Diltiem vs bisoprolol

[Harefieldfan]

Hi. Does anyone take or has anyone heard of Diltiem as an alternative to bisoprolol? I think it’s a calcium channel blocker though I’m not sure what that means. I know someone who’s been on it for 10 years as he couldn’t tolerate bisoprolol, and I’d love to know if anyone here has any thoughts or experience. Thanks.

[Hidden]

With the caveat that I’m not medically qualified. Diltiem (diltiazem hydrochloride) is indeed a calcium channel blocker, which are a family of drugs primarily intended to treat high blood pressure by relaxing the blood vessels as a result of altering the way the body moves and utilises calcium. Depending on which specific drug you’re talking about, they’re also considered effective in atrial fibrillation, some other arrhythmias, and angina. CCBs are a wide class of drug, though, with several different modes of action depending on which group a drug belongs to: there are 2 groups based on the effect the drug has, although some resources actually refer to diltiazem being the only drug in a third group. This link is for the BHF page explaining what CCBs are:

bhf.org.uk/informationsuppo...

Whether or not a CCB is a suitable alternative to a beta blocker for someone will depend on which CCB is being considered and why the beta blocker is being given in the first place. I have supraventricular tachycardia or SVT, which is a form of relatively mild arrhythmia that causes the heart to beat extremely fast, and the first (and main) line of drug treatment is beta blockers: I was initially on sotalol after my first episode, then took bisoprolol for about 9 years, before switching to a CCB (verapamil) when I started having issues with severe side effects. I’ve been on verapamil for the last 4 years without any issues or change in effectiveness, but many other CCBs wouldn’t be considered appropriate for managing SVT as they can cause reflex tachycardia.

[Kittysmom in reply to Hidden]

Hi Charlie, I too had SVT, I remember it starting when I was at senior school but routine ECGs never picked anything up so I lived with it for 35 years, it became troublesome and was eventually picked up during a “bubble test” I had an episode during the test and was told I had a “wiring” issue not a “plumbing” one! 😊 I have since had 3 cardiac ablations , the first 2 sadly didn’t work but I had my 3rd last September and so far so good! I was taking 100mg Flecainade twice a day and 120mg Diltiazem every 12 hours and Edoxaban 60mg once a day, I saw my consultant in January and came off all medication (Diltiazem was gradually reduced) I still get the occasional skipped beat or sudden pounding but compared to previous symptoms it’s nothing 😊 Have you been offered an ablation? It really has changed my life and would recommend it to anyone with arrhythmia issues.

[Hidden in reply to Kittysmom]

No. Although I now know from medics I should have been offered an ablation, and would have jumped at the chance of one, unfortunately I received appalling care when I was first diagnosed. I was morbidly obese at the time, which was likely a factor - everything is ‘your own fault’ when you’re massively overweight. Even if that bias is unconscious, which for many doctors is often the case, my experience is that it’s very much real and causes harm. I actually had a number of chronic conditions dismissed as being because of my size when they were nothing to do with it, and am still paying the price for that shortsightedness now. In terms of the SVT, I wasn’t even told to go to A&E if the episodes lasted more than half an hour or made me feel unwell, so for 6 years was having 2 or 3 prolonged episodes above 180bpm a month, sometimes a week, and just putting up with most of them at home, even after I independently lost ten stone to get to a healthy size. After yet another episode at 220bpm that made me feel horrendously unwell with chest pain and nausea etc. and that I needed adenosine for, I read up properly on SVT, systematically cut out or altered all the things medically proven to increase or worsen ectopics, and now haven’t had an episode at all in the last 7 years. I know full well I still need meds as part of keeping control, but it is fully under control. Other than a few noticeable ectopics a day, a heart rate that massively overacts to the slightest stimuli (jumps 20 to 30bpm just talking and gets over 180 when exercising), recurrent chest pain, wonky cholesterol, borderline high bp, and bradycardia overnight, I’m told my heart is fine 👀🤷‍♂️ I’m now trying to save up to go private as local cardiology have refused to see me.

Having now finished my whine (sorry! 🙈), I am very glad to hear that ablation was finally a success for you. Fingers crossed it’s a permanent fix.

[Ada-eve]

Hi Harefieldfan im commenting on your post as i would like to know the answer too .Ive just opened a letter from my cardiologist asking for me to change from Bisoprolol to Dilitazem for possible coronary artery spasms. Hopefully someone will be along with some info 🤗

[Hidden in reply to Ada-eve]

Hiya, see the above reply. Calcium channel blockers work by relaxing blood vessels, and Diltiazem is specifically indicated for coronary vasospasms.

[Hidden in reply to Ada-eve]

You might also find this post useful:

healthunlocked.com/bhf/post...

Specifically the reply from Milkfairy who has been living with vasospastic angina (the more recent name for coronary artery spasms) for a long time and is extremely knowledgeable about it.

[Ada-eve in reply to Hidden]

Thankyou for the reply I was prescribed calcium channel blockers for high blood pressure but had a reaction to them and was changed after a few weeks not sure if they are all the same .

[thehypnotist in reply to Ada-eve]

Me too! Had to be switched back fairly quickly!

[Milkfairy Heart Star in reply to Ada-eve]

Diltiazem is usually recommended rather than beta blockers if you live with coronary vasospasms.

I have vasospastic angina and have been on Diltizem for 10 years along with Isosorbide mononitrate tablets and patches, Nicorandil, Statins and clopidogrel

Beta blockers are contraindicated if you have vasospastic angina. Beta blockers can make coronary vasospasms worse.

I was prescribed them when I was presumed to have microvascular angina . I ended up in Coronary Care for a week as a result.

I also suggest that you ask your Cardiologist for the appropriate testing to determine whether you have microvascular or vasospastic angina.

The symptoms can be very similar however the treatment options are different.

If not treated properly both conditions can cause a heart attack, stroke, heart failure and major adverse cardiac events.

[Hidden in reply to Milkfairy]

You must have been typing as I was tagging! 😂

[Milkfairy Heart Star in reply to Hidden]

Haha, yes 😂

[Harefieldfan in reply to Milkfairy]

Thanks everyone. I had a mild heart attack on May 1 last year and since have had two stents inserted. I take aspirin 75mg, ticagrelor (90 mg 2X a day), Losartan 25mg, bisoprolol 1.25, atorvastatin 80, amliodopine 7.5. Originally they said aspirin for life; the rest for a year but I don't know if that's still the case; I never see anyone, so who knows? At my surgery it's pretty impossible to see a GP. I think it's the bisoprolol that makes me feel exhausted long after I should feel that way. (I got my second stent in November, via rotablation.) So that's why I'm investigating alternatives to biso. I know there's another alternative to biso that's been mentioned on this forum but I forget what it's called. I'm not seeing the cardiologist again until the autumn. He thought the problem was caused by biso as well and asked if I wanted to try another one, but at the time I thought 'better the devil you know'.

[Milkfairy Heart Star in reply to Harefieldfan]

Perhaps have a chat with your Pharmacist?

They are knowledgeable about medications.

Another alternative is Ivabradine, however this I think needs to be initially prescribed by a Cardiologist.

You could contact your Cardiologist's medical secretary and ask for a review of your medication by your Cardiologist.

You sound as though you are falling between two stools without access to your GP or Cardiologist.

It's a position that sadly too many patients are in at the moment.

[Ada-eve in reply to Milkfairy]

Hi Milkfairy I recently had an angiogram following ct angiogram would they have tested at that time for microvascular or vasospastic angina ? My other concern is that when first diagnosed with high blood pressure i was put on amlodipine which is a calcium channel blocker but was change to an ACE because i had a reaction to them causing pains in my left arm.

[Milkfairy Heart Star in reply to Ada-eve]

Do you have a copy of your angiogram report?

Testing for microvascular dysfunction which causes microvascular angina can be performed during an angiogram.

If a person's coronary flow reserve is less than 2.5 along with a resistance of blood flow in the small blood vessels.

Microvascular angina can be diagnosed.

If during an angiogram a transient constriction in the coronary artery is seen

accompanied by chest pain and ECG changes. Then vasospastic angina is diagnosed.

In a very few centres they are using a chemical acetylcholine to provoke vasospasms.

A coronary vasospasm is not something you miss. I had spontaneous and acetylcholine induced vasospasms during my angiogram. I was given morphine to relieve my severe chest pain as well as nitrates.

My coronary vasospasms feel like I am in labour in my heart. .

Your Cardiologist should have explained whether they were going to do these extra tests before you signed your consent form.

I suggest you ask your Cardiologist to go through your angiogram report with you and explain why they suspect you may have coronary vasospasms.

Ask for the appropriate testing too.

Microvascular dysfunction can be detected by some Cardiac perfusion MRI.

[Ada-eve in reply to Milkfairy]

thanks for the reply.I was only given a discharge letter which showed where the blockage is . I think he is basing the coronary artery spasms on the fact that i said most of pain when i have any is deep in my left breast and that i still had them 2 weeks after starting medication hence thats why he is going to stop beta blocker.I will follow up with him to ask for additional tests.

[Mirador19 in reply to Milkfairy]

Can I ask what the appropriate tests for micro vascular/ vasospastic angina are please. My cardio nurse thinks this could be my problem on top of other things.

[Milkfairy Heart Star in reply to Mirador19]

The BHF website has this information about microvascular and vasospastic angina .

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

Microvascular dysfunction causing microvascular angina can be detected by some Cardiac MRIs

Invasive angiograms measuring how the blood flows in the small vessels can help diagnose microvascular dysfunction.

Acetylcholine can be used to provoke coronary vasospasms in the small and coronary arteries, to diagnose vasospastic angina.

Rarely a spontaneous coronary artery spasm is seen during a routine angiogram.

There is a study taking place at St Thomas's hospital in London into using various techniques during an angiogram to assess how the blood vessels function.

isrctn.com/ISRCTN94728379

Here are the latest recommendations from the leading researchers into angina non obstructive coronary arteries ANOCA.

This is a joint BHF and National Institute of Healthcare Research, NIHR supported working group.

heart.bmj.com/content/early...

[Mirador19 in reply to Milkfairy]

Thank you Milkfairy. I will have a good read of those before my video appointment on Monday with my cardiologist.

[Harefieldfan]

Thanks Milkfairy. Very helpful.

[Heather1957]

I have never heard of it but am interested in the responses.

When my next prescription is filled I will be on 5 mg of bisoprolol up from 2.5 mg, It is always good to know there is an alternative out there if needed.

[Breesha in reply to Heather1957]

Why does Biso get such bad press , it seems to have worked for me 15 MGP for 15 years , has kept me going , and working , let’s have a good word for this lifesaving drug .

[Ada-eve in reply to Breesha]

Hi Breesha Ive only been on Biso for 7 weeks and havent had a problem so far i was expecting it after all the negative comments but its the cardiologist who wants to change mine.

[Heather1957 in reply to Breesha]

I don't have any problems with 2.5 mg but am concerned that 5 mg, along with my other 10 tablets MAY cause a problem so it never hurts to know about alternatives.I am glad that you have had no problems with Bisoprolol but not everyone can say the same, different drugs can have different side effects on different people.

[Hidden in reply to Breesha]

I think some of it is that people aren’t willing to give drugs time for our bodies to adjust to them. In many cases, and for many meds, side effects can settle over time. That’s not to say people should put up with really intolerable side effects, just that being a bit more open to tolerating discomfort can sometimes be helpful in the longer term, particularly in situations where treatment options are more limited. I took bisoprolol for years without any issues, before it suddenly started to cause problems with my heart rate going low even at tiny doses. I’d lost a huge amount of weight, and the docs think that could have had something to do with it, but the bottom line is they couldn’t say for sure, and I clearly needed to be switched off it.

The other thing is that many people that aren’t having a problem with something, be that a medical condition or a med, aren’t going to frequent boards like this. The people that tend to be here broadly fall into those that are newly diagnosed and seeking information, those that aren’t doing well, or those that are doing well and want to support and share with the first two groups, but I’d argue the first two groups significantly outnumber the last one. Most of those that are well and getting on with life are not here, so you get a disproportionate view of certain medications and treatments.

Last but not least is the nocebo effect, which is where people develop side effects as a result of being told they’re a possibility - studies have proven this is a genuine thing, and there was a really interesting one done with statins, which also have a terrible press for intolerable side effects.

[Goldfish7 in reply to Breesha]

Because it can cause a whole host of very unpleasant problems in a reasonable number of people - Im one of them. Sadly it is the only drug that works for my AF and heart rate. Im now on a small dose again 1.25mg x 2 per day following another ablation and still have a lot of unpleasant symptoms - fatigue, weight gain, breathlessness, sleep disruption, cold extremeties, etc. As Ive been on and off them for years I can identify all of the side effects I get linked to bisoprolol. Despite the claims of some GPs over the years bisoprolol can cause a wide range of problems quite commonly. The older I get the more freinds and relatives I know ending up on bisoprolol with a significant number (more female than male) having significant side effects from it - but not all of them. I agee its worth trying it for a month or so, but if it is causing problems it would be well worth exploring alternatives with a Dr.

[Scho1]

I've taken diltiazem. It has been around for quite a while and is often used instead of bisoprolol. I was fine on it.

[jerry12953]

I was prescribed Zemtard ( a slow release form Diltiazem as an alternative to Amplodipine late last year. The advice to my GP/pharmacist was to start on the lowest dose (90mg IIRC) and gradually increase the dose. I'm now on 240 mg and I haven't noticed any side-effects although I'm not sure its helping with my (probably microvascular) angina!

[Milkfairy Heart Star in reply to jerry12953]

You might be interested in this research that suggests Diltiazem may not be an effective treatment for those living with microvascular angina .

Unfortunately there is a scatter gun approach to treating angina non obstructive coronary arteries ANOCA.

Too few patients have proper testing to confirm a diagnosis of either microvascular or vasospastic angina.

tctmd.com/news/anoca-diltia...

[dunestar]

Hello Harefieldfan. I'm intrigued by your name tag. Is that Harefield as in Harefield hospital? If so, I'm a fan too. I live just down the road from the hospital and had all my initial testing and subsequent diagnosis there about three and a half years ago. I went back there a few weeks ago for a further test, although I am now under a cardiologist at Hillingdon Hospital.As for your question both calcium channel blockers and bisoprolol lower blood pressure but bisoprolol also lowers the heart rate.

[Harefieldfan in reply to dunestar]

Hmm. Thought I'd replied. Trying again. Harefield as in Harefield Hospital, yes. It was there that a wonderful cardiac surgeon used a rotablator to get rid of the calcium that was blocking my lower anterior descending artery (so called 'widow maker') and which was totally resistant to balloon angioplasty. He was kind and considerate, called me by my name and kept checking in with me. I was originally treated at Luton and Dunstable hospital, which seems to have (luckily for me) a link with Harefield, cause L and D didn't have a drill. So I'm a fan of Harefield.

[dunestar in reply to Harefieldfan]

Thanks Harefieldfan. My experience is that at Harefield they combine technical excellence with real care for the patient. A rare combination.

[Nannysue1]

Yes, I'm on Diltiazem and find it fine. I tried Bisoprolol but couldnt get on with it, it made me feel exhausted.

[Simcoxh in reply to Nannysue1]

Hi there I had the same Bisop..made me sob fatigued and exhausted ..

[Tricia7048]

My cardiologist gave me Ivabradine as alternative to Bisoprolol. I lost the 20kg weight gain and my kidney stones went away. and I have had no problem with them. I havent tried Diltiem but I hope they work for you. X

[Funky_Uk]

Hi… I had episodes of AF and SVT I was put on bisoprolol but I was really poorly off it. My blood pressure was very low (I have a PM) and I couldn’t breathe, dizzy spells and no energy. During lockdown I couldn’t get in touch with cardiology and I couldn’t get a doctors appointment so I was on them for 9 months until they changed them to diltiazem. I’ve been on those for about 18 months now, I have more energy on the whole and all the other symptoms are less than with bisoprolol but I still don’t feel great 😊