Combining Diltiazem and Tambocor

[RogB]

There can be a major interaction between these two meds.  Also be very careful about adding a beta blocker!

[DeltaDawn23]

Sounds like you had a scary experience.  I just saw my cardiologist's nurse practitioner.  She said my ekg looked fine, I am just having an extra beat every so often.  I am getting a 24 hour Holter monitor at the end of the month to check it, then will see her again for follow-up.  She told me to take one half of a 25 mg. at night and see how that works.  But not to let my heart rate up go up too high because it can lead to afib.  I tried that, need a little more during the day.  She says Atenolol is a 24 hour drug, but it doesn't stay in my system that long.  I do have a pulse oximeter, but it only tells the rate and oxygen saturation, not the irregular beats.  My ep says some people are taking 200 mg. of Atenolol -- I believe he meant when in permanent afib.  When I was on the 50 mg., I was also off the Norpace.  I am very discouraged about this.  Today my heart is irregular due to digestive upset -- vagal nerve irritation I guess -- and it's giving me fits.  This nurse practitioner was very negative about ablations when I told her I was going to OSU med ctr for an evaluation.  She said they (meaning people who perform the ablations overstate their success rates and they can cause damage.  It seems like you can get as many different answers as doctors you ask -- it is discouraging to say the least.

[RogB]

Do you have an Oximeter? Nice device to have, got mine from Amazon.  In my case the event recorder picked up the pauses, but that was when (on my own) I added 25 mg of Atenolol evening of one day and morning of next to try to slow down the A Fib.  

EP doc said don't even think about doing that again.

50mg of Atenolol is a pretty hefty dose.  I'm no doc but please verify that this is not harmful.

You sure don't want to have happen what almost  happened to me, passed out cold in Best Buy shortly after arriving, and while driving there I was going between 55-60.  No warning, instant blackout.  Could have been disastrous.

[DeltaDawn23]

This is very interesting, because after my cardioversion 3 weeks ago, I went back on my Norpace CR and was told to stay on the 50 mg. of Atenolol I was on previously.  For the last week I have been having (some major) dizzy spells and a feeling of a pause.  Also felt like I might faint, short of breath.  This has happened sitting, standing and lying down and scared me.  I have an appt. Thursday for a follow-up on the cardioversion, so maybe I can find out what's going on.  Sounds like it may well be the Atenolol with the increased dose of Norpace CR.  I have scaled the Atenolol back to 3/4 of a 25 mg. tablet per day and I seem  little better.  I tend to get a little tachycardia now and then and the Atenolol slows it down.  Thanks for posting this -- it may be the answer to my problem.  I will post what I find out at the follow up appt.  It makes me mad that I was told just to stay on the meds with no one knowing about this interaction.  I had to call and ask for a follow-up, which usually is scheduled at the time of the cardioversion. Thanks again for the heads up!  

[Jerry_NJ]

Flecainide is a very powerful anti arrhythmic drug, and I am not surprised it would not be used with a beta or calcium blocker. The strongest drug I have ever taken was Rhythmol and that was without any other heart rhythm/rate meds.

I have found Atenolol to be a rather powerful rate control drug, and that is why I take it... I see a HR as low as the upper 50s when fully at rest in bed.  I figured I was lucky when Metoprolol got me down in the 70s..talking about the same level of dosage.  In both cases I was/am taking Diltiazem 120 mg twice a day.

[RogB]

Atenolol can and often does have an additive affect when taken along with other beta blocking meds.

In my case, even though the Atenolol was only 25 mg, it was enough to cause several heart pauses (flatlines) of 3 to 4 second durations detected via an event recorder.

Regarding the interaction between Diltiazem and Tambocor, this is from drugs.com:

"Using diltiazem together with flecainide can increase the effects of either medication. This can cause dizziness, weakness, chest pain, shortness of breath, fainting, an unusually fast or slow heartbeat, coma, slurred speech, and confusion."

I had gotten advice (from an EP) that taking Atenolol when having an A Fib episode won't stop the episode but will lower the heart rate.  In my case, after episode was over but while still having Atenolol in my system, the flatlines occurred.

[DeltaDawn23]

I just googled it -- Tambocor is Flecainide.  I would like to know what the bad interaction was, just for future reference.

[Jerry_NJ]

I have been taking a combination of beta blocker (now Atenolol) and Calcium Channel Blocker. They work in different ways to lower my HR.  I to not know what Tambocor is and haven't looked it up.

[DeltaDawn23]

Good to know -- what happened?