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What Causes Constipation After Taking Diltiazem?
Question: i had afib and in 2008 i had an ablation which was considered success i have had 5 breaks since then and take 50mg flecainide twice a day and i currently take 120 of Diltiazem once a day which was switched after I ask the doctor if going on Diltiazem from Toprol er would give me more energy. So i switched to Diltiazem and since then have had bad constipation. Now i am taking stool softeners and some laxitives. I have had straining stools and i am supposed to take one tablet of Colace twice a day. Should I or can i go back to the Toprol 25 er xl. I really don't want to go on laxatives the rest of my life. I really brought up the idea and now i wish i didn't What are you thoughts on both of these drugs and what would you do.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
I passed carefully through your concern and would like to explain that though you have undergone through cardiac ablation for atrial fibrillation it is actually known that the success rate is around 70% to 75%. So around 30% of patients will have recurrences of atrial fibrillation.
It seems that you are in this latter group of patients.
Nevertheless, considering your actual therapy I would say that Toprol er seems to be a safer alternative for you.
Constipation is frequently found in patients of your age; Diltiazem may exacerbate this unpleasant finding in around 1-10% of patients.
It would be wise switching to Toprol and gradually up-titrating the daily dose to the most appropriate value for non exacerbating adverse effects like fatigue, etc.
Another option to reduce the daily dose of Toprol would be to increase Flecainide daily dose to 100mg twice daily and maintain Toprol to only 50mg daily.
Anyway, all anti-arrhythmic drugs have theirs own side effects and I think that it would be worth discussing again with your cardiologist and eventually considering a second cardiac ablation which generally offers a higher success rate (85% - 90%) regarding recurrent afib elimination.
You should discuss with your attending cardiologist on the above mentioned issues.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
I passed carefully through your concern and would like to explain that though you have undergone through cardiac ablation for atrial fibrillation it is actually known that the success rate is around 70% to 75%. So around 30% of patients will have recurrences of atrial fibrillation.
It seems that you are in this latter group of patients.
Nevertheless, considering your actual therapy I would say that Toprol er seems to be a safer alternative for you.
Constipation is frequently found in patients of your age; Diltiazem may exacerbate this unpleasant finding in around 1-10% of patients.
It would be wise switching to Toprol and gradually up-titrating the daily dose to the most appropriate value for non exacerbating adverse effects like fatigue, etc.
Another option to reduce the daily dose of Toprol would be to increase Flecainide daily dose to 100mg twice daily and maintain Toprol to only 50mg daily.
Anyway, all anti-arrhythmic drugs have theirs own side effects and I think that it would be worth discussing again with your cardiologist and eventually considering a second cardiac ablation which generally offers a higher success rate (85% - 90%) regarding recurrent afib elimination.
You should discuss with your attending cardiologist on the above mentioned issues.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Doctor, Thank you for your thoughts my doctor at XXXXXXX Dr. Lin told me that ablation is not a cure but control and over the last 9 years i really have only had 5 episodes and two were back to back when i had brochitis. I have been on the flecainide since 2010 and was on toprol 25er until i ask how about Diltiazem so we agreed to try it. That was july 21st when i started on it. As far as afib if i do get an episode i take the Pill in the pocket. 2 100mg flecainide tablets and one 50mg toprol tartrate and my heart goes back into rhythm within usually 30-40 mins. It has worked. I think i will ask to go back on the toprol 25er again because i did not have any constipation with that and only used a laxative once in a while. I don't think with my success with ablation that i would even qualify for a second one. I have not(knock on wood) had a breakthrough for over 2 years and that was because of an antibiotic drug which has history of heart symptoms. XXXXXXX
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again, dear XXXXXXX
Considering the fact that you had no eventful experience with Flecainide and Toprol, it would be a rational approach switching to this drugs combination again.
Nevertheless, if afib recurrences become more frequent, a second cardiac ablation could be a medically indicated option.
It remains to be ascertained by your attending cardiologist the most appropriate time for ablation (considering an increase of afib recurrences, the level of drugs adverse effects, the severity of the overall symptomatology, etc.)
But the first opinion goes in favor of Flecainide and Toprol combination and see if it will remain a well-tolerated strategy.
Wishing you a pleasant weekend!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again, dear XXXXXXX
Considering the fact that you had no eventful experience with Flecainide and Toprol, it would be a rational approach switching to this drugs combination again.
Nevertheless, if afib recurrences become more frequent, a second cardiac ablation could be a medically indicated option.
It remains to be ascertained by your attending cardiologist the most appropriate time for ablation (considering an increase of afib recurrences, the level of drugs adverse effects, the severity of the overall symptomatology, etc.)
But the first opinion goes in favor of Flecainide and Toprol combination and see if it will remain a well-tolerated strategy.
Wishing you a pleasant weekend!
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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