Diltiazem


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult: PO Angina pectoris Conventional tab: 30 mg 4 times daily, may increase dose gradually in divided doses at 1-2 day intervals until desired response is achieved. Max: 360 mg daily in divided doses. Modified-release tab/cap: Initial: 60 mg tid, may increase to 360 mg daily in divided doses or 480 mg daily, as necessary. Hypertension Modified-release cap: Initial: 90-120 mg bid, may increase to 180 mg bid if necessary. Max: 360 mg daily. IV Cardiac arrhythmias Initial: 250 mcg/kg via bolus injection over 2 minutes. May give a further dose of 350 mcg/kg after 15 minutes if needed.
Administration
Normal release prep: May be taken with or without food.
Contraindications
Sick sinus syndrome, 2nd or 3rd degree AV block without a functioning pacemaker, severe bradycardia (<50 beats/minute), hypotension (<90 mmHg systolic), severe CHF, acute myocardial infarction and pulmonary congestion; IV: atrial fibrillation or flutter with accessory bypass tract (e.g. Wolff-Parkinson-White syndrome), ventricular tachycardia. Lactation. Concomitant use with ivabradine, dantrolene, and IV β-blockers.
Special Precautions
Patient with reduced left ventricular dysfunction, intestinal obstruction, 1st degree AV block; diabetes mellitus, pre-existing bronchial hyperactivity, supraventricular arrhythmias with comprised haemodynamics (IV). Renal and hepatic impairment. Elderly. Pregnancy. Patient Counselling This drug may cause dizziness and malaise, if affected, do not drive or operate machinery. Avoid abrupt withdrawal. Monitoring Parameters Monitor heart rate, blood pressure, ECG, kidney and liver function, signs and symptoms of respiratory impairment.
Adverse Reactions
Significant: AV block or sinus bradycardia, hypotension with or without syncope, mood changes, bronchospasm (including asthma aggravation). Rarely, elevated hepatic transaminases (e.g. alkaline phosphatase, LDH, AST, ALT), hepatic injury. Cardiac disorders: Palpitations, ventricular extrasystoles (IV). Gastrointestinal disorders: Constipation, dyspepsia, gastric pain, nausea. General disorders and administration site conditions: Malaise, asthenia; inj site reaction (e.g. itching, burning). Metabolism and nutrition disorders: Oedema, peripheral oedema. Nervous system disorders: Headache, dizziness. Skin and subcutaneous tissue disorders: Erythema multiforme including Stevens-Johnson syndrome, toxic epidermal necrolysis; exfoliative dermatitis. Vascular disorders: Flushing.
Drug Interactions
Increased depression of cardiac conduction, risk of bradycardia and AV block with amiodarone, digoxin, and clonidine. Potentiated depressive effects on cardiac contractility, conductivity, and automaticity, and vascular dilatation of anaesthetics. Increased antihypertensive effect with α-antagonists. Increased serum concentration of ciclosporin, phenytoin, carbamazepine, cilostazol, benzodiazepine (e.g. midazolam, triazolam), buspirone, quinidine, corticosteroids (e.g. methylprednisolone), lithium and theophylline. Increased plasma concentration with CYP3A4 inhibitors (e.g. cimetidine). Decreased serum concentration with CYP3A4 inducers (e.g. rifampicin). Increased cardiovascular effect (e.g. hypotension) of IV ionic X-ray contrast media. May enhance effects of antiplatelet drugs. Increased risk of myopathy and rhabdomyolysis with concomitant use of statins metabolised by CYP3A4 (e.g. atorvastatin, fluvastatin, simvastatin).
ATC Classification
C05AE03 - diltiazem ; Belongs to the class of muscle relaxants. Used in the topical treatment for the treatment of hemorrhoids and anal fissures.
C08DB01 - diltiazem ; Belongs to the class of benzothiazepine derivative selective calcium-channel blockers with direct cardiac effects. Used in the treatment of cardiovascular diseases.
Disclaimer: This information is independently developed by CIMS based on diltiazem from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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