Diltiazem

Indications
 Oral
Angina pectoris
Adult: Initially, 60 mg tid, increased to 360 mg daily or up to 480 mg daily, if necessary.
Renal impairment: Dosage adjustment may be needed. Initial dose of 120 mg daily, as a single dose or in 2 divided doses depending on the formulation and titrated carefully as required. Do not increase dose if the heart rate drops <50 beats/min.
Hepatic impairment: Dosage adjustment may be needed. Initial dose of 120 mg daily, as a single dose or in 2 divided doses depending on the formulation and titrated carefully as required. Do not increase dose if the heart rate drops <50 beats/min.
Oral
Hypertension
Adult: Initially, 60-120 mg bid increased if needed. Max: 360 mg daily.
Renal impairment: Dosage adjustment may be needed. Initial dose of 120 mg daily, as a single dose or in 2 divided doses depending on the formulation and titrated carefully as required. Do not increase dose if the heart rate drops <50 beats/min.
Hepatic impairment: Dosage adjustment may be needed. Initial dose of 120 mg daily, as a single dose or in 2 divided doses depending on the formulation and titrated carefully as required. Do not increase dose if the heart rate drops <50 beats/min.
Intravenous
Cardiac arrhythmias
Adult: Initially, 250 mcg/kg by bolus IV Inj over 2 mins, if necessary, after 15 min, may administer another dose of 350 mcg/kg. Individualsie subsequent doses. In patients with atrial fibrillation or flutter: 5-10 mg/hr infusion, increased in increments of 5 mg/hr up to a rate of 15 mg/hr continued for 24 hr.
Renal impairment: Dosage adjustment may be needed.
Hepatic impairment: Dosage adjustment may be needed.
Contraindications
 Sick-sinus syndrome; 2nd or 3rd ° AV block; porphyria. Severe congestive cardiac failure; marked bradycardia. Pregnancy and lactation.
Warnings / Precautions
 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.
Adverse Reactions
 Headache, ankle oedema, hypotension, dizziness, fatigue, flushing, nausea, GI discomfort, gingival hyperplasia, rashes, erythema multiforme, exfoliative dermatitis, photosensitivity, occasionally hepatitis.
Potentially Fatal: AV block, bradycardia, asystole, sinus arrest.
Overdose Reactions
 Symptoms: Altered mental status, shock, bradycardia, hypotension, ECG changes, arrhythmias, heart block, cardiac arrest and heart failure. Management: Treatment is supportive and symptomatic. Gastric lavage and administration of activated charcoal may help to reduce drug absorption. Haemodialysis and peritoneal unlikely to be useful. Charcoal haemoperfusion may be useful.
Drug Interactions
 Increases serum theophylline levels. Cimetidine may increase plasma concentrations of diltiazem. Concurrent use may lead to increased blood ciclosporin levels.
Potentially Fatal: Increased depression of cardiac conduction with amiodarone, β-blockers, digoxin and mefloquine. May potentiate risk of bradycardia and conduction disturbance of propranolol and risk of neurotoxicity of lithium.
See Below for More diltiazem hydrochloride Drug Interactions
Food Interactions
 Serum levels may be elevated if taken with food.
Mechanism of Actions
 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.
Absorption: Rapidly and almost completely absorbed from the GI tract (oral).
Distribution: Enters breast milk. Protein-binding: 80%.
Metabolism: Hepatic: Extensive first-pass effect; yields desacetyldiltiazem (posseses 25-50% of the activity of the parent drug).
Excretion: Via urine (2-4% as unchanged and metabolites), via bile (remaining metabolites); 3-5 hr (elimination half-life).
Administration
 Normal release prep: May be taken with or without food. (Admin instructions for modified release prep may vary according to brands, refer to lit.)
Storage Conditions
 Intravenous: Store at 15-30°C. Oral: Store at 15-30°C.
ATC Classification
 C08DB01 - diltiazem ; Belongs to the class of benzothiazepine derivative selective calcium-channel blockers with direct cardiac effects. Used in the treatment of cardiovascular diseases.
Storage
 Intravenous: Store at 15-30°C. Oral: Store at 15-30°C.
Available As
  • Diltiazem 120 mg
  • Diltiazem 180 mg
  • Diltiazem 240 mg
  • Diltiazem 30 mg
  • Diltiazem 5 mg
  • Diltiazem 60 mg
  • Diltiazem 90 mg

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