Generic Name

Diltiazem Hydrochloride

Precaution

Elderly. Hepatic or renal impairment; impaired left ventricular function; prolonged AV periods; DM; hypotension. Avoid abrupt withdrawal and long-term use. Patients with sick-sinus syndrome, preexisting AV block, bradycardia and those taking beta-blockers or digitalis are at risk of developing AV block, bradycardia, asystole or sinus arrest. Lactation: Drug enters breast milk; because of risk for serious adverse reactions in nursing infants from diltiazem, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother

Indication

Supraventricular tachycardia, Hypertension, Angina, Atrial fibrillation, Arrhythmias, Atrial flutter

Contra Indication

Sick-sinus syndrome; 2nd or 3rd ° AV block; porphyria. Severe congestive cardiac failure; marked bradycardia. Pregnancy and lactation.

Dose

N/A

Side Effect

>10% Edema (2-15%),Headache (5-12%) 1-10% Dizziness (3-10%),AV block (2-8%),Peripheral edema (2-8%),Bradyarrhythmia (2-6%),Headache (1-5%),Hypotension (2-4%),Nausea (3%),Vomiting (2%),Vasodilation (2-3%),Extrasystoles (2%),Flushing (1-2%),Drug-induced gingival hyperplasia (<2%),Myalgia (2%),Diarrhea (1-2%),Constipation (2-4%),Bronchitis (1-4%),Sinus congestion (1-2%),Dyspnea (1-6%),Congestion (1-2%) < 1% Increased Alkaline phosphatase as well as ALT and AST,CHF,Thrombocytopenia,Toxic epidermal necrolysis,Hemolytic anemia,Photosensitivity,Extrapyramidal symptoms,Syncope

Pregnancy Category

Mode of Action

Diltiazem relaxes coronary vascular smooth muscles by inhibiting influx of calcium ions during depolarisation of the vascular smooth muscles and myocardium. It increases myocardial O2 delivery in patients with vasospastic angina and inhibits cardiac conduction, particularly at the SA and AV nodes.

Interaction

Increased AV blocking effect w/ clonidine. May increase serum levels of statins (e.g. atorvastatin, lovastatin), carbamazepine, phenytoin. May increase bradycardic affect of amiodarone, digoxin, mefloquine. May enhance antihypertensive effect w/ other antihypertensives (e.g. aldesleukin), antipsychotic. Increased serum levels w/ cimetidine. Decreased serum levels w/ rifampicin, phenobarbital. Potentially Fatal: IV: May enhance hypotensive effect of IV ?-blockers.

Pregnancy Category Note

Pregnancy category: C Lactation: Drug enters breast milk; because of risk for serious adverse reactions in nursing infants from diltiazem, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother

Adult Dose

Angina Conventional tablet: 30 mg PO q6hr; increased every 1 or 2 days until angina controlled (usually 180-360 mg/day PO divided q6-8hr); not to exceed 360 mg/day SR: 120 mg/day PO; titrate after 7-14 days; maintenance range usually 120-320 mg/day; not to exceed 540 mg/day Hypertension Conventional tablet: Initial: 60-120 mg twice daily. Max: 360 mg/day. SR: Twice-daily dosing: 60-120 mg PO q12hr; may be adjusted after 14 days; maintenance range usually 240-360 mg/day Hepatic Impairment Use caution

Child Dose

N/A

Renal Dose

Renal Impairment Use caution

Administration

May be taken with or without food. The capsules should be swallowed whole with a drink of water. They should not be crushed or chewed