Diltiazem

What is Diltiazem?

• Diltiazem (Cardizem; Cardizem CD; Cardizem LA; Cardizem SR; Cartia XT; Dilacor XR; Dilt-CD; Diltzac; Taztia XT; Tiamate; Tiazac) is a non dihydropyridine calcium channel blocker used in the therapy of hypertension and angina pectoris.

Diltiazem structure

Diltiazem ball-and-stick

• Diltiazem is also available in intravenous formulations which are used in therapy of atrial arrhythmias, including atrial fibrillation or flutter and superventricular tachycardia.

What are the uses of this medicine?

• Diltiazem (Cardizem; Cardizem; Cardizem LA; Cardizem SR; Cartia XT; Dilacor XR; Dilt-CD; Diltzac; Taztia XT; Tiamate; Tiazac) is indicated for:
• treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. It can be used alone or in combination with other antihypertensives.
• improving exercise tolerance in patients with chronic stable angina.

How does this medicine work?

• Diltiazem (dil tye' a zem) belongs to the benzothiazepine class of calcium channel blockers and is used for the treatment of hypertension, angina pectoris and superventricular tachyarrhythmias.
• Like other calcium channel blockers, diltiazem acts by inhibiting the transmembrane influx of calcium ions into cardiac muscle and vascular smooth muscle cells.
• The inhibition of calcium flux causes arterial vasodilation and decreases cardiac work and oxygen consumption.
• Diltiazem, like verapamil (but unlike other calcium channel blockers), also decreases the rate of the sinus node pacemaker and slows atrial-ventricular conduction accounting for its effects on superventricular tachyarrhythmias.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• Sick sinus syndrome except in the presence of a functioning ventricular pacemaker.
• Second- or third-degree AV block except in the presence of a functioning ventricular pacemaker.
• Hypotension (less than 90 mm Hg systolic).
• Hypersensitivity to the drug.
• Acute myocardial infarction and pulmonary.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• atazanavir (Reyataz)
• benzodiazepines such as midazolam (Versed) and triazolam (Halcion)
• beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol, metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Inderal, Innopran, in Inderide)
• buspirone
• carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
• cimetidine (Tagamet)
• cyclosporine (Gengraf, Neoral, Sandimmune)
• digoxin (Lanoxin)
• lovastatin (Altoprev, Mevacor, in Advicor)
• quinidine (in Nuedexta)
• rifampin (Rifadin, in Rifamate, in Rifater, Rimactane)

Is this medicine FDA approved?

• Diltiazem was approved in the United States in 1982 and currently several million prescriptions are filled yearly.

How should this medicine be used?

Recommended dosage:

Hypertension:

• Adjust dosage to individual patient needs.
• When used as monotherapy, reasonable starting doses are 180 to 240 mg once daily, although some patients may respond to lower doses.
• Maximum antihypertensive effect is usually observed by 14 days of chronic therapy; therefore, schedule dosage adjustments accordingly.
• The usual dosage range studied in clinical trials was 240 to 360 mg once daily.
• Individual patients may respond to higher doses of up to 480 mg once daily.

Angina:

• Dosages for the treatment of angina should be adjusted to each patient’s needs, starting with a dose of 120 or 180 mg once daily.
• Individual patients may respond to higher doses of up to 480 mg once daily.
• When necessary, titration may be carried out over a 7- to 14-day period.

Administration:

• Diltiazem comes as a tablet, an extended-release tablet, and an extended-release capsule to take by mouth.
• The regular tablet is usually taken three or four times a day.
• The extended-release capsule and tablet are usually taken one or two times a day.
• Ask your pharmacist if you should take diltiazem with or without food, because instructions may vary with each product.
• Take diltiazem at around the same time(s) every day.
• Swallow the extended-release capsules and tablets whole; do not chew or crush them.
• Your doctor will probably start you on a low dose of diltiazem and gradually increase your dose, not more than once every 7 to 14 days if you are taking the extended-release tablet or capsule and not more than once every 1 to 2 days if you are taking the regular tablet.
• If taken regularly, diltiazem may control chest pain, but it does not stop chest pain once it starts.
• Your doctor may give you a different medication to take when you have chest pain.
• Diltiazem controls high blood pressure and chest pain but does not cure them.
• It may take up to 2 weeks before you feel the full benefit of diltiazem.
• Continue to take diltiazem even if you feel well.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As a tablet, an extended-release tablet, and an extended-release capsule

This medicine is available in fallowing brand namesː

• Cardizem; Cardizem CD; Cardizem LA; Cardizem SR; Cartia XT; Dilacor XR; Dilt-CD; Diltzac; Taztia XT; Tiamate; Tiazac

What side effects can this medication cause?

The most common side effects of this medicine include:

• lower limb edema
• sinus congestion and rash in patients treated for hypertension
• headache
• dizziness
• fatigue
• bradycardia
• first-degree AV block
• cough in patients treated for angina

• Rare but potentially severe adverse events include cardiac conduction defects, hypotension, hypersensitivity reactions and instances of Stevens Johnson syndrome.

What special precautions should I follow?

• Diltiazem may cause abnormally slow heart rates or second- or third-degree AV block.
• Worsening of heart failure has been reported in patients with impairment of ventricular function. Experience with the use of diltiazem in combination with beta-blockers in patients with impaired ventricular function is limited.
• Significant elevations in liver enzymes such as alkaline phosphatase, LDH, AST (SGOT), ALT (SGPT) and signs of acute hepatic injury have been reported with diltiazem therapy. Such elevations were usually transient and frequently resolved even with continued diltiazem treatment.
• Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme and/or exfoliative dermatitis have been reported.
• if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking diltiazem.
• Diltiazem is excreted in human milk. ecause of the potential 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.
• Diltiazem therapy is associated with serum enzyme elevations and has been linked to rare instances of clinically apparent liver injury.

What to do in case of emergency/overdose?

Symptoms of overdose may include:

• bradycardia, hypotension, heart block, and cardiac failure

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• In the event of overdose or exaggerated response, institute appropriate supportive measures and gastrointestinal decontamination.
• Diltiazem does not appear to be removed by peritoneal or hemodialysis.
• Limited data suggest that plasmapheresis or charcoal hemoperfusion may hasten diltiazem elimination following overdose.

The following measures may be considered:

• Bradycardia: Administer atropine (0.60 to 1.0 mg). If there is no response to vagal blockage, administer isoproterenol cautiously.

• High-degree AV Block:Fixed high-degree AV block should be treated with cardiac pacing.

• Cardiac Failure: Administer inotropic agents (isoproterenol, dopamine, or dobutamine) and diuretics.

• Hypotension: Use vasopressors (e.g., dopamine or norepinephrine).

Can this medicine be used in pregnancy?

• Pregnancy Category C.
• There are no well-controlled studies in pregnant women; therefore, use diltiazem in pregnant women only if the potential benefit justifies the risk to the fetus.

Can this medicine be used in children?

• Safety and effectiveness in pediatric patients have not been established.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• Diltiazem Hydrochloride

Inactive ingredients:

• carnauba wax
• silicon dioxide
• croscarmellose sodium
• ethyl acrylate and methyl methacrylate copolymer
• HYPROMELLOSE, UNSPECIFIED
• magnesium stearate
• MICROCRYSTALLINE CELLULOSE
• microcrystalline wax
• polydextrose
• POLYETHYLENE GLYCOL, UNSPECIFIED
• polysorbate 80
• POVIDONE, UNSPECIFIED
• sucrose stearate
• talc
• titanium dioxide

Who manufactures and distributes this medicine?

Manufactured for:

• Bausch Health US, LLC
• Bridgewater, NJ USA

By:

• Bausch Health Companies, Inc.
• Steinbach, MB, Canada

• Cardizem is a trademark of Bausch Health Companies Inc. or its affiliates.

What should I know about storage and disposal of this medication?

• Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F).
• Avoid excessive humidity and temperatures above 30°C (86°F).
• Dispense in tight, light resistant container as defined in USP.

calcium channel blockers

• amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nimodipine, nisoldipine, verapamil

Antihypertensive agents

• Dailymed label info on Diltiazem
• FDA Diltiazem

Diltiazem Resources
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