Diltiazem

I have seen some comments about using a brand rather than the generic in you are taking this drug for arrhythmia/rapid hear beat/palpitations, etc. Can I ask what brand? Cardizem? Also, do you take a 3-4 times a day dose, or twice a day, or once daily? I am wondering if a once a day timed release capsule might be best so it is spread out evenly? very confusing---ER/SR/LA/CD etc. thanks

Some say time release and if you get an episode then to take a fast release as a pill in the pocket. It depends on each patient’s situation and if you have a pacemaker how much is safe to take. I just switched from 3/day rapid (useless now) to time release/then smaller dose rapid release PIP.

I have found that if you split the fast release it’s faster to convert. I’ve gotten converted within 15-20 minutes by splitting it. I’m not sure if the rapid tablet is enteric coated and the act of splitting it gets released quicker. The time release is a capsule.

I’m 81 hours in flutter. Miserable rotting in the hospital. They are trying now time release today and PIP rapid tomorrow. I’m up to 54 ecv now. Burns are more painful this time. I’ll let you know bneedell as an individual experience which (rapid or time release) is better. But everyone is different. So far my hr is faster on the slow/time release. I don’t like time release so far but it’s only been 1.5 hours and I have to give it a chance.

Regarding generic vs brand, my husband is a retired pharmacist and he believes in brand for cardiac and cancer over generic. Tambocor I used instead of flecainide and I noticed the difference. I wasn’t offered in the hospital Cardizem brand. They are giving me generic which is useless.

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susan.d
I wasn’t offered in the hospital Cardizem brand. They are giving me generic which is useless.

That's simply untrue. Millions of people take generic diltiazem daily with the exact same results as brand name Cardizem. All the drugs I take are generic except one, which doesn't have a generic, and they all do what they're supposed to do. I know you've got this thing about generic drugs but the reality is insurance companies and government health plans aren't going to pay for brand names when licensed generics exist.

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Carey

I wasn’t offered in the hospital Cardizem brand. They are giving me generic which is useless.

That's simply untrue. Millions of people take generic diltiazem daily with the exact same results as brand name Cardizem. All the drugs I take are generic except one, which doesn't have a generic, and they all do what they're supposed to do. I know you've got this thing about generic drugs but the reality is insurance companies and government health plans aren't going to pay for brand names when licensed generics exist.

My beef with generic brands is where they are manufactured and how strict they are compliant to storage and temperature control vs American brand drugs usually/not always made in the states. I said that this hospital stay the hospital’s generic for cardizem was not effective. I have no clue where it was manufactured. Somewhere they were able to get a good price. China? I don’t know or have a choice because I don’t have the luxury to see the bottle. Also most meds (see bottle insert instructions) are more effective between 67-76 degrees. I don’t have it handy right now, but I once shared a Ny article on how 9 months after a NY heatwave usually has a higher volume of births due to women not storing their birth control pills at a optimal temperature. At home I store my drugs in a controlled temperature environment with a digital temperature display. Hospitals are notorious for being cold. Even the nurse tonight admitted it. That’s not to say the drugs I’m getting are useless because it’s generic, there could be multiple reasons I listed that is the reason the generic I’m getting is useless and not successful for me. I have better expiration dates with brand and had a few expired meds dispensed a few times with bulk generic drugs. It depends on how long the bottle was on the warehouse shelf. That’s why I prefer getting the original bottle when possible for the correct date. You may notice that some chains dispense in their own plastic vials and hand write exactly a year in the future from the actual date it was dispensed. I’ve asked to see the original bottles and snap a picture to get lot numbers and dates. Twice I had drug recalled and knowing the lot number and expiration date comes in handy.

My retired pharmacist husband has a different outlook of brand vs generic drugs. He looks at the chemical composition of both. They are not always mirror identical. He told me there is always a tweak difference. Some don’t react differently from brand vs generic. Some people (yes me) find by trial and error that brand does make a noticeable difference. I gave Tambocor as an example for my preference and experience in being more effective when I was taking the brand.

And yes insurance companies prefer the cheapest. But my life matters and I advocate for what’s best for me and am willing to pay the slight copay difference to give me an advantage of staying healthy.

An interesting discussion of the generic vs brand meds in this Peter Attia podcast with Katherine Eban.

Branded vs. generic drugs: Why they aren’t the same thing [11:15];
The Food and Drug Administration: Why it was originally created and what it does today [20:45];
How the generic drug industry really got its start in the U.S., and the flaw of the Hatch-Waxman Act [28:20];
PEPFAR: How a well-intentioned plan to help Africa with the AIDS epidemic laid the groundwork for corruption [36:30];
The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45];
How the FDA approves drugs, the impact of “first to file”, and Peter’s tangent on moral corruption [47:30];
A booming generic drug market and the FDA struggling to keep up [57:15];
Dinesh’s internal investigation finds widespread fraud and falsified data inside Ranbaxy [1:00:15];
Presenting the famous SAR document to Ranbaxy’s board of directors which spells out the company-wide fraud [1:09:15];
Dinesh blows the whistle on Ranbaxy which leads to a raid on their US plant [1:19:45];
Formal investigation of Ranbaxy is launched, but the FDA keeps approving Ranbaxy drug applications [1:33:30];
What role does the culture in India play in the high prevalence of fraud in the drug industry? [1:41:00];
The extreme prevalence of data fraud/manipulation in foreign generic drug factories [1:52:30];
Concluding the Ranbaxy story [2:06:15];
How concerned should you be when buying a generic drug from your local pharmacy? [2:11:15];
How to investigate your own drugs for quality to ensure you are getting what you need [2:18:30];
An innovative pharmacy that tests all its drugs for quality [2:24:45];
Reforming the FDA and generic drug industry: Why we need reform and ideas on how to do it [2:27:45];
The importance of taking individual ownership and not waiting for Congress to bail us out [2:34:00];
Closing thoughts from Katherine [2:36:50];

Also this Attia podcast with David Light CEO of Valisure, an online pharmacy that tests all its meds.

Per Susan's comment, I've bought branded flec, Tambocor, from Europe (not sold in the US anymore) after my initial US Tambocor pills expired - they were purchased the year (2004) that Tambocor went off patent.

Susan, that's all well and good but generic diltiazem is not "useless," which is what you said. It works as intended and just as well as Cardizem for millions of people.

Do you subscribe to Peter's podcast?

I

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bneedell
Do you subscribe to Peter's podcast?

If your question is directed to me, the answer is yes.

I again disclaim it’s may not be useless/as effective for everyone. Generic isn’t equivalent to brand for many of the reasons I mentioned previously. I would never buy a generic from India-thanks George, and from what George handsomely shared for other reasons explained from his linked podcast.

If someone has an indifference attitude about getting the best choice for their drug selection availability (or spend the effort to special order from their pharmacy on getting a drug that is not manufactured from poor temperature and quality controlled countries) and are not striving to get the best results they can advocate for themselves by drug choices..then by all means buy the generic. I personally use the analogy of drug choices to picking the best EP for an ablation.



Edited 1 time(s). Last edit at 11/16/2022 02:40PM by susan.d.

Has anyone been able to get Cardizem CD 120 mg? None of the pharmacies I have tried can get it for me.

Try blink pharmacy. They deliver and undercut prices. Two options- their discounted online delivery or their expensive option of ordering it online and picking it up at your local pharmacy.
(844) 926-2480

GeorgeN, my husband and I just listened to Peter’s podcast. It is amazing what we learned. For insurance purposes, most of our meds are generic. I will be going through each one to try to find out which are manufactured in India and will be switching the ones I find. I found a great website for the generic manufacturer AMNEAL. It lists each drug they have and the country of origin. Easy to use and I already called the pharmacy and told them to switch an expensive drug my husband takes to AMNEAL because it is not from India but the USA!! I know brand drugs would be the best, but this is the second best at this point!

What great information! …..
Depressing at the same time!!

No luck, Susan. even they only have the generic, but is made in Taiwan and I'm going to give it a shot.

I agree with Susan and George and amazingly Peter Attia who sometimes has an agenda and other times gets basic facts wrong.

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bneedell
Has anyone been able to get Cardizem CD 120 mg? None of the pharmacies I have tried can get it for me.

I checked a few discount sources like GoodRx. For brand name Cardizem CD (30 pills), the lowest price on GoodRx was $848. Meanwhile, generic diltiazem can be found for less than $5.

I find that's pretty typical for brand name drugs that have generic equivalents. The sales volume is so low that manufacturers have to charge outrageous prices to make it worthwhile keeping the factory running.

I’ve recommended israelpharm before. I get many rx from them

[www.israelpharm.com]

Generic Adizem Cd 120mg 30 Tablets

$14.74

Yes it’s generic but they cover my checklist-great temperature control, great expiration date, 3 day free delivery with $75 order (I buy six months in advance which is convenient). I used this pharmacy while I was recently in Israel.

If you use the following code you get $50 off. $75 qualifies for 3-4 day free shipping. Mine are DHL shipped.
ref6604998 Is the code

Susan, a person at Blink Pharmacy told me to use their pharmacies in my zip code. There are several. I can call those pharmacies and have the staff there check out the drug and manufacturers and have it filled there for me to pick up. No mail order, etc needed.



Edited 2 time(s). Last edit at 11/16/2022 09:04PM by Pixie.

for those of you who take a once a day capsule, does anyone take it in the evening? My palpitations are worst at night and HR stays high. Am transitioning from a 3X per day IR tablet. thanks

Mine at 6pm -time delay/release . I found flutter took me until midnight to end and by morning it was back. I like the IR so if I’m around 45 minutes early in flutter I can take a pill.

I did switch from 3x day 75mg (1 1/4 tablets) to one time release and then PIP 60mg IR every 8 hours as needed PIP. 3 max a day. It’s less meds to take and I’m on day 2 so I can’t say which is better. I will say I was more successful when I split the pills (pill cutter to quarters which exposed the enteric (?) coating) and became fast acting within 20 minutes. You may want to discuss with your EP if you get afib/flutter if you can cut/split the next scheduled dosage to convert faster. I know many here chew their flecainide and convert quicker. Perhaps cutting your IR will help. IDK.

Britain says there is a difference. According to the Brits, in their experience diltiazem is one of the few meds where which brand of generic a patient takes matters. Decide for yourself.

"As stated in the BNF and SPS, modified release Diltiazem containing more than 60 mg*
should always be prescribed by brand, rather than generically. Different versions of
modified-release preparations containing >60mg diltiazem hydrochloride may not have
the same clinical effect. To avoid confusion between these different formulations of
diltiazem, prescribers should specify the brand to be dispensed."

[nwlmcs.org]

Thank you Michael! I wasn’t successful with my Chinese generic Cardizem and ended up not converting for 16 days. I blame the Chinese generic. Since I was hospitalized I didn’t have the luxury of asking for brand. I have to bring my own brand Crestor with me to the hospital pharmacy and they place their barcode on it for the nurse to give me because many drugs are not available to them. They didn’t even carry the generic for Prilosec and only offered Lipitor and protonix for crestor and Prilosec.