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Diltiazem HCl A to Z Drug Facts Diltiazem HCl Actions Indications Contraindications Route/Dosage Interactions Lab Test Interferences Adverse Reactions Precautions Patient Care Considerations Administration/Storage Assessment/Interventions Patient/Family Education (dill-TIE-uh-zem HIGH-droe-KLOR-ide) Cardizem Tablets: 30 mg Tablets: 60 mg Tablets: 90 mg Tablets: 120 mg Powder for injection: 25 mg Powder for injection: 50 mg Cardizem CD Capsules, extended-release: 120 mg Capsules, extended-release: 180 mg Capsules, extended-release: 240 mg Capsules, extended-release: 300 mg Capsules, extended-release: 360 mg Cardizem SR Capsules, sustained-release: 60 mg Capsules, sustained-release: 90 mg Capsules, sustained-release: 120 mg CartiaXT Capsules, extended-release: 120 mg Capsules, extended-release: 180 mg Capsules, extended-release: 240 mg Capsules, extended-release: 300 mg Dilacor XR Capsules, extended-release: 120 mg Capsules, extended-release: 180 mg Capsules, extended-release: 240 mg Dilacor XT Capsules, extended-release: 120 mg Capsules, extended-release: 180 mg Capsules, extended-release: 240 mg Tiazac Capsules, extended-release: 120 mg Capsules, extended-release: 180 mg Capsules, extended-release: 240 mg Capsules, extended-release: 300 mg Capsules, extended-release: 360 mg Capsules, extended-release: 420 mg Alti-Diltiazem Apo-Diltiaz Gen-Diltiazem Nu-Diltiaz Class: Calcium channel blocker Actions Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle; slows calcium ion movement across cell membranes in both cardiac muscle and cardiac pacemaker cells, decreasing sinoatrial and atrioventricular (AV) conduction. Indications Oral: Treatment of angina pectoris caused by coronary artery spasm; chronic stable angina (classic effort-associated angina); essential hypertension (extended- and sustained-release forms only). Parenteral: Treatment of atrial fibrillation or flutter; paroxysmal supraventricular tachycardia. Contraindications Sick sinus syndrome; second- or third-degree AV block; except with functioning pacemaker; hypotension with systolic pressure less than 90 mm Hg; acute MI; pulmonary congestion. Route/Dosage Dosage regimens should be individualized. Angina: ADULTS: PO Immediate release: Start with 30 mg qid before meals and at bedtime. Gradually increase dosage at 1- to 2-day intervals until optimum response (average optimum dose range 180 to 360 mg/day). Extended release: Start with 120 to 180 mg once daily. Some patients may respond to doses up to 480 mg once daily. When necessary, titrate the dose over 7 to 14 days. Cardizem CD and Cartia XT: Start with 120 to 180 mg once daily. Some patients may respond to doses up to 480 mg once daily. When necessary, titrate the dose over 7 to 14 days. Dilacor XR and Diltia XT : Start with 120 mg once daily. Some patients may respond to doses up to 480 mg once daily. When necessary, titrate the dose over 7 to 14 days. Tiazac: Start with 120 to 180 mg once daily. Some patients may respond to doses up to 540 mg once daily. When necessary, titrate the dose over 7 to 14 days. Hypertension: ADULTS: PO Extended release: Start with 60 to 120 mg bid or 180 to 240 mg once daily. Maximum antihypertensive effect usually occurs by 14 days of chronic therapy (optimum dose range 240 to 360 mg once daily but some patients respond to lower doses or higher doses up to 480 mg once daily). Cardizem CD and Cartia XT: 180 to 240 mg once daily; however, some patients may respond to lower doses. Maximum effect is usually achieved by 14 days of chronic therapy. Usual range is 240 to 360 mg once daily. Dilacor XR and Diltia XT: 180 to 240 mg once daily (usual dose range 180 to 480 mg once daily. Individual patients, particularly those 60 yr and older, may respond to lower doses of 120 mg once daily. Some patients may require doses up to 540 mg once daily. Tiazac: Start with 120 to 240 mg once daily. Maximum effect is usually achieved by 14 days of chronic therapy. Usual dose range is 120 to 540 mg once daily. Sustained release: Cardizem SR: Start with 60 to 120 mg twice daily. When a maximum antihypertensive effect is achieved (usually about 14 days), adjust dosage (optimum dosage range is 240 to 360 mg/day). Parenteral: ADULTS: Direct IV single bolus injection Initial dose is 0.25 mg/kg as a bolus administered over 2 min (reasonable dose is 20 mg for average patient). If response is inadequate after 15 min, administer as a second 0.35 mg/kg over 2 min (reasonable dose is 25 mg for average patient). Individualize subsequent IV doses. Dose low body weight patients on a mg/kg basis. Although the duration of action may be shorter, some patients may respond to an initial dose of 0.15 mg/kg. Continuous IV infusion For continued reduction of heart rate (up to 24 hr) in patients with atrial fibrillation or atrial flutter, IV infusion may be administered. Immediately following administration of a bolus dose of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) and reduction of heart rate, begin an IV infusion. The recommended initial infusion rate is 10 mg/hr; however, some patients may maintain response to an initial rate of 5 mg/hr. The infusion rate may be increased in 5 mg/hr increments up to 15 mg/hr as needed, if further reduction in heart rate is necessary. The infusion may be maintained for up to 24 hr (max, 24 hr and 15 mg/hr). Interactions Beta-blockers: May have additive negative inotropic and chronotropic effects. Carbamazepine: Carbamazepine levels may increase. Cimetidine, ranitidine: Diltiazem levels may be increased. Cyclosporine: Cyclosporine levels and toxicity may increase. Encainide: Encainide levels may increase. Other antihypertensive agents: May have additive effects. Do not mix with furosemide. Lab Test Interferences None well documented. Adverse Reactions CARDIOVASCULAR: Peripheral edema; hypotension (especially during initial treatment or with dose increases); bradycardia; angina; AV block; abnormal ECG; arrhythmias. CNS: Dizziness, lightheadedness; headache; weakness; shakiness; somnolence; asthenia. DERMATOLOGIC: Dermatitis; photosensitivity; petechiae; rash; hair loss; erythema multiforme; Stevens-Johnson syndrome. GI: Nausea; vomiting; constipation; abdominal discomfort; cramps; dyspepsia; dry mouth. HEMATOLOGIC: Leukopenia. OTHER: Flushing; micturation disorder; gingival hyperplasia; gynecomastia; joint pain. Precautions Pregnancy: Category C. Lactation: Excreted in breast milk. CHILDREN: Safety and efficacy not established. CHF: Use with caution. Hepatic or renal impairment: Use with caution. Dosage may need to be decreased. Withdrawal syndrome: Abrupt withdrawal may cause increased frequency and duration of angina. Dosage is tapered gradually. PATIENT CARE CONSIDERATIONS Administration/Storage Oral doses may be given with meals if GI irritation occurs. Keep injectable solutions under refrigeration. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Monitor BP and pulse periodically throughout therapy. Monitor ECG frequently during IV administration. Be alert for evidence of AV block. Measure I&O and weight during therapy. Assess for symptoms of fluid overload: edema, rales, dyspnea, weight gain, jugular vein distention. Notify health care provider if these signs occur. Assess lab studies for renal and hepatic function with long-term therapy. Consider dosage adjustment if hepatic dysfunction is present. If patient is receiving cardiac glycosides (eg, digoxin) concurrently, monitor serum digoxin levels. If signs of digitalis toxicity occur, notify health care provider. If dizziness occurs, institute safety precautions for falls. Have patient sit up for a few minutes before rising. OVERDOSAGE: SIGNS & SYMPTOMS Bradycardia, hypotension, high-degree AV block, heart failure Patient/Family Education Teach patient to take pulse. Emphasize importance of doing so regularly while taking medication. Remind patient to swallow sustained-release capsules whole. Caution patient to avoid sudden position changes to prevent orthostatic hypotension. Notify health care provider if irregular heart beat, shortness of breath, swelling of the hands and feet, pronounced dizziness, constipation, nausea, or hypotension develop. Advise patient of importance of regular use of this medication. If dose is missed but remembered shortly after it was scheduled, take the missed dose. However, if time is close to next scheduled dose, skip the missed dose. Counsel patient to avoid intake of alcoholic beverages and OTC medications without consulting health care provider. Books@Ovid Copyright © 2003 Facts and Comparisons David S. Tatro A to Z Drug Facts