Diltiazem CD

Could someone comment on what are typical doses of Diltiazem CD for various stages of AFIB?
Is 120 mg very low dose?
Or could you refer me to another reference for information.
Thanks.

Diltiazem is dosed to the patient's needs, not any sort of stages of AF (there really isn't such a thing). The dose that works for one person might not work for another with the same "level" of AF, so doctors generally start with a standard dose somewhere in the middle range and tweak it as needed. Most patients with AF are on doses between 180 and 360 mg PER DAY, so if you're taking 120 mg twice daily, that puts you somewhere in the middle of the usual dosing range.

But whether your dosage is lower or higher than anyone else's doesn't matter. The purpose of diltiazem is to control your heart rate. It doesn't prevent AF, it simply keeps your heart rate under control when AF happens. Allowing your heart rate to exceed 100 bpm for long periods of time (weeks, months) can do serious damage, so it's an important drug if you're in AF persistently. But even if you're only in AF for short periods of time, it will reduce your heart rate and make you feel much more comfortable.

So does it keep your heart rate under 100 when you're in AF? Do you feel okay while taking it? If the answer is yes to both, then what you're taking is about right.

Thank you for your kind reply Carey.
I have persistent AF and switched from metoprolol to diltiazem CD 120 mg daily a week ago; tomorrow I begin 180 mg daily. I have been experiencing periods of unsteady walking and periods of mild to severe feeling wired/hyper/jittery when I don't seem to have outright AF. Has anyone else gone through this? I am only below 100 bpm with AF if I lie down.
Thanks.



Edited 1 time(s). Last edit at 02/05/2021 11:30PM by Vince.

You need to be under 100 all the time except when you're exercising. This is really important because allowing tachycardia (HR > 100) to continue for months can lead to heart enlargement and ultimately heart failure. I would imagine this is why your doctor is increasing the dosage.

As for the symptoms you're feeling, that's probably due to coming off the beta blocker. People who've been on beta blockers for years often develop a sort of dependence on them that can make stopping them uncomfortable. You can ask your doc to taper you off them instead of just going cold turkey, or you can just tough it out and it will eventually go away on its own.

thanks again for your reply Carey.
I am now on 240 mg diltiazem and seems to meet the HR < 100 criteria. However after 23 days I am still suffering from metoprolol withdrawal - including heart rate more sensitive to activity whether or not I have AF; more AF than usual; "low AF", by which I mean AF down to 60's and 70's bpm which did not happen before; unsteady walking; lightheadedness; foggy brain/head ache with high blood pressure; severe wired/hyper feelings with tingling of arms and legs; feeling hyper with arm or hand tremor; tingling hands; chills. All-in-all I feel horrible.
All of which seem to be common in beta blocker withdrawal.

I sure would appreciate it anyone could give me any practical suggestions how to manage this - drugs, supplements or techniques.
thanks a lot.

Basically, the problem is that while on a BB your body produced more adrenaline to try and compensate for it being blocked by the BB. After years of this, producing excess adrenaline became the norm for your body. So that's what you're feeling now -- a constant fight-or-flight reaction due to excess adrenaline. I've known other people who've gone through this and it can take months. You could ask your doc for a low dose BB and taper it down from there, or an anti-anxiety med like Xanax would also help. But be careful with those; you really don't want to trade a BB dependency for a benzo addiction.

Another thing that would probably help is more exercise, maybe lots more. Burn off as much of that adrenaline as you can.

Carey, thanks once again for your reply; your information has been very helpful for me.

I did increase my exercise and it has really helped to improve my unsteady walking and lightheadedness, to the point I went walking outside for 30-40 minutes the last two days (which I haven't done for a long time). Yesterday through the day I did a combined 1-1/2 hours of light exercise, walking on the treadmill and using an elliptical machine. Do you think that too much exercising could be counterproductive?

I still am having a problem sleeping. With diltiazem, in sinus rhythm occasionally, my HR was 60-65; 58-62 sleeping. When I have a-fib the diltiazem will generally keep my HR 80-100. With a-fib, sitting, HR goes lower, 75-80, and when trying to sleep the HR can go all the way down to 65 in a-fib. Last night during my sleep my HR was 70-80, quite variable. I slept almost 3 hours, but then was continuously wakened with a wave of feeling wired/tingling all over, which stops if I move around. This happened upwards of 10 times over 4 hours. It seems like this happens when my heart rate is at the low end of the range and wants to go lower but something is preventing it from going lower. These episodes are very uncomfortable and obviously disrupt my sleeping. If you have any explanation for what is happening and what I could do to prevent it I would be very grateful.

These wired episodes seem to be happening every second night and also have occurred when I try to nap in the morning or afternoon.

I am measuring my heart rates with my Garmin sports watch. My doctor has given me a very limited supply of lorazepam, but he has emphasized that they are for emergency only and I have avoided them. At my doctor's suggestion I am taking a supplement called NeuroCalm (by Designs for Health) to try to help with sleep. Thanks for any help.