Chewing Diltiazem ?

Hello all

I have very little experience with rate or rhythm meds for afib/flutter because for 3 yrs a really low dose of metoprolol was all I needed for paroxysmal afib/flutter. Things changed suddenly about 3 months ago to a 24/7 persistent flutter that I couldn’t just live with because the top rate was 150 and the low dose of metoprolol couldn’t keep it down. I had an ablation but flutter came back in a few days, this time with a top rate of 170. Now I’m on Diltiazem immediate release which is working ok. I just need it to work til the end of July when I’m scheduled for a second ablation. The problem is it seems like the amount I need to stay out of the 170 rate seems to vary depending on my activity level and maybe stress. I’ve had my heart rate jump from the 55 flutter rate to the 170 (bypassing the perfectly serviceable 85 rate for some reason) then I’ve wound up in ER . I’m too old to wait an hour for a Diltiazem tablet to work with a 170 hr. I don’t want to up my dose or go on extended release because it will likely put me in bradycardia or give me pauses. The NP agrees with that. Taking a little extra Diltiazem when I feel like I need it I think would work but it takes at least 45 minutes for it to get into my system.
So I’ve read about people chewing PIP meds to get them to work faster and wondering if anyone has tried this with Diltiazem. The pharmacist has assured me that it’s ok to cut the pills so it seems worth a try. Also, when I had my first episode of afib, they gave me Diltiazem and told me to take it “if I needed it”. I didn’t have another afib episode for 10 months so I never did take it.
Better than having to go to ER.

Can you chew it? Sure. As the pharmacist said, it's okay to cut it so if it's okay to cut, it's okay to chew or crush into a powder and mix with water. I would probably go with crushing it and mixing it in lukewarm water. That will probably achieve the maximum speeding up you can get.

Thanks Carey
That will be my plan

I’m shooting my stomach up BID with heparin. Why don’t they have injectable Diltiazem as a shot in pocket method to convert? I know it’s dangerous because I would ask for a push in my vein instead of an IV drip in an ER trauma room setting and they slowly had to push the contents of the vial over 8 minutes into my vein.

Wouldn’t it have a safer slower absorption rate if one shot it into a fatty area in their stomach or hip instead of a vein like heparin?

However I don’t see a doctor prescribing it for liability and safer risks.

Just thinking out loud .

There really aren't many circumstances where a patient needs diltiazem to act so rapidly as to justify a home injection. Plus, who knows if it would be absorbed well that way?

Hi Susan

Hmmm. They gave me a 10mg Diltiazem injection in a vein in the ER the other day and I went from 170 to 85 bpm within five minutes. Then it was just a matter of waiting an hour til my hr was 55.

How big of a dose requires an 8 minute push or an IV drip?

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Evelyn
Hi Susan

Hmmm. They gave me a 10mg Diltiazem injection in a vein in the ER the other day and I went from 170 to 85 bpm within five minutes. Then it was just a matter of waiting an hour til my hr was 55.

How big of a dose requires an 8 minute push or an IV drip?

I can also share experience with this as I had an IV push of Diltiazem in the ER. They pushed 10 mg but VERY slowly--a few mg at a time, wait to see how I responded, then a few more mg. They were cautious about causing Bradycardia. They stopped when my HR stabilized at about 60 and I had converted. The push worked much better than the drip they gave me during another visit.

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Evelyn
How big of a dose requires an 8 minute push or an IV drip?

It's not the dosage that matters as much. Getting a drug IV eliminates the entire digestive process, which typically takes at least 20-30 minutes for the drug to start becoming effective, and that will be slowed by food in the stomach. Getting it IV push has immediate effect and getting a drip is more comparable to taking it orally.

Interesting. They only did this once on one of several recent trips to ER. Another time they had a hypo all ready to inject but I was slowing down on my own fast enough that they didn’t need to inject it. But the time they did do the “push” it sure didn’t seem like 8 minutes.
Maybe my sense of time was a little skewed.

IV push requires the patient on a monitor. The few times I was bolused the ED doc came in and watched the monitor while RN pushed the med. And yes the IV med is given slowly.

All I know was I was getting a 8 minute push into the vein (15mg) and it worked for me.

Once a RN nurse was starting to administer a drip alternative and I told him for my body a push would convert me. He rolled his eyes so I asked him if he could talk to Robert, the other ER RN who usually does it.

Bottom line he gave me a 8 minute push and we both watched the clock and I converted at 8 minutes. i was in and out of the ER and this method worked for 6-8 months until it became ineffective, even at 20mg, and nothing could convert me even an ECV (I had 54). That’s when my only choice was an AV node ablation.

Disclaimer I have a pacemaker so they were willing to push the drug safely. Currently I electively decided to remain in 120mg CD slow release diltiazem BID because it helps calm my Afib. My ventricles beat steadily at 60 but my upper chambers, although safe, beat as high as 350-400 which is no longer a concern but I feel the palpitations . With diltiazem it feels calmer. I can see the difference when I read my pacemaker downloads . Between the pacemaker therapy and diltiazem, I convert quicker at home, knock on wood. Except when I had covid, I had to let it run it’s course because nothing worked