What Causes Severe Joints And Muscle Pain While On Diltiazem?

Posted on Wed, 3 Aug 2016

Question: I am presently taking Pradaxa b/c of long standing afibrillation and Telmisartan for high blood pressure and hydrochlorthiazide for Meniere's. No side effect. My doc felt my heart rate is too high and prescribed Metropolol - which I could not tolerate. It made me feel very tired, could not walk up even a very low grade w/out getting breathless, tired and feeling like my neck was pressured as if I was hanging by my knees. So he replaced it with Diltiazem CD. That still makes me tired and slowed down, and at first I did not get the tight throat sensation. However, now I am getting it and I am also having very severe joint pains. Sometimes, I can't lift my arms due to the shoulder pain, and my hips and knees are very sore, making it difficult to stand up from a chair and get out of bed. I've had slight shoulder pain in the past which I addressed with exercises prescribed by my physical therapist. However, now, the exercises are not working and sometimes are very difficult to perform due to the pain. I've started taking Advil when I need to feel better. Could this joint pain be a side effect of adding the Diltiazem to the mix of meds I'm taking? Could this pain be an effect of either Diltiazem CD, itself, or some part of the combination. I don't see it listed as a side effect, although I'm not sure I have a complete list.

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I passed carefully through your question and would explain that Diltiazem could cause muscular pain or cramps as an adverse effect in up to 6% of the patients.

From the other hand it can interact with Hydroclorothyazide and Pradaxa as follows:

1- It increases the effects of Hydroclorothyazide. This is not something to be concerned off, but I would recommend performing uric acid levels, as they are known to be increased by Hydroclorothyazide and could trigger this symptomatolgy.
2- It increases the effects of Pradaxa, thus leading to an increased risk of bleeding.

Besides other possible causes of muscular pain like inflammation should be excluded. For this purpose, I recommend performing a complete blood count, inflammation tests (PCR, sedimentation rate), blood electrolytes and muscular enzymes (CPK).

I would also recommend consulting with your attending physician and performing a cardiac ultrasound in order to examine better your cardiac function and structure in order to examine for possible cardiac causes of increased heart rate.

Hope you will find this answer helpful!

Feel free to ask any other questions whenever you need!

Kind 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