Paxlovid and Diltiazem

I am posting this in this forum rather than the General Health Forum because it pertains to AFIB. I know there has been discussion about Eliquis and Paxlovid, but I don’t recall anything about diltiazem. I have been so careful about Covid issues for the last three years! I was in Austin on 11/30 for my first tee. I think my husband and I were the only ones wearing masks. Well, on Saturday I started having Covid symptoms. Took 2 tests that day and they were both negative. I got worse and on Sunday took two tests and both were positive.

Since my Dr. Natale ablations, my heart rates have been in the 70’s, 80’s and 90’s. I asked Dr Natale about that and, as Carey has said in this forum, it could take a year for the heart rate to drop.

I will be talking to my PCP tomorrow about Paxlovid and diltiazem. I just received an e-mail back from one of Dr. Natale’s APNPs and he said do not take diltiazem if I took Paxlovid. I asked him about my heart rate going into the 100’s without the diltiazem and then what about the Paxlovid rebound if that were to happen. I hope he responds to my email quickly.

Any thoughts on this would be appreciated. Of course the decision has to be made in a day or two. I am high risk because of my age and AFIB??

As an aside, I am still unsure about getting the bivalent booster after talking with Dr. Natale.



Edited 2 time(s). Last edit at 12/05/2022 12:54AM by Pixie.

In my case, i tested positive for Covid for 10 consecutive days recently. I decided not to take Paxlovid because of my paroxysmal AF and taking Flec & Eliquis as pip.
First night and following day of symptom onset was very uncomfortable. Second and third days not so much. After that i just felt NQR but otherwise ok. My symptoms were, cough and 'soreness in bones' like flu, lacking energy - otherwise ok.
Two weeks after testing negative i dug up soil and filled a 6 cubic meter bin with it (over 3 days). All manually with shovel and wheelbarrow - a bit uphill as well.

If your symptoms are not too bad perhaps not taking Paxlovid is the better option?

I was very careful for 2.5 years. Stayed home and got everything delivered —unless I was in the hospital and even then my hospital door was closed and my nurses wore n95 and food serve and housekeeping was denied entry. Fast forward to this august and I left my cave and caught covid within days. My tachycardia lasted 29.5 hours. I regretted it. I developed o2 saturation at 70 and I still have long covid with fluid.

Is the antibody treatment still available? I wish I had that. However you need to get it within a few days of symptoms and it may not apply.

Feel better.

I plugged Paxlovid, Diltiazem and Eliquis into the drugs.com interaction checker. Here are the results:

Interactions between your drugs
Major
ritonavir apixaban
Applies to: Paxlovid (nirmatrelvir / ritonavir), Eliquis (apixaban)

Ritonavir may significantly increase the blood levels of apixaban. This can increase the risk of serious or life-threatening bleeding complications. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.


Moderate
dilTIAZem ritonavir
Applies to: diltiazem, Paxlovid (nirmatrelvir / ritonavir)

Ritonavir may increase the blood levels and effects of dilTIAZem. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience increased side effects. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.


dilTIAZem apixaban
Applies to: diltiazem, Eliquis (apixaban)

DilTIAZem may increase the blood levels of apixaban, which may result in a higher risk of bleeding complications. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Pixie
As aside Dr. N is still not supporting the bivalent booster.

Do you know why he doesn't support it? I'd be interested to hear. Sorry you have Covid--take care of yourself!

My main complaint with my Covid symptoms is the cough and a tremendous sore throat. I can barely swallow and eating is an issue. This came so soon after my TEE, I am wondering if one can get this throat issue a few days after getting a TEE. I don’t know. It is just a thought.

Adding this information in case someone else may be asking the same thing. My first reply when I asked about this was to stop the diltiazem if I start Paxlovid. The second reply had a different take on it. That person was not finding any issues with Diltiazem and Paxlovid. The study said these are ok together but monitor for individual side effects. This helps me make a decision that is right for me.

Get some strong gum when you start taking Paxlovid, it has your mouth feeling like you're eating aluminum foil.

Quote
PavanPharter
Get some strong gum when you start taking Paxlovid, it has your mouth feeling like you're eating aluminum foil.

Thanks for the tip. Did they have to adjust any of your medications for the 5 days?

Quote

As aside Dr. N is still not supporting the bivalent booster.


Do you know why he doesn't support it? I'd be interested to hear. Sorry you have Covid--take care of yourself!

He probably has good reasons. Perhaps he even listened to Paul Offit (a member of the FDA advisory committee and co-developer of the Rotor virus vaccine among other top qualifications)

"As an aside, I am still unsure about getting the bivalent booster after talking with Dr. Natale" was the original statement
"As aside Dr. N is still not supporting the bivalent booster". is what was quoted.
I am wondering if he actually said that he didn't support it, because the quote is not accurate.
I realize this is off the original topic but but it seems like an important concern for many.

Quote
JDfiB
"As an aside, I am still unsure about getting the bivalent booster after talking with Dr. Natale" was the original statement
"As aside Dr. N is still not supporting the bivalent booster". is what was quoted.
I am wondering if he actually said that he didn't support it, because the quote is not accurate.
I realize this is off the original topic but but it seems like an important concern for many.

I changed the original wording to this: “as an aside I am still unsure about getting the bivalent booster after talking with Dr. Natale “. Frankly I did it because I knew this might be controversial and I wanted it to be reflected fairly. I have much respect for Dr. Natale . He has seen some cardiac issues with folks who received the bivalent booster. In talking to him a second time he said it might be because those folks got the combo……flu and bivalent at the same time. He said I should do what is right for me and if AFIB issues arose, we could handle that.

Thanks for the clarification

Note: I got the bivalent booster in September wanting to be protected for my upcoming trip to Austin—I did not get the flu vaccine. I had Afib episodes every day for about 10 days after the vaccination, though of course it could have been unrelated.

I had a second hit of covid 4wks ago (first in 2020). Not sure where I contracted it because I considered myself the poster child for covid protection with constant masking, hand sanitizing and avoiding indoor crowds! Very sick both times. The urgent care doctor said I was not a candidate for the Paxlovid because I was on Eliquis and Flecainide. So, I toughed it out without it. I went to see my EP last week and asked about the bivalent booster that I didn't get yet, and I was told many of his patients got very sick from it. I got the feeling he didn't recommend it but wanted the decision left up to me. Since I just recovered from covid, I'm not due for booster until March. My EP said if I get the booster and have any cardiac issues, he'll take care of me. That's comforting but scary as hell that I could be putting my heart at risk for severe complications! I haven't made up my mind yet.

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Muntz
I was told many of his patients got very sick from it.

Oh c'mon, it's maybe 24 hours of feeling kind of crappy, and that's only for some people. COVID would scare me a hell of a lot more than a minor reaction to the vaccine that mainly just proves it's doing what it's supposed to do.

Had my Pfizer bivalent booster (third booster so far) a couple of months ago and had a slightly sore arm for half a day. Got my flu shot in the other arm at the same time.

I have had two Pfizer vaccines and two Moderna, and I'm getting the bi-valent on the 22nd. I'm almost disappointed because I have yet to have even the slightest reaction from any of them. I have gotten the flu vaccine since 2000, a requirement for those in the Canadian Armed Forces since about that time if one is 'deployable' (able to be sent off for months at a time with as little as 48 hours notice). I have had a slightly sore arm a number of times, maybe five in all that time.