What might I do next?

Hello, it’s been a while. I take metoprolol, flecainide, and Pradaxa. Today before I took my metoprolol 25 mg extended release at the regular time of 4 pm o’clock, I noticed I was having tachycardia. I tend to have a slow heart rate with my regular meds, but my heart rate was 118 and climbing. I took the metoprolol extended release at 4pm and now it’s two hours later without much change except that my heart rate has climbed to 128.. I’ve had the big pee too. I drank some low sodium V-8. I have some diltiazem that my EP suggested I use as PIP but I’ve never taken it before. His instructions were to take it at least an hour after my metoprolol. Since I usually have a low heart rate when I am “normal”, will taking the diltiazem likely lower my heart rate even more? That worries me as I’ve never used it. My EP is of course gone for the weekend and I’m really trying to avoid going to emergency— I would have to go by ambulance because there’s no one who could drive me. People might think it’s weird getting input from a forum but collectively, you’re all the smartest people I know about experiences with this. It’s close to 6 PM here on the West Coast, Friday night. Thanks in advance.
SueChef



Edited 1 time(s). Last edit at 02/09/2024 08:57PM by SueChef.

I'm not a doctor and this is from my experience only. Metoprolol would work in about an hour for me (I don't like metoprolol, it had too many side effects for me) and it would start doing whatever it could. I take 240 mg of diltiazem CD right now, and it lowers my heart rate about 15–20 BPM. When I was taking diltiazem 120 CD, it would lower my heart rate about 10 BPM. I'm guessing they gave you the normal release, and it should work out of your system in about 8 hours. Myself I would take it with my heart rate at 120 BPM, I know that is not a good position to be in, I was at that rate for a long time as my normal resting heart rate. You could try calling your EP's office, most have an after hours person on call and can help you decide with the medication.

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Since I usually have a low heart rate when I am “normal”, will taking the diltiazem likely lower my heart rate even more?

Yes, it will—it will also lower your BP. What strength do you have and is it extended release or immediate release? People react individually but when I was given a Diltiazem “push” in the ER to convert me, they filled a syringe with 10 mg and slowly pushed it in over about 10 minutes, carefully watching my BP and HR. When my HR got down to about 65 I converted. Of course you would be taking a much higher dose when you take it orally as it takes up to an hour to be metabolized and, for me, I eliminated it very quickly. The instructions from my EP were to start with about 60 mg immediate release and to take another 30 mg each hour if my HR and BP stayed at reasonable levels. Of course you don’t know what your own EP would say I can only share what mine said. It would be trickier with extended release as you can’t fine tune your dose.

Thank you both for ringing in. My EP said nothing about my BP when he prescribed Diltiazem as PIP. I ended up taking half a tablet, it’s a 30mg tablet so half was 15mg. It’s not extended release. I my take the other half in 30 minutes & wait another half hour & if that doesn’t work, I’ll call an ambulance. Thanks again.

30 minutes is barely enough time for a pill to dissolve. You need to wait longer, at least an hour or two. And frankly, I can't see why you would want to call an ambulance and spend the night in the ER. You're in no danger and it will most likely stop on its own if you stay home and relax.

Thank for the input Carey. My EP said that if my bpm gets over 110 that I should go to the ER. I’ll give the Diltiazem some more time to work. Isn’t there a human health limit as to how many hours you can have tachycardia before you should seek medical intervention??

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SueChef
Thank you both for ringing in. My EP said nothing about my BP when he prescribed Diltiazem as PIP. I ended up taking half a tablet, it’s a 30mg tablet so half was 15mg. It’s not extended release. I my take the other half in 30 minutes & wait another half hour & if that doesn’t work, I’ll call an ambulance. Thanks again.

In my experience 15 mg is too low a dose to have much of any effect. I only started to notice it with 60 mg and usually had to take at least 90 to lower my HR to a normal level. And I was told to wait an hour between doses so as to have assimilated it enough to see what was happening.

Thanks, Daisy for the extra info—very helpful to me!

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SueChef
Thanks, Daisy for the extra info—very helpful to me!

If you go to the ER they would most likely put you on a diltiazem drip and you would have a miserable night of it! You can do the same thing at home with oral Diltiazem , it just takes a bit longer. But if you do end up in the ER ask for a push rather than a drip.

Thanks again, Daisy!!!! In the past, I’ve converted after 2 “pushes” of metoprolol, given 10 minutes apart. The max they were going to do was three pushes but thankfully I converted after the second one. Thanks so much!!

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SueChef
Thank for the input Carey. My EP said that if my bpm gets over 110 that I should go to the ER.

110? Really? Unless you have some vulnerabilities I don't know about, that's extremely conservative advice. Like off the charts conservative. There's really nothing an ER can do for you other than give you diltiazem and let you wait for hours until it resolves on its own, which it would probably have done if you had just stayed at home.

I guess I’m wondering how long it would take for it to resolve if I stayed home —-and to me, a hr of 110 to 125 for hours and hours is worrisome. In the past ER visits, I was given metoprolol, which resolved the issue.

It's been 8 hours. Things any better now?

Hi Carey & thanks for checking in. I was due to take Flecainide at 11pm last night but I had already taken Diltiazem at 7:40pm and I remembered some thing about how they don’t play nicely together so I called after hours at Kaiser, which is available 24/7, and they checked with the ER doctor and I was told to not take any more diltiazem but to take my flecainide as scheduled at 11 o’clock because as I mentioned, they don’t play nicely together. If the Flecainide didn’t resolve the tachycardia after a couple of hours, I was told to go to the ER. A bit past 1:00a.m. My heart rate did start to come down. By 2:30a.m. It was almost back to normal-for-me & I’m thankful I didn’t have to get to the ER. Thanks to everyone who rang in here!

Great news!

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SueChef
because as I mentioned, they don’t play nicely together. If the Flecainide didn’t resolve the tachycardia after a couple of hours, I was told to go to the ER. A bit past 1:00a.m. My heart rate did start to come down. By 2:30a.m. It was almost back to normal-for-me & I’m thankful I didn’t have to get to the ER. Thanks to everyone who rang in here!

Glad things appear to have resolved, but don't understand "they don't play nice together". If you're talking about Flec and Diltiazem, they do play nice together and that's why they are often prescribed together with the Diltiazem acting as a nodal blocking agent.

A couple of other thoughts. The possibility exists that your tachycardia was aflutter with the rate repressed by your beta blocker. If that is the case, according to my ep, you should never take Flecainide while in aflutter. So without an ekg to rule out flutter, I think it was irresponsible for the ER doctor to advise you take it. Here is where an ekg genertated by Kardia or Apple Watch can help dictate home treatment.

I agree with the others that in most cases it's preferable to treat various tachycardia's at home, versus running to the ER. When you finally get in touch with your ep, you should discuss various scenarios and come up with a home plan for each.

Jim

I speculate ChefSue meant they may interact.

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susan.d
I speculate ChefSue meant they may interact.

Zero drug into reactions per drug checker. That said there's always the possibility that a certain combination of drugs don't work for a particular person. But in general, these two medications are prescribed together all the time.

Jim

Agree that diltiazem and flecainide are prescribed together all the time. No problems there.

I suspect the ER doc was worrying about BP effects, which is kind of an ER doc thing to worry about. They picture you bottoming out your BP, hitting the floor, and ending up back in their ER with a head injury.

Advice: Don't get your cardiology advice from ER docs unless you're in serious distress. Distress is what they do, not disease management.

Jim, what’s the difference between tachycardia and aflutter? How do you tell one from another?

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mjamesone

A couple of other thoughts. The possibility exists that your tachycardia was aflutter with the rate repressed by your beta blocker. If that is the case, according to my ep, you should never take Flecainide while in aflutter.

quote=Yuxi]
Jim, what’s the difference between tachycardia and aflutter? How do you tell one from another?
./quote]


Tachycardia simply means your heart rate is over 100. It could be a regular or irregular beat. It could even be due to exercise which is a normal response.
Atrial flutter is a specific type of tachycardia of most often fast but evenly spaced beats that can sometimes be confused with other tachycardia's, or even afib. It is therefore best diagnosed with an EKG so the treatment is appropriate.

Jim



Edited 1 time(s). Last edit at 02/10/2024 07:25PM by mjamesone.