Diltiazem

Did anyone have the experience of some brands of extended release diltiazem working better than others? Which brand is the best? My previous brand seemed to keep my pulse more stable through the day. When my pharmacy switched me to a different brand, my pulse seemed to vary more throughout the day. As monitored by my battery powered pulse/ox.

No I haven't noticed a difference between brands, but to just to cover all of the possibilities, I have observed the following:

-- Sometimes on a Pulse/Ox the batteries get worn down and it gives erratic readings.
-- The device itself just stopped working correctly.

-- In addition there are various forms of Diltiazem that get confused.

Sustained release
Extended release
Immediate release
Controlled release

You can always check your pulse ox with a manual pulse reading of the radial pulse.

Okay, I didn't know there was a difference between sustained release, extended release, and controlled release. Which is best for diltiazem 360, and which brands use the best method?

I own 4 different pulse/ox units, and check their readings versus each other. The batteries are fairly new in all of them.



Edited 1 time(s). Last edit at 09/19/2021 11:50PM by Michael777.

I am on the extended release right now b/c I am in afib.. so mine is erratic anyway but I 100% believe various brands can do that on some meds. If you get it at a small pharmacy you can ask for the same brand. And a doc can always write it for a specific brand... although the pharmacy may not always be able to get it..

The brand I successfully took for many years was from Sun Pharmaceuticals. It was an oblong white/blue capsule with 679 stamped on it. This is it: [www.drugs.com]

The pharmacy I was obtaining it from said they couldn't get it anymore. I went to another pharmacy to ask. They looked it up and said Sun wasn't making them anymore. (Then they offered to sell my a different brand for $1000.)

The 679 Sun brand used to keep my resting pulse pretty steady at 62 BPM. The two brands I have tried since then vary my resting pulse between 57 and 71. That is, sometimes there was too much diltiazem in my system, and other times of day too little. I was event free for several years when taking the Sun pill. Within weeks of switching to the other brand I was in afib with RVR 3 times. This seemed to coincide with the period when my resting pulse was around 70, and thus very little diltiazem in my system. I would like to find the 679 Sun brand again, or a pill made with the same time release mechanism.



Edited 1 time(s). Last edit at 09/20/2021 11:04AM by Michael777.

I don't think it matters much if your pulse is variable. Why are you focusing on that? If you have afib it's going to be variable.

I am focusing on how much diltiazem is in my system during various times of the day. Resting pulse is just a proxy for that variable. When I had a constant amount of diltiazem in my system, I was event free for years. When the quantity of diltiazem varied during the day, afib happened 3 times when diltiazem in my blood was low.

I've been trying to do a bit of research. There seems to be different time release mechanisms. Controlled delivery being the best, as it keeps the level fairly constant. Extended delivery seems to be periodic release every few hours, which allows levels to vary throughout the day.

Another thing is puzzling me. There seems to be different molecular configurations of diltiazem made by different companies. ab2, ab3, and ab4. ab3 being trigonal planar, and ab4 being tetrahedral. I'm not quite sure how this affects different people when they are switched from one to the other. Anyone understand what this is all about?

Quote
FDA Orange Book Section 1.7
In certain instances, a number is added to the end of the AB code to make a three character code (i.e., AB1, AB2, AB3, etc.)...Drugs coded with a three-character code under a heading are considered therapeutically equivalent only to other drugs coded with the same three-character code under that heading.

So AB3 and AB4 are not considered to be therapeutically equivalent forms of diltiazem. Only other brands of AB3 are therapeutically equivalent to each other. Something that might help someone else, if their pharmacy unexpectedly switches them from one form to another. The FDA helpfully sent me a list of different AB3 brands that I can buy, and still stay within the AB3 rating. Along with the link to their Orange Book explaining how the rating system works, and which drugs are rated what. Here is a link to the preface which explains their rating system:

[www.fda.gov]



Edited 1 time(s). Last edit at 09/26/2021 05:09PM by Michael777.