Starting Diltiazem with Toprol

[Cynaburst]

Hi all,

I am going to be starting diltiazem together with Toprol tomorrow, and wanted to know any tips or experiences that anyone has had with the drug.

I am starting on a tiny dose...he gave me 30 mg. tablets of the short acting drug, and I am to start with only one pill for a few days, add in a second for a few days, and then a third, so until we see how it goes. I know that the starting dose is usually 120 mg, but I find that I am very sensitive to drug changes, so going slow sounds good to me.

Also, I read on the internet that grapefruit can react with diltiazem. Have any of you been told to avoid grapefruit?

[LindaSo]

Yes, there is a food/drug interaction with Grapefruit. You should have a warning label on the bottle. If you google food and drug interactions and then put in the name of the drug, it pops right up. So, yep, Grapefruit/juice is on your new list of "no no's". Has to do with the uptake I think.

[latecruiser]

I am on both (50mg Toprol and 120mg Diltiazem, and yes - no grapefruit)! I do seem to get a little more light-headed on both drugs, so i have to be careful about how fast I get up and start walking, etc.

[Largehearted]

Grapefruit seems to interact with a lot of heart meds (which is a drag as I love - or used to love grapefruit).

Let us know how the adjustment goes.

Peace,

Leon

[Cynaburst]

So far so good. I took one 30 mg. tablet this a.m. and I waited around the house for awhile to see how I felt. While I did feel a little foggy, I then decided to take a walk around the neighborhood, and I have to tell you...the chest pain was clearly improved over my walk yesterday without the diltiazem. So I am very hopeful that this will improve my symptoms.

[Pam Alexson]

I remember that foggy head feeling... it went away when I adjusted.

[mtlieb]

Cynthia, my biggest problem with taking diltiazem + beta blocker was edema. I doubt you'll experience the same side effect but it's worthy of mention nonetheless. My feet blew up like a freaking parade float when I was put on diltiazem. In fact I had not previously experienced a single bout of edema until my doc put me on Cardizem. I think I started out at something like 180 mg. Anyway, just something to look out for.

[Cynaburst]

Well, so far, so good. I am up to 90 mg. a day. I think that the smallest dose of the extended release is 120 mg. so I guess I will go up to that, but to start he put me at this dose. It has helped alot with the chest pain, and I have not had any edema and I seem to be tolerating this dose well, so that is all good.

[LindaSo]

Cyn,
I have never had any problem with swelling. After max dose of Verapamil with increasing chest pain frequency, we decided to give Cardizem a try. What did we have to loose? I lost nothing and gained everything. My chest pain is very much improved. My hope is that your diligence with titrating to the correct dose for you will result in great results. After all, this is the season for miracles.
Linda

[shirleymahoney]

The doctor was going to put me on Diltiazem but my blood pressure was too low like 90/50 so he said no, he wanted to because of chest pain and tachy problems I get from time to time. Cynthia good luck on your change.

Shirley

[tenor12bucks]

I used to love grapefruit too. Here's the deal:

The body processes some drugs (not all) in the liver through an enzyme system known as P450. Grapefruit and grapefruit juice - as well as some other drugs classified as P450 inhibitors - contain compounds that impair or shut down the P450 system.

The result, if you ingest both a P450 inhibitor and a drug that is metabolized by P450, is that your exposure to the drug can go through the roof. That's a potentially dangerous situation.

Man, I miss grapefruit, especially this time of year, with the citrus catalogs coming out of Florida and all that. Fortunately, oranges, tangerines, and clementines (my fave) are OK.

Michael



Grapefruit seems to interact with a lot of heart meds (which is a drag as I love - or used to love grapefruit).

Let us know how the adjustment goes.

Peace,

Leon

[sunnylady24]

I take 240 mg of Diltiazem and 50 mg of Toprol twice a day. The Toprol seems to work better for me in the am with breakfast, next dose is around 3 pm and again I take it with some food. The Diltiazem I take it before bedtime this schedule seems to work for me. The edema for me is the result of heat and humididy....my feet can look like watermelons! but as soon as I get cool (air conditioning) it is gone. This meds react to the sun so be careful! but I doing a lot better with this combination of meds. Good luck!

[Kimberly]

Diltiazem (60 mg) was just added to my medical regimen after my 4 week post-septal myectomy check-up. I'd been on it this past summer when my doctors were experimenting with different drug combo's to help alleviate my symptoms. It definitely makes me feel a bit dizzy/light-headed, but I have started taking it at night, along with my Atenolol (25 mg). And it is MUCH better for me (side effect-wise) than the Verapimil was. I just have to take few deep breaths when I first get out of bed in the morning--and put my hands out in front of me, in case I walk sideways into a wall (yup, done that, more than once! :), but the dizziness does go away quickly. No edema or swelling though....

What I am curious about is this: you had a myectomy, yet you still have chest pains!?! What's that about? Is this common?!? I won't even have my first post-surgery echo until March 2010, to measure how effective/successful the procedure was, but would like to hear more about what others have experienced in terms of recurring symptoms after their surgeries. Perhaps I was being naive, but I kind of thought--or at least I'm hoping that--I'd be "good as new" afterwards.

[Cynaburst]

Hey Kimberly. I guess that the short answer is, yes. I had a myectomy and I do still have chest pain sometimes. It is not the same as it was before the surgery. Those pains were alot worse. I also am alot less short of breath than I was before the surgery. But I am not cured. I still have HCM and I still have a thick heart which does not fill properly. It is called diastolic dysfunction. If you read alot of old posts by Pam, she describes this condition quite well. Basically, the heart which is too thick (and I have concentric hypetrophy, so my whole heart is thick..the surgery couldn't fix that) can't relax properly so it can't fill with blood completely. That causes a need for oxygen which is not being met, and thus, chest pain. The diltiazem increased the blood flow to the heart muscle and thus helps the chest pain.

But your recovery may be different. Everyone's anatomy is different and some have no symptoms after surgery. Some have more. You will just have to wait and see where you wind up. And it changes over time. I was doing fine on Toprol alone for awhile, had to increase, and now have to change. In a few months or years, I will probably change again. It is a continuing process. You will probably always take some meds.

[gfox42]

Hi Kimberly,
The bad news is that myectomy doesn't make us good-as-new. What it is very good at (when done by an expert surgeon) is relieving outflow obstruction. For example, before my myectomy I was severely obstructed. Now I'm not, but I certainly still have HCM -- my heart is still stiff, doesn't relax properly, (and everything Cynthia said . . .). I still take meds and will always have some issues.

That said, I feel vastly better than before my myectomy, and can do a lot of things I couldn't do before. In other words, it's not a cure-all, but it can make a huge difference for people who are badly obstructed.

Gordon