Diltiazem

Oral
Intravenous
Class
Antiarrhythmics
Subclass
Nondihydropyridine calcium channel blockers
Substance name
dilTIAZem hydrochloride
Brand names
Cardizem®
Common formulations
Tablet
See also
Diltiazem ER (Cardizem CD®, Cartia Xt®, Matzim La®, Tiadylt ER®, Taztia Xt®, Tiazac®)
Dosage and administration
Adults patients
Stable angina
•
Start at: 30 mg PO QID
•
Maintenance: 180-360 mg PO daily, in 3-4 divided doses
Take before meals and at bedtime. Titrate gradually at 1-2 day intervals to response.
Vasospastic angina
•
Start at: 30 mg PO QID
•
Maintenance: 180-360 mg PO daily, in 3-4 divided doses
Take before meals and at bedtime. Titrate gradually at 1-2 day intervals to response.
AF • Rate control • Off-label
•
60 mg PO TID
LVOTO in patients with HCM • Off-label
•
Start at: 60 mg PO TID
•
Maximum: 360 mg per day
Pulmonary arterial hypertension • Off-label
•
Start at: 60 mg PO BID
•
Maintenance: 120-360 mg PO BID
Raynaud's phenomenon • Off-label
•
30-120 mg PO TID
SVT • Ongoing management • Off-label
•
Start at: 120 mg PO daily, in divided doses
•
Maintenance: 120-360 mg PO daily, in divided doses
•
Maximum: 360 mg per day
Tenesmus in patients with cancer • Off-label
•
30 mg PO QID
Other off-label uses
•
Treatment of nocturnal leg cramps
•
Treatment of premature ventricular contractions
•
Adjunctive treatment for NSTEMI
Indications for use
Labeled indications
Adults
•
Treatment of stable angina
•
Treatment of vasospastic angina
Off-label indications
Adults
•
Treatment of Raynaud's phenomenon
•
Treatment of AF (rate control)
•
Treatment of LVOTO in patients with HCM
•
Treatment of nocturnal leg cramps
•
Treatment of premature ventricular contractions
•
Treatment of pulmonary arterial hypertension
•
Treatment of SVT (ongoing management)
•
Treatment of tenesmus in patients with cancer
•
Adjunctive treatment for NSTEMI
Safety risks
Contraindications
Hypersensitivity to diltiazem or its components
Acute myocardial infarction with pulmonary edema
Hypotension
•
Do not use diltiazem in patients with a SBP < 90 mmHg.
Second- or third-degree AV block
•
Do not use diltiazem in patients with second- or third-degree AV block except in the presence of a functioning ventricular pacemaker.
Sick sinus syndrome
•
Do not use diltiazem in patients with sick sinus syndrome except in the presence of a functioning ventricular pacemaker.
Warnings and precautions
Bradycardia
•
Use caution in patients taking β-blockers or cardiac glycosides.
Drug-induced liver injury
•
Maintain a high level of suspicion, as diltiazem may cause acute liver injury with elevations in liver enzymes.
Exacerbation of HF
•
Use caution in patients with congestive HF.
Hypotension
•
Maintain a high level of suspicion, as diltiazem may decrease BP resulting in symptomatic hypotension.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use with caution. Monitor renal function in prolonged use.
Renal replacement therapy
Continuous renal replacement
•
No dose adjustment required. Use with caution.
Intermittent hemodialysis
•
No dose adjustment required. Use with caution.
Peritoneal dialysis
•
No dose adjustment required. Use with caution.
Hepatic impairment
Any severity
•
Use with caution. Monitor liver function tests in prolonged use.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C, C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Halt breastfeeding temporarily.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Peripheral edema, asthenia, dizziness, headache, nausea, skin rash
Uncommon < 1%
•
Congestive heart failure, premature ventricular contractions, angina pectoris, cardiac arrhythmias, AV block, bradycardia, hypotension, syncope, tachycardia, memory impairment, nightmares, gait disturbance, depression, hallucinations, insomnia, paresthesia, behavioral or personality changes, somnolence, tremor, constipation, loss of appetite, dysgeusia, ↑ serum ALP, ↑ serum ALT, ↑ serum AST, ↑ serum LDH, petechiae, pruritus, urticaria, photosensitivity of skin, ↑ serum CK, amblyopia, dyspnea, dry mouth, nosebleed, eye irritation, ↑ blood glucose, ↑ serum uric acid, erectile dysfunction, nasal congestion, nocturia, muscle cramps, arthralgia, polyuria, tinnitus, sexual dysfunction, skin flushing, diarrhea, dyspepsia, palpitations, nervousness
Unknown frequency
•
Acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, toxic epidermal necrolysis, hemolytic anemia, leukocytoclastic vasculitis, myocardial infarction, asystole, hair loss, angioedema, erythema multiforme, extrapyramidal signs, swollen gums, ↓ WBC count, ↑bleeding time, purpura, ↓ platelet count
Interactions
Drug(s)
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