Switching from bisoprolol to diltiazem

[blue_reader]

After 4-5 years on bisoprolol, my EP has agreed to let me try diltiazem. I have heavy legs when trying to walk up stairs or hills, and am fatigued most days. I am currently on flecainide 2x50mg and take 1.25mg of bisoprolol. My EP has said to just take a last dose of bisoprolol one day and then start taking diltiazem 120mg the next day. For anyone who has made the switch, does this method work without any issues? Or is there a better way to do it to avoid any beta blocker withdrawal issues?

Thank you.

UPDATE (2025-03-18):

I took my last dose of 1.25 mg bisoprolol on a Thursday night and then started with 120mg diltiazem on Saturday morning. I stayed on the diltiazem for 10 days and then decided to move back to the bisoprolol. To do that, I took my last dose of diltiazem on a Tuesday morning and then resumed the bisoprolol on Wednesday night. Here were my findings:

(1) My main reason for switching back to bisoprolol was because I experienced swelling/edema in my legs that was uncomfortable. This is apparently one of the common side effects of diltiazem. I didn't want to have to take yet another pill to lessen the swelling/edema.

(2) I didn't notice any effects on my heart from switching between the 2 medications in the way that I've described above. That was a positive. Note that I was on very low doses of both medications.

(3) My hands and feet are noticeably colder when taking bisoprolol. They felt normal and warm while taking the diltiazem. This was a positive consequence of the diltiazem.

(4) I didn't feel any less fatigued nor did my legs feel less heavy on the diltiazem. It's either because I wasn't on the diltiazem long enough or those symptoms are unrelated to the bisoprolol for me.

Anyway, I'm glad I finally tried the experiment because now I know and don't have to wonder if I'd feel better on the diltiazem. My next experiment at some point this year will be to try using the bisoprolol and/or flecainide as a pill in the pocket given that my bouts of afib have seemed to be associated with having a virus at the time. My EP has agreed that I could try this. There have been so many viruses around over the fall and winter that I felt for sure I would get one of them so I wanted to stay on the meds, just in case. So far I've been virus-free (knock on wood). Maybe I'll try the next experiment during the summer....

[mjames1]

Personally, I would not stop the beta blocker cold turkey. You might try half dose of your bisoprolol and 30mg of fast acting diltiazem tabs 2x/day, which is the half dose of your prescribed 120mg extended release diltiazem 1x/day., If you cannot get the fast acting diltiazem tabs in your country, then I'd take the full 120mg as prescribed along with the half dose of bisoprolol.

If you feel OK after three or four days, then I would go every other day with the bisoprolol for a few more days and then see how you feel. If ok, then stop the bisoprolol completely and continue on with the prescribed dose of diltiazem.

This is just how I would do it based on my knowledge and situation and of course you should run it by your doctor.

Jim

[JOY2THEWORLD49 in reply to mjames1]

Hi

You are quite wrong.

Her specialist said to stop the BB @ 1.25mg the least dose and start Diltiazem next day.

It was a dramatic change for me,

As both work on BP and H.Rate you don't need both as the specialist has directed.

Read my post.

The 120mg CD is in capsule form too.

She can't 1/2 x 1.25mg as the 2.5mg is already cut in half.

I stopped 1.25mg Bisoprolol cold turkey in December as BP went low. My specialist said always stop Bisoprolol is too low in either H.Rate or BP.

cheri JOY. 76. (NZ)

[mjames1 in reply to JOY2THEWORLD49]

OP is in Canada, not New Zealand. In Canada, they have 1.25 tabs of bisoprolol that can be cut in half. They also have fast acting Diltiazem tabs starting at 30 mg. Using the approach I cited, there should be no lowering of blood pressure in fact the opposite. The important point is the OP has legitimate concern which should be addressed with her medical team and come up with a shared decision.

Cheers.

Jim

[JOY2THEWORLD49 in reply to mjames1]

Hi

But her Heart Specialist has correctly directed her.

I am privileged to use my experience and further directions given.

I would say reduce slowly if no other meds to replace it.

Why are you suggesting 'against' her heart specialist.

cherio JOY

[blue_reader in reply to mjames1]

Thanks for the replies, Jim. I actually can only get 5mg tablets of bisoprolol, so to get to my 1.25 mg I need to cut it in quarters. Any more splitting than that, I'd be left with powder. Also, the lowest dose of diltiazem I could apparently get is the 120 mg capsule. I am going to follow up with my pharmacy about that though. I'll have to ponder the various replies I've received to my question. My EP seems convinced I can just stop bisoprolol one day and start diltiazem the next, but I like to hear the experiences of others who have made the switch.

[Oldforge73]

I was on the same dose of Bisoprolol as you for 16 months, stopped it one day and started Diltiazem 60mg modified release the next, I can take up to two x 60mg a day but find it is too much and only need the one which I have to cut in half taking it morning and evening as it causes my heart rate to drop too much also my blood pressure. My observations on how it felt are that my heart was unhappy at first as hearts hate change. Afib episodes lasted longer and felt more uncomfortable and occurred more frequently but I toughed it out and all has settled down now after two months. I suffered no personnel anxiety from the lack of the beta blocker but common sense tells us all that physiologically the human body will experience some withdrawal symptoms one way or another. I had no choice but to change drugs as the Bisoprolol was depressing my sinus node and causing some very alarming incidents, I take no anti arrhythmic drugs such as flecinaide. I can only suggest that you give it a try and if you find 120mg is more than you need get the dose adjusted. I am particularly sensitive to prescription medication but that's just me others are different. I guess there is a very good reason that your EP is stopping your Bisoprolol but do go cautiously on being tempted to take both drugs at the same time without his agreeing to it. Regards Kathleen

[blue_reader in reply to Oldforge73]

Thanks for the reply, Kathleen. I actually asked to try something other than bisoprolol due to my heavy legs and fatigue. It's been ~5 years and I thought it's finally worth a try to see if the symptoms are alleviated with another medication. I anticipate my heart will be a bit unhappy as I make the change, but hopefully it won't complain for an extended period of time.

[Oldforge73 in reply to blue_reader]

Hi, it’s just a matter of accepting a change may make your heart a bit clunky, as far as I am concerned Diltiazem is so much kinder than ever Bisoprolol was. It does not affect my stamina and once you find the best dose for you it all settles down. I also sleep better now and no longer feel the brake that was on my breathing. Do let us all know how you get on with the change as it helps so many make informed decisions. It’s only through this forum that I discovered that you don’t have only a beta blocker to effect rate control, indeed my knowledge of Afib has increased so much because of the wonderful people who post on here. Regards Kathleen

[Hrpapa]

It was fine for me. I only had a day of ectopics. I feel much better with the calcium blocker than the beta blocker.

[blue_reader in reply to Hrpapa]

Good to know. Thank you, Hrpapa.

[Herbie30]

For me, stopping Bisoprolol one day and starting with Diltiazem the next day did not cause any issues at all and the Diltiazem helped with my stamina.

[blue_reader in reply to Herbie30]

Good to know. Thank you, Herbie30.

[JOY2THEWORLD49]

Hi

What is your heart rate?

Do you have ventricle abnormallity? If you have you should not be on flec, or diltiazem. there are other CCBs.

I was on bisoprolol when diltiazem 180mg was introduced.

You are already on the lowest dose of bisoprolol. But diltiazem could dramatically reduce your heart rate. Mine did, but I still had uncontrolled H/Rate Day @ 156 Day. Should be 100 or under.

My H/rate fell from 156 to 51 Heart Rate Day on the newly introduced 180mg CD CCB Diltiazem so this was reduced to 120mg which I have AM. 180mg CD was too high. 360mg is a normal dose.

Bisoprolol in my case did reduce H.Rate to 156 but more importantly reduced my BP. I was told to reduce Bisoprolol. So immediately it was reduced to 2.5mg and to have it PM away from the CCB by 12 hours.

You must monitor your vitals BP and H/Rate closely every hour after introducing it..Taje early morning with food. My Diltiazem lasts in my blood 8 hours. This allows my H/R 47avg at night to stay.

Stop the bisoprolol as your specialist has directed.

I stopped the bisoprolol in December as my BP was going too low.

In NZ the lowest dose of Diltiazem is 120mg.

As it also acts as a safe anti-arrhymic med, you may not need the flec.... which is a risky anti-arrhymic.

Cherio JOY. 76. (NZ)

[blue_reader in reply to JOY2THEWORLD49]

Thanks for the replies, Joy. My heart is structurally sound so the EP was comfortable prescribing flecainide for me 4-5 years ago. With the flecainide, I literally have no afib episodes which is wonderful since it felt like a galloping horse in my chest when I did have some episodes.

With the 1.25 mg of bisoprolol and 2x50mg of flecainide, my resting heart rate is in the low 60s, so not super low.

I will be thinking some more about the replies I have received to my post before determining how to go about making the switch.

[JOY2THEWORLD49 in reply to blue_reader]

Hi

Yes, 60s is good. The 120CDmg Diltiazem settled at 60s rising towards end afternoon.

I feel that you will have a further reduction on 120mg Diltiazem. Less would be cautious like 60 CD mg but have it twice a day. That way makes it cautious.

It was very dramatic when I started it.

cheri JOY. 76. (NZ)

[Ducky2003]

Hi. I did go from one to the other but my Bisoprolol dose was a lot higher, so I had to taper it off over a few days. Yours is a small dose, which is probably why you've been given that advice.3 months on Bisoprolol drained every ounce of energy from me so moving to Diltiazem was fantastic.

[blue_reader in reply to Ducky2003]

Thanks for the reply, Ducky. Yes, I am on a teeny, tiny dose (as my EP says) so it may be ok to just switch from one to the other over a day. I've wanted to try to make the switch for quite a while now and just haven't had the courage, but if there's a hope of feeling better I really should go for it. I'm still relatively young.

[Ducky2003 in reply to blue_reader]

You're a bit older than me and this will be my 9th year of AF, so it's not respectful of age 😁. Hopefully your QoL will improve by the switch. Mine certainly did.😊.

[JefferyW]

I struggled with Bisporol and felt dreadful - so my Arrythmia clinic initially changed my drug to Sotalol - another Betablocker but that too had bad side effects. They then gave me Diltazem - Adizem XL120mg which was a game changer. I didn’t wean off beta blockers as was told I was on a very low dose was and that it Diltiazem was better at controlling rate rather than rhythm but it made such a difference to my quality of life and did the job.

I’ve had 2 ablations which have been effective although I still get the odd glitch and now have Diltiazem as my Pill in the Pocket and it works fine.

[blue_reader in reply to JefferyW]

Thanks for the reply, JefferyW. Good to hear that you felt better on the diltiazem and didn't seem to have any issues with switching over from bisoprolol. I'm feeling better about making the switch after reading the replies to my post. Fingers crossed.

[Diddy97 in reply to blue_reader]

Hi , I am in exactly the same position you were re switching from Bisoprolol to Dilitazem.

Could you please if you made the switch and if so how did it go

Thank you

[blue_reader in reply to Diddy97]

Your post today prompted me to come in and give an update. I will also post the update in my initial post at the top.

I took my last dose of 1.25 mg bisoprolol on a Thursday night and then started with 120mg diltiazem on Saturday morning. I stayed on the diltiazem for 10 days and then decided to move back to the bisoprolol. To do that, I took my last dose of diltiazem on a Tuesday morning and then resumed the bisoprolol on Wednesday night. Here were my findings:

(1) My main reason for switching back to bisoprolol was because I experienced swelling/edema in my legs that was uncomfortable. This is apparently one of the common side effects of diltiazem. I didn't want to have to take yet another pill to lessen the swelling/edema.

(2) I didn't notice any effects on my heart from switching between the 2 medications in the way that I've described above. That was a positive. Note that I was on very low doses of both medications.

(3) My hands and feet are noticeably colder when taking bisoprolol. They felt normal and warm while taking the diltiazem. This was a positive consequence of the diltiazem.

(4) I didn't feel any less fatigued nor did my legs feel less heavy on the diltiazem. It's either because I wasn't on the diltiazem long enough or those symptoms are unrelated to the bisoprolol.

Anyway, I'm glad I finally tried the experiment because now I know and don't have to wonder if I'd feel better on the diltiazem. My next experiment at some point will be to try using the bisoprolol and/or flecainide as a pill in the pocket given that my bouts of afib have seemed to be associated with having a virus at the time. My EP has agreed that I could try this.

Hope this information is helpful to you as you make the switch yourself.

[Diddy97 in reply to blue_reader]

Thank you so much for your reply, it really helps. To be honest I would prefer to take something as pill in the pocket method as I think that might eliminate any unwanted side effects of either medication.

I was initially taking 1.25 Bisoprolol and have slowly reduced to half of a tablet, but after trying twice to stop from there caused racing heart rate.

Thank you again and good luck with whatever you decide to do with your medication