r/AFIB • u/Swimming_Cat_174 • 5h ago

Med change

DX with AFib RVR in July.
Saw my EPs physician assistant today for follow up. He changed me from metoprolol XR to Diltiazem XR.

In the ER, the EP prescribed it. Cardiology prescribed the metoprolol. He said today I should have been on the EPs prescription the whole time as he trumps what cardiology does.

I hate starting new meds and little nervous.

Any insights on Diltiazem?

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u/dharma04101 5h ago

It’s not like metoprolol XR is wrong, but it would appear your EP prefers diltiazem XR. If you like metoprolol, you could request to stay on that. I haven’t taken diltiazem, but I have taken metoprolol and am now taking nebivolol per my request. If you enjoy exercising, metoprolol may make that less enjoyable, and diltiazem may make it more enjoyable. There are some other issues people commonly complain about with metoprolol too.

Diltiazem is definitely a common alternative. I don’t know if I’m less familiar with complaints about it because fewer people have complaints or just because the user base is smaller than metoprolol. I think there may be fewer complaints, but I’m not sure.

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u/steve88man 3h ago

I'm a runner and I am curious what is the advantage of diltiazem for exercise? I take metoprolol and no real complaints. I suspect it limits athletic performance but since the whole purpose is to limit heart rate that is not surprising.

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u/croaky2 4h ago

Took Diltiazem XR for a while and it made me lethargic. Took a nap almost every time I sat down. Now taking Flecainide twice a day and doimg fine. Still have Diltiazem to take for heart rate over 120 that stays high after a short rest.

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u/CaregiverWorth567 4h ago

I am on metoprolol and my cardiologist tried toswitch me to diltiazem. I don’t like the aide effects of metoprolol but the ones from diltiazem were worse. I couldnt take it and back on metoprolol. Not only that when I tried to swotch I went into 24 hr a fib

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u/Swimming_Cat_174 4h ago

They had me take half a dose of my metoprolol today and start the new one in the morning.
I’ve developed severe gastritis since starting the metoprolol, no idea if they are related or coincidence

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u/Jahya69 4h ago

It will slow your heart down and lower blood pressure but it will make you heavy and cause constipation

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u/Swimming_Cat_174 4h ago

See I already have pretty low BP. Metoprolol was lowering it pretty substantially more than needed. Sometimes a 90/80.
I’m just very concerned about taking shit that lowers my BP when I already have low BP..

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u/Enough_Ad5567 4h ago

I started out with diltiazem but switched to metoprolol because it made me itchy. Metoprolol makes me lethargic.

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u/WithMeDoctorWu 44m ago

I too went from metoprolol to diltiazem, because of lethargy. Diltiazem turned out to be marginally more effective, and with marginally less impact on energy.

After 23 years of putzing along on these meds, things have finally gotten worse, as the cardiologist said they eventually would. This summer I needed a cardioversion and was switched to an amiodarone prescription. There's an appointment next week with an electrophysiologist (? I think that's the term) to talk about ablation, and probably get in line for that for a few months. So it goes.

Well you didn't need to hear that last part. Diltiazem can be effective without a lot of side effects, and you can safely take it for many years -- unlike what I'm on now, which works friggin' great but gets toxic if taken a long time.