Dailtiazem hydrochloride
Trade name: Alti-Diltiazem ,Apo-Diltiaz,
Cardizem, Dilacor XR,
Gen-Diltiazem ,
Novo-Diltazem , Nu-Diltiaz , Tiamate,
Tiazac
Drug classes
• Calcium channel-blocker
• Antianginal agent
• Antihypertensive
Pregnancy: (Category C)
Action: Calcium-channel blockers
"anti anginal, antihypertensive"
Inhibits the movement of calcium ions across
the membranes of cardiac and arterial muscle cells, resulting in the depression
of impulse formation in specialized cardiac pacemaker cells, slowing of the
velocity of conduction of the cardiac impulse, depression of myocardial
contractility, and dilation of coronary arteries and arterioles and peripheral
arterioles; these effects lead to decreased cardiac work, decreased cardiac
energy consumption, and in patients with vasospastic (Prinzmetal's) angina,
increased delivery of oxygen to myocardial cells.
Indications
• Angina pectoris due to coronary artery spasm (Prinzmetal's
variant angina)
• Effort-associated
angina; chronic stable angina in patients not controlled by β-adrenergic
blockers, nitrates
• Essential hypertension (sustained release)
• Treatment of hypertension (sustained release, Tiamate) Paroxysmal supraventricular
tachycardia (parenteral)
Dose
Available Forms:
Tablets--30, 60, 90, 120 mg; SR capsules--60, 90, 120, 180, 240, 300 mg;
injection--25, 50 mg as 5 mg/mL
Evaluate patient carefully to determine the appropriate dose
of this drug.
Angina,
60 mg 3 times daily (elderly initially twice
daily); increased if
necessary to 360 mg daily
Pediatric: Safety and efficacy not established. Contraindications/cautions
Allergy to diltiazem,
impaired hepatic or
renal function, 
sick sinus
syndrome, hypotension, 
pulmonary congestion, and MI 
heart block (second or third
degree), and 
lactation
Side effects
• CNS: Dizziness,
light-headedness, headache, asthenia, fatigue
• GI: Nausea, hepatic injury
• CV: Peripheral edema, hypotension,
arrhythmias, bradycardia, AV block, asystole Dermatologic: Flushing,
rash
Clinically important interactions
• Drug-drug
o Increased serum levels and
toxicity of cyclosporine if taken concurrently with diltiazem
Nursing
Considerations
• Monitor patient carefully (BP, cardiac rhythm, and output) while
drug is being titrated to therapeutic dose; dosage may be increased more
rapidly in hospitalized patients under close supervision.
• Monitor
BP carefully if patient is on concurrent doses of nitrates.
•
Monitor cardiac rhythm
regularly during stabilization of dosage and periodically during long-term
therapy.
• Report irregular heart beat, shortness of breath, swelling of
the hands or feet, pronounced dizziness, constipation.
