First of all, it may be best to speak with your cardiologist in regards to your symptoms of shortness of breath, rapid heart rate, and swollen legs. These may be signs of heart failure and/or worsening of atrial fibrillation and should be assessed as soon as possible.
In regards to the drug interactions, it is important to discuss your concerns with your physician, as they should have the complete information necessary to make informed treatment decisions. Below we will discuss potential drug interactions between the medications that you have listed.
Interaction Between Diltiazem And Digoxin
Both diltiazem and digoxin can be used to help treat atrial fibrillation and have an impact on heart rate control. Diltiazem is a calcium channel blocker that helps to lower heart rate. Digoxin is a cardiac glycoside that helps control ventricular heart rate in patients with atrial fibrillation.
Diltiazem decreases the clearance of digoxin from your body by inhibition of P-glycoprotein, which helps removes digoxin from cells in the body. In effect, the amount of digoxin is increased in your blood and could lead to an increased risk of digoxin toxicities, like GI side effects and visual disturbances.
With that being said, at times these medications are sometimes used together to improve control of heart rate. It may be a good idea to ask your doctor about monitoring of your digoxin levels, as these can help decide the dose of digoxin that you will need.
Interaction Between Diltiazem And Empagliflozin
Diltiazem and other calcium channel blockers can cause increases in blood glucose levels. Assuming your blood glucose is well controlled on metformin and empagliflozin, it may be necessary to take diltiazem even as a diabetic patient.
Interaction Between Diltiazem And Xarelto (Rivaroxaban)
Diltiazem may increase the concentration of Xarelto by a similar mechanism that it increases digoxin levels. Because Xarelto depends on P-glycoprotein and CYP3A4, both inhibited by diltiazem, Xarelto is not cleared as well. This is riskier in patients with worsened kidney function. Since Xarelto is a blood thinner used to prevent the risk of stroke, this could lead to an increased risk for bleeding. While on blood thinners of any sort, it is important to monitor for signs of bleeding including dark stools, severe upset stomach, and extreme fatigue.