progressive increasing of diltiazem dosage

hello

I will be put back on diltiazem XL soon (not my favourite, I felt generally ill with no effect on chest pain and made my HBP uncontrolled as in higher) and I assume off amlodipine. This is to bring rate down to 60 and progressive levels will be tried until they work or not.

I am committed to trying again as these and an anti depressants (see other post if interested) look like my last medical hope I believe. Best outcome is they make pain tolerable and I can get on with some form of a decent life, I’m not expecting miracles but you never know,

So I’ve already been on 90mg slow release twice daily in 2022 for 5.5 months when cardiologist stopped it in October and put me back on amlodipine because it wasn’t helping. i like amlodipine for HBP as keeps it controlled and no side effects but does nothing for chest pain).

I will be asking a pharmacist but I am always interested in the lived experience of people here.

Qn: can incremental increases in dosage make a significant difference when previously found didn’t work? Can that jump perform a Miracle?

Logic tells me if it made me feel bad last time and didn’t do what is was supposed to and messed with BP and made it higher, more of it will will be even worse?

Can a med at half strength that didn’t work and made you feel bad then work at full strength and not feel bad?

Just interested in people’s experiences rather than after medical advice.

Hope questions make sense.

[MountainGoat52]

I think that you may have asked the unanswerable question. I guess the only way to find out what happens on a full dose is to try it, after all we are all different. I can't comment specifically about the medications concerned as I had an opposite reaction to you... I cannot tolerate Amlodipine, but I am okay with Diltiazem (admittedly at 60mg).

I would hope that there is an alternative to anti-depressants. No-one seriously wants to be on those. They might provide a temporary solution, but I would hope that a permanent solution to your problem can be found with a more appropriate medication.

Whatever happens with this trial at the higher dose I would encourage you to remain positive. I would suggest that you keep your cardiologist informed of what is happening as this trial progresses and certainly don't let matters go on if your are unhappy.. Let us know how it goes.

With my best wishes,

Gerald

[Hidden in reply to MountainGoat52]

thank you for the reply and supportive words, from my other post on the anti depressants they don’t look promising and I’m not convinced about taking them. There could be better actions I can take ti resolve work stress which I should have really done years ago. But my issue is a congenital heart defect, it’s anatomical and pain comes due to the heart working harder!

I understand what you’re saying, I won’t know and no one can know till I give the diltiazem a good go. 😊

[MountainGoat52 in reply to Hidden]

I can certainly relate to the issue of stress as it was implicit in me having a heart attack. The other factor was a high homocysteine level which made me prone to blood clots.

I had been self employed for 25 years and had just closed my business when I had my heart attack. I was still doing consultancy work which I thought would be less stressful, but aspects of it weren't. Since my heart attack I have adopted a more manana approach and in Cornish fashion (not as though I live there) get to doing things dreckly. I eventually retired fully after doing 3 years consultancy... then I had to get over the guilt issue caused by not bringing in money each month other than through my pensions!

As for medication to relieve your symptoms, I wonder whether you have been prescribed a beta blocker which is supposed to support heart function. Of course, all meds can bring other problems. It took over two years for me to get mine sorted and I am still keeping it under review. I'm pleased to see that you are proactive in respect of your medication. Doing so has served me well, though some clinicians do find it hard to discuss medication.

All the best,

Gerald

[Hidden in reply to MountainGoat52]

stress is a terrible disease. But I’m hopeful I can make changes too, I must there is no way I can work like I used to. So change is a must. I’m asthmatic so beta blockers are out. Thanks for the supportive words.

[jerry12953]

My medications were changed from Bisoprolol, then Amlodipine, to Diltiazem (Zemtard), originally on a low dose and increased gradually to the maximum 300mg. . The specialist I saw said there were no actual studies that showed this would reduce the pain of my angina but anecdotal evidence - presumably other patients of his - suggested it might.

I have had no side-effects and my angina is, I believe, less troublesome. I can do quite steep hills without any pain . Of course, it could be that my angina has reduced naturally but there is no way of knowing this unless I stop the meds, so it is a difficult one.

My blood pressure is also under control although it wasn't wildly high before.

Is it possible that the bad reactions you previously suffered were coincidental to the meds you were on?

[Hidden in reply to jerry12953]

thanks that could be true as I was on ranolazine at the same time, it was also stopped at the same time, but the chest pain continued but I felt less ill and head was clearer. only felt better lying down. That’s why I often thought they were the cause of increased chest pain as a side effect but when stopped the chest pain continued / has worsened. Yes a difficult one - unless I take one med at a time it’s difficult to say. I’m not looking forward to it but I will give it a go.

[MustyK]

Hi.

Hi. I have microvascular angina. I have been on Diltiazem 60mg for close to 8 years, and no side effect. I take it alongside Ranolazine, Losartan, Statin and Aspririn. I also carry a GTN spray in case of attacks ( they are very rare). Initially, I was on higher dosage of Ranolazine; I was experiencing more chest pains, and sever constipation. I halved the Ranolazine dosage; constipation and chest pains gone!! I should also add than mental being, for me, is extremely important and it does make a huge difference. I am involved in all sorts of voluntary work which keeps very busy. I go out for long walks every day to clear my head from my work (voluntary work), I enjoy close with my family and friends. I treat everyday as a bonus day. All in all I feel great. That works for me. You need to work out what would work for you to nej

[MustyK]

... sorry pressed reply by mistake. You need to work out what would work you to have a good state of mental being. Have a serious talk with yourself, and have conversations with friends : we live in an age where we are loosing the benefit of conversations. Try things and if they do not work, then try others, till you find a good set of things. Talking about it as you have done on this forum is good so keep reaching out for ideas, help, etc.

Take care.

[Hidden in reply to MustyK]

thank you for the words of encouragement I’m pretty down at the moment, it hasn’t sunk in. Because my LAD is compressed by the heart muscle that grew over it (congenital didn’t know till last year) as soon as my heart beat raises from sitting (or an emotional trigger that increases adrenaline) the pain begins, so this limits physical activities. I will give the diltiazem a good go because I’ve exhausted every other med apparently otherwise I’d hope they would have come up with it. I’ve seen four cardiologists plus I’ve now seen the UK expert on this condition and if he can’t come up with anything better, I guess I need to accept where I am, but look at this as an opportunity to work on creating a “new” life albeit working around my health issues. I will keep posting and reading other people’s posts because we can always get something positive to chivvy us along! 👍

[MustyK]

Medicine is not an exact science; some say that it has a good dose of social science. It is also a bit of a joint venture between the doctor and the patient ie you know your body and how you feel; the doctor may have different treatment/therapies. So it can be a bit of a trial and error. Having a few opinions by seeing different doctors is fine, but at the end of the day, you need to fly with one. And it does not work, that 's all it means ... nothing else, so it is perfectly okay to change and change (of course in discussion with the doctor). I keep going back to Mental well being because it is so so key to you and all of us. How we feel is how we feel. It is very difficult to change it. But, there are many things that we can do to help us lift our mood. Sharing, talking about it, seeing the being picture / perspective, looking for little things in life that we are grateful for (I am always grateful that I can drink clean water on tap when 40% to 60% of the world cannot do that for sure). Life can be peppered with little moments of little happiness : and when they happen, hold onto them, bask in them. At the end of the day, you are never on you own. So hand in there. Take care

[Hidden in reply to MustyK]

thank you for the encouraging words, not likely to sink in quickly but I’ll work on it as my mental state can’t stay as it is.