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What Are The Effects Of Stopping The Diltiazem Medicine For Vascular Dementia?
Question: my husband is 68 years old and had diltiazem for at least 1o years. When is was decreased 7 years ago he had TIA's . Recently in December 2014 it was not given for 3 days and restarted. He appeared to have had a TIA. He now has had it stopped altogether and it appears to have been another TIA. He has vascular dementia but has been very able until the last stoppage. Could it be the lack of diltiazem? Thank you for your help.
Brief Answer:
Not such strong relation. Perhaps not TIA?
Detailed Answer:
I read your question carefully and I understand your concern.
It is a little unclear what do you mean by TIA. Us doctors call that a transient neurological accident, but since you afterwards say he has vascular dementia could it be that they weren't transitory?
Diltiazem is a drug used mainly to control rapid heart rate and to a lesser extent high blood pressure. Of course both of those conditions are risk factors for vascular event like TIA and stroke, but they are not so closely related in time to Diltiazem use, it's prolonged interruption can increase his chances of stroke (when diltiazem is necessary), but not in such a strict relation in time as you describe it (on 3 occasions)
So I wouldn't rush into blaming a TIA on Diltiazem. On the other hand he might have heart issues which cause symptoms which might be mistaken as TIA, so that's why it would be useful if you described exactly what happened, in what did these TIA consist. Perhaps it's an exacerbation of his arrhythmia causing the symptoms.
It is also unclear why did the psychiatrist interrupt it. Even if he doesn't take diltiazem there are other drugs to control heart rate which can substitute it if necessary.
The best means to prevent a stroke apart from addressing risk factors (arrhythmias, high blood pressure, diabetes etc), is by taking a blood thinner. The choice is between antiagregants (aspirin, clopidogrel) or anticoagulants (warfarin) and depends by his heart condition and its potential for causing stroke.
I remain at your disposal for further questions.
Not such strong relation. Perhaps not TIA?
Detailed Answer:
I read your question carefully and I understand your concern.
It is a little unclear what do you mean by TIA. Us doctors call that a transient neurological accident, but since you afterwards say he has vascular dementia could it be that they weren't transitory?
Diltiazem is a drug used mainly to control rapid heart rate and to a lesser extent high blood pressure. Of course both of those conditions are risk factors for vascular event like TIA and stroke, but they are not so closely related in time to Diltiazem use, it's prolonged interruption can increase his chances of stroke (when diltiazem is necessary), but not in such a strict relation in time as you describe it (on 3 occasions)
So I wouldn't rush into blaming a TIA on Diltiazem. On the other hand he might have heart issues which cause symptoms which might be mistaken as TIA, so that's why it would be useful if you described exactly what happened, in what did these TIA consist. Perhaps it's an exacerbation of his arrhythmia causing the symptoms.
It is also unclear why did the psychiatrist interrupt it. Even if he doesn't take diltiazem there are other drugs to control heart rate which can substitute it if necessary.
The best means to prevent a stroke apart from addressing risk factors (arrhythmias, high blood pressure, diabetes etc), is by taking a blood thinner. The choice is between antiagregants (aspirin, clopidogrel) or anticoagulants (warfarin) and depends by his heart condition and its potential for causing stroke.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
my ex-husband was diagnosed with Transient ischemic attacks via CT scan, MRI scan and clinical investigations at the hospital and memory clinic. This appeared to be caused when his diltiazem had been reduced after a number of years successful treatment for atrial fribulation.
He then returned to his optimum dose and successfully managed 7 years without further problems. In December he had 3 days missed dose and appeared to have had another TIA saying he was sin a fog and unable to walk properly and increased memory and behavioural problems. He then restarted the diltiazem add he continues very well again until hospital admission and they have stopped it. He is now in dire straights with increased memory problems and clearly more dementia like behaviour and poorer memory. It again seems linked TIA follow diltiazem reduction or stoppage so I am thinking it may be worth asking them to reconsider the diltzem, He successfully took warfarin with it without problems. His initial diagnosis was short term memory loss and possible vascular dementia. Thank you for your help and advice. XXXX
I forgot to mention that I am still seeing what I see as a clear link being the diltiazem reduction/stoppage is always historically followed by TIA and in this instance the arterial fribullation is not well controlled as it has always been on diltzem. Please can you give me some further help and advice regarding diltiazem and the relationship with TIA etc. I realise you are not fully informed of the whole medical history so this is only one aspect of focus for which your expertise would help greatly. Thank you XXXXXXX
He then returned to his optimum dose and successfully managed 7 years without further problems. In December he had 3 days missed dose and appeared to have had another TIA saying he was sin a fog and unable to walk properly and increased memory and behavioural problems. He then restarted the diltiazem add he continues very well again until hospital admission and they have stopped it. He is now in dire straights with increased memory problems and clearly more dementia like behaviour and poorer memory. It again seems linked TIA follow diltiazem reduction or stoppage so I am thinking it may be worth asking them to reconsider the diltzem, He successfully took warfarin with it without problems. His initial diagnosis was short term memory loss and possible vascular dementia. Thank you for your help and advice. XXXX
I forgot to mention that I am still seeing what I see as a clear link being the diltiazem reduction/stoppage is always historically followed by TIA and in this instance the arterial fribullation is not well controlled as it has always been on diltzem. Please can you give me some further help and advice regarding diltiazem and the relationship with TIA etc. I realise you are not fully informed of the whole medical history so this is only one aspect of focus for which your expertise would help greatly. Thank you XXXXXXX
Brief Answer:
Atrial fibrillation needs treatment, EKG necessary.
Detailed Answer:
Thank you for providing some more info.
From what you say there seems to be a direct relation between its use and neurological functioning noticed on several occasions. I still maintain that the relation between diltiazem use and stroke is not direct, it's the atrial fibrillation which is the culprit, diltiazem is used to control it (control its rate not make it disappear) and its disuse exacerbating the fast rhythm does increase the possibility of stroke.
However that is something which should be confirmed by EKG studies, if they interrupted it perhaps they noticed particularly slow heart rate during treatment and were worried about its complications. I fail to understand why the psychiatrist though, usually it is done by a cardiological consult or at least the GP. Diltiazem has no contraindications in psychiatric conditions.
So I suggest you do take it up with your GP and have EKG studies for the heart rhythm. According to its results it will be decided whether to resume Diltiazem on the same or a lower dose (if previously it was causing slow rate) or another antiarhythmic drug.
Wishing you good health.
Atrial fibrillation needs treatment, EKG necessary.
Detailed Answer:
Thank you for providing some more info.
From what you say there seems to be a direct relation between its use and neurological functioning noticed on several occasions. I still maintain that the relation between diltiazem use and stroke is not direct, it's the atrial fibrillation which is the culprit, diltiazem is used to control it (control its rate not make it disappear) and its disuse exacerbating the fast rhythm does increase the possibility of stroke.
However that is something which should be confirmed by EKG studies, if they interrupted it perhaps they noticed particularly slow heart rate during treatment and were worried about its complications. I fail to understand why the psychiatrist though, usually it is done by a cardiological consult or at least the GP. Diltiazem has no contraindications in psychiatric conditions.
So I suggest you do take it up with your GP and have EKG studies for the heart rhythm. According to its results it will be decided whether to resume Diltiazem on the same or a lower dose (if previously it was causing slow rate) or another antiarhythmic drug.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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