has a long history and is a well studied and is a reliable medication but the last few years its ability to influence the metabolism of certain other drugs has become more prominent especially with newer medications and adding other medications. But since it's a moderate influence it usually gets the green light to take.

And even grapefruit juice is also a CYP3A4 inhibitor and can lead to slightly higher concentrations of drugs in the bloodstream. Though interestingly it's noted as a strong inhibitor not moderate. Much worse than diltiazem believe it or not. So I'm still taking diltiazem and apixaban both have kept my heart steady and avoiding stroke -- I just won't drink grapefruit juice with it.😁

[miltonmilo]

I take both of these, I have times when I feel extremely winded on hills or stairs which I think is the dilatizan but not sure? Im65 two ablations seven years ago.

[Maggi79]

Thank you all for your replies..I always double check all meds herbs etc ..I go on the Internet and use webmd.com..reason being my husband was put on meds in the past that can cause blood clots..if you had a history of it ..which he has. not to be used ..long story short caused multiple clots Also my son was prescribed a beta blocker containing lactose which he is allergic to ..by a major children's hospital..so it has left me wary ..

Maggi

[Ppiman]

I have just read the same. That's interesting. I would question this before taking them together. I take bisoprolol and when I asked about changing to a calcium agonist like diltazem, my specialist said not.

Steve

[JOY2THEWORLD49 in reply to Ppiman]

Hi

Why did you want to change? Fatigue symptoms with Bisoprolol?

I found if it is for heart rate control and a dramatic lowering - me and Diltiazem intro on 1/2 dose 180mg CD AM dropped from 156 on Bisoprolol to 51 in 2 hours. (Before that On Metoprolol h.r was 186 with pauses.). 24hr heart monitor is best to monitor your meds day and night. My Diltiazem was immediately reduced to 120mg CD.

Bisoprolol is better for BP control. But I've just lowered mine to 1.25mg PM.. BP was dropping 108/62 with symptoms of vision (under weather), dizzy after picking up ping pong ball at Table Tennis, loss of concentration going down stairs and resting closing my eyes 1.2 vertigo sensation.

Too long to wait for a heart specialist's opinion I halved my pill of 2.5.

After I did this much improved. See Dr 1 mth since I told her symptoms ..nothing so as I do I make a judgement call and I will have an ECG on Thursday morning.

cheri jOY. 75. 9NZ)

[Ppiman in reply to JOY2THEWORLD49]

It was just a question I asked and was surprised at the reply. I had read a study that showed Ca++ agonists were better for AF - he clearly didn't agree.

Also, my heart rate goes down to the mid-high 40s, so I have also thought of stopping the bisoprolol.

Steve

[JOY2THEWORLD49 in reply to Ppiman]

Hi

Yes well my normal Night Heart Rate regardless of meds avges at 47 according to 3 24hr Heart Monitors sessions.

So I take Diltiazem early morning. It controls but as it wears off according to Dr - used up by the dramatic action 60s - 80s.

Them as it does not need controlling at night but systollic does 180/90 it was the Bisoprolol is taken at PM.

Diltiazem does control my heart rate at night as it is not needed. But some take Diltiazem AM and PM.

All interesting.

Is it at night that your heart rate goes down which is normal. 47avg is OK. If I get up in the night I am careful to hold on to handles but I feel OK and probably as I move it rises.

You may need a review of meds depending when your heart rate falls. Mine is clear drops at night when asleep.

BBs and CCBs do the same by reducing and controlling BP and heart rate. But with me although BBs does its job in BP but 156 is not controlling taking 5mg twice a day.

How much Bisoprolol are you taking? I can't see if you have answered above Pipiman.

Read all about CCB interesting. If you are not a worrier or anxious then adrenaline does not need blocking. CCB is calcium blocking. It is a med best for me.

Now I read that a person diagnosed with AF should have a trial of both BBs and CCBs I didn't have that trialled because it took 2 years 3 mths before I had the heart rate controlled hence the damage.

You may be like me and that your heart rate falls when you are asleep. CCB will then control during the day if you have the CD one.

Taking away Bisoprolol fully may mean I need to go up to 180mg Diltiazem. We will see what the ECG says. Also I read stop BBs before having it by 48 hrs. I will only have 36 hrs. I won't have any Biso... tonight.

The old regime was BBs for AF patients but now patients like me are reported as having a better result from CCBs.

cheri JOY

[Ppiman in reply to JOY2THEWORLD49]

My heart rate drops at various times but most noticeably in the evenings. The lowest is around 45bpm but many days it's 55bpm rising to 110bpm, maybe (depending what I get up to). I take 1.25mg of bisoprolol each morning.

Overnight, I am not sure what the rate is as I don't often where my Apple Watch while in bed, unless I am having an episode of AF. When I have worn it, the rate has been much the same as at other times. I also have another arrhythmia called LBBB which is said to cause bradycardia, so that the likely cause of the low rate. The cardiologist I see has hinted that a PM might eventually help but I have an ablation first for the ectopic beats and AF.

In your own case, since bisoprolol has a long half-life, and soon reaches a steady state in the bloodstream, it shouldn't really matter when it's taken. Diltiazem is different, with a much shorter half-life, so (unless sustained release version), will have an effect if only used once a day.

Steve

[JOY2THEWORLD49 in reply to Ppiman]

hi

Separating them are directions from a well-versed nurse at NZ HEART FOUNDATION. Its about how they work. She was my private specialist nurse.

My Diltiazem 120mg is slow release but because it does a big task bringing down an over 100 heart rate l guess it uses itself up.

BP is better taken at PM. Because BP rises early morning. I had my stroke at 2am.

anyway reducing the 2.5mg Biso... by 1/2 made the vision problem and concentration and stopping every 20 yds disappear.

energy thing still there but much improved.

cheri JOY

[Ppiman in reply to JOY2THEWORLD49]

It seemed odd as any drug that has a long half-life reaches a steady state concentration in the blood stream so it shouldn't matter at what time of day it is taken once the steady state has been achieved, usually after a couple of days.

Steve

[JOY2THEWORLD49 in reply to Ppiman]

Hi

You are still overlooking their roles and their action on the heart in the muscle.

It works for me separating them.

Lovely day.

cherio JOY

[Ppiman in reply to JOY2THEWORLD49]

If the drug levels are high enough in the bloodstream, it won't mater when it is taken, though, since the steady-state effect will keep it active.

Steve

[JOY2THEWORLD49 in reply to Ppiman]

Hi Steve

Been to the Dr and had a ECG on Diltiazen 120mg CD which is controlled Dose.

ECG was great BPM 81. Showing that Diltiazem is still controlling my Heart Rate.

Missed the BB Bisoprolol for 36 hours prior to ECG as instrucyions were to leave it our as ir woud heywy the ECG. Never knew that before.

It clearly stated AF but with normal Ventricle pressure???? pressure.

Then we discussed the Heart Specialist's reply about Sotolol.

He said NO to sotolol. But he did repeat what he said to me when I cornered him "What do I do..... if...." Stop the Bisoprolol.

So I was a bit put out that she waited 3 weeks to tell me his reply! She left it until my month later appointment.

SOTOLOL is a Beta Blocker, Steve.

But it is one of the new BBs.

So I reckon I will drop the whole Bisoprolol at sometime and have another ECG at my clinic.

But Diltiazem CD 120mg is being monitored with 31 January 2025 expiry date! A Pharnac letter reads that if my Chemist has a Dr's letter from an indidual they will get the 2026 supply first when it becomes available mid to ed of January.

I explained this to my standin Chemist and he argued. as I sent a copy from Pharmac as to the state of supply.

The Dr gave me 2 copies. I gave 1 into them.

Much improved on 1/2 biso but I left yesterday's 1/2 out.

Should I stop it altogether??? Or carry on 1/2 for a whie. A decision.

CROWN done. quite a job.

Especially as it is a molar back 2 from the pointed one. I do not have them!

No eating on the CROWN!

Soups for me. I managed to get a nice Phillppino Chicken Noodle ? $14 the chicken was small and thin, some greens and noodles to slurp down.

Filled me up.

Then I delayed my PRADAXA 110mg. Had it at 2pm. So tonight I shall have it at 12 plus.

Taking it twice a day I don't worry too much but sometimes I need to get it back to 10am and 10pm. My designated times.

I'm sure Diltiazem would iron out your up and down heart beat. BB didnt control heart beat from a high figure.

Happier now that I did the right thing by stopping the wholr 2.5mg Biso.

cheri JOY

[Teresa156]

I always check the NHS ‘NICE’ guidelines for interactions and after checking it just now, there are no interactions between Diltiazem and Apixaban listed.

[JOY2THEWORLD49]

Hi

I wouldn't take them together anyway.

Diltiazem a CCB Calcium Channrl Blocker is a great choice of med.

Not Metoprolol 186 and pauses or Bisoprolol 156 could control my heart rate but Diltiazem did.

I takr my thyroid pills early morning.

My Diltiazem CCB 1.5 hours later

My Bisoprolol 1.25mg PM for BP control.

My twice a day PRADAXA 110mg 10am and 10pm approximately.

A CCB and BB should be separated 12 hours apart said the Nurse at NZ Heart Foundation.

Cherio JOY. 75. (NZ)

[Lovetheoutdoors]

I have been taking apixaban since my first AF episode. Ive had no side effects. I get blood tests and reviews once a year. not on Diltizem

[TullowHill]

Please check with your GP or prescriber if only for peace of mind