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Medication Safety Issues
Sound-alike/look-alike issues:
Cardizem® may be confused with Cardene®, Cardene SR®, Cardizem CD®, Cardizem SR®, cardiem
Cartia XT™ may be confused with Procardia XL®
Diltiazem may be confused with Dilantin®
Tiazac® may be confused with Tigan®, Tiazac® XC [CAN], Ziac®
High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication (I.V. formulation) among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.
Significant differences exist between oral and I.V. dosing. Use caution when converting from one route of administration to another.
International issues:
Cardizem® may be confused with Cardem® which is a brand name for celiprolol in Spain
Cartia XT™ may be confused with Cartia® which is a brand name for aspirin in multiple international markets
Dilacor®: Brand name for digoxin in Serbia, a brand name for verapamil in Brazil, and a brand name for barnidipine in Argentina
Tiazac® may be confused with Tazac® which is a brand name for nizatidine in Australia
Tiazac® may be confused with Tiazac® XC which is a brand name for diltiazem available in Canada (not available in U.S.)
Pronunciation
(dil TYE a zem)
U.S. Brand Names
Index Terms
Generic Available
Yes: Excludes extended release tablet
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use
Oral: Essential hypertension; chronic stable angina or angina from coronary artery spasm
Injection: Atrial fibrillation or atrial flutter; paroxysmal supraventricular tachycardia (PSVT)
Use: Unlabeled/Investigational
Investigational: Therapy of Duchenne muscular dystrophy
Pregnancy Risk Factor
C
Pregnancy Implications
Teratogenic and embryotoxic effects have been demonstrated in small animals. There are no adequate and well-controlled studies in pregnant women.
Lactation
Enters breast milk/not recommended (AAP considers “compatible”)
Breast-Feeding Considerations
Freely diffuses into breast milk; however, the AAP considers diltiazem to be compatible with breast-feeding. Available evidence suggests safe use during breast-feeding.
Contraindications
Oral: Hypersensitivity to diltiazem or any component of the formulation; sick sinus syndrome; second- or third-degree AV block (except in patients with a functioning artificial pacemaker); severe hypotension (systolic <90 mm Hg); acute MI and pulmonary congestion
Intravenous (I.V.): Hypersensitivity to diltiazem or any component of the formulation; sick sinus syndrome; second- or third-degree AV block (except in patients with a functioning artificial pacemaker); severe hypotension (systolic <90 mm Hg); acute MI and pulmonary congestion; administration concomitantly or within a few hours of the administration of I.V. beta-blockers; atrial fibrillation or flutter associated with accessory bypass tract (eg, Wolff-Parkinson-White syndrome); ventricular tachycardia (with wide-complex tachycardia, must determine whether origin is supraventricular or ventricular)
Canadian labeling: Additional contraindications (not in U.S. labeling): I.V. and oral: Pregnancy; use in women of childbearing potential
Warnings/Precautions
Concerns related to adverse effects:
• Conduction abnormalities: May cause first-, second-, and third-degree AV block or sinus bradycardia; risk increases with agents known to slow cardiac conduction.
• Hypotension/syncope: Symptomatic hypotension with or without syncope can rarely occur; blood pressure must be lowered at a rate appropriate for the patient's clinical condition.
• Peripheral edema: The most common side effect is peripheral edema; occurs within 2-3 weeks of starting therapy.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with hepatic impairment; may require lower starting dose.
• Hypertrophic obstructive cardiomyopathy (HOCM): Use with caution in patients with HOCM.
• Left ventricular dysfunction: Use with caution in left ventricular dysfunction; due to negative inotropic effects, may exacerbate condition.
• Renal impairment: Use with caution in patients with renal impairment.
Concurrent drug therapy:
• Beta-blockers: Concomitant use with beta-blockers can result in conduction disturbances, hypotension, and worsened LV function; I.V. administration concomitantly or within a few hours of I.V. beta-blockers is contraindicated.
• Digoxin: Concomitant use with digoxin can result in conduction disturbances.
Adverse Reactions
Note: Frequencies represent ranges for various dosage forms. Patients with impaired ventricular function and/or conduction abnormalities may have higher incidence of adverse reactions.
>10%:
Cardiovascular: Edema (2% to 15%)
Central nervous system: Headache (5% to 12%)
2% to 10%:
Cardiovascular: AV block (first degree 2% to 8%), edema (lower limb, 2% to 8%), pain (6%), bradycardia (2% to 6%), hypotension (<2% to 4%), vasodilation (2% to 3%), extrasystoles (2%), flushing (1% to 2%), palpitation (1% to 2%)
Central nervous system: Dizziness (3% to 10%), nervousness (2%)
Dermatologic: Rash (1% to 4%)
Endocrine & metabolic: Gout (1% to 2%)
Gastrointestinal: Dyspepsia (1% to 6%), constipation (<2% to 4%), vomiting (2%), diarrhea (1% to 2%)
Local: Injection site reactions: Burning, itching (4%)
Neuromuscular & skeletal: Weakness (1% to 4%), myalgia (2%)
Respiratory: Rhinitis (<2% to 10%), pharyngitis (2% to 6%), dyspnea (1% to 6%), bronchitis (1% to 4%), sinus congestion (1% to 2%)
<2%: Albuminuria, alkaline phosphatase increased, allergic reaction, ALT/AST increased, amblyopia, amnesia, angina, anorexia, arrhythmia, AV block (second or third degree), bruising, bundle branch block, CHF, CPK increased, crystalluria, depression, dreams abnormal, dry mouth, dysgeusia, ECG abnormalities, epistaxis, gait abnormality, gynecomastia, hallucination, hyperglycemia, hyperuricemia, impotence, insomnia, LDH increased, muscle cramps, nausea, neck rigidity, nocturia, pain, paresthesia, personality change, petechiae, photosensitivity, polyuria, pruritus, somnolence, syncope, tachycardia, thirst, tinnitus, tremor, ventricular extrasystoles, weight gain
Postmarketing and/or case reports: Alopecia, angioedema, asystole, bleeding time increased, erythema multiforme, exfoliative dermatitis, extrapyramidal symptoms, gingival hyperplasia, hemolytic anemia, leukopenia, purpura, retinopathy, Stevens-Johnson syndrome, thrombocytopenia, toxic epidermal necrolysis
Drug Interactions
Substrate of CYP2C9 (minor), 2D6 (minor), 3A4 (major); Inhibits CYP2C9 (weak), 2D6 (weak), 3A4 (moderate)
Alfentanil: Diltiazem may increase the levels/effects of alfentanil; fentanyl and sufentanil may be affected similarly.
Alpha1-blockers: Hypotensive effects of diltiazem may be enhanced by alpha1-blockers (eg, doxazosin, terazosin).
Amiodarone: Concomitant use with diltiazem may lead to bradycardia, other conduction delays, and decreased cardiac output; monitor closely if using together.
Amphetamines: May diminish the antihypertensive effect of diltiazem.
Anilidopiperidine opioids: May enhance the bradycardic and hypotensive effects of diltiazem.
Antifungals agents (azole derivatives, systemic): May inhibit/decrease metabolism of diltiazem; avoid this combination if possible; concomitant use requires dose reduction of diltiazem and close monitoring.
Aprepitant: Diltiazem may increase levels/effects of aprepitant; likewise aprepitant may increase levels/effects of diltiazem; monitor.
Barbiturates: May increase the metabolism and thus decrease the levels/effects of diltiazem; monitor.
Benzodiazepines (metabolized by oxidation): Diltiazem may decrease the metabolism, and thus increase levels/effects, of benzodiazepines metabolized by oxidation (particularly midazolam, and triazolam); avoid concomitant use if possible; concomitant use likely requires a dose reduction of the benzodiazepine; monitor for prolonged CNS depression.
Beta-blockers: Diltiazem may increase the levels/effects of beta-blockers; bradycardia and signs of heart failure have also been reported.
Buspirone: Diltiazem may decrease the metabolism and thus increase serum levels of buspirone; monitor.
Calcium channel blockers (dihydropyridine): Diltiazem may decrease the metabolism and thus increase the levels/hypotensive effects of dihydropyridine calcium channel blockers.
Calcium salts: May reduce the effects of diltiazem; monitor.
Carbamazepine: May decrease levels/effects of diltiazem; conversely, diltiazem may increase the levels/effects of carbamazepine with potential toxicity; dose reduction of carbamazepine may be warranted; concomitant use requires careful monitoring of patient.
Cardiac glycosides: Diltiazem may increase the levels/effects (eg, AV-blocking effect) of cardiac glycosides (digitoxin, digoxin).
Cimetidine: May increase levels/effects of diltiazem; monitor closely or consider use of an alternative H2 antagonist.
Colestipol: May decrease absorption and thus the levels/effects of diltiazem; separating doses by 4 hours appears to have limited impact on the interaction; the impact of separating doses by more time has not been evaluated.
Corticosteroids (systemic): Diltiazem may decrease the metabolism and thus increase the levels/effects of systemic corticosteroids; monitor for possible corticosteroid toxicity.
Cyclosporine: Diltiazem may decrease the metabolism and thus increase the levels/effects of cyclosporine; likewise, cyclosporine may decrease the metabolism and thus increase the levels/effects of diltiazem; concomitant use of these agents requires careful monitoring of cyclosporine levels, renal function, and blood pressure however if possible, avoid concomitant use or consider use of another calcium channel blocker (eg, dihydropyridine).
CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of diltiazem. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.
CYP3A4 inhibitors: May increase the levels/effects of diltiazem. Example inhibitors include azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, quinidine, telithromycin, and verapamil.
CYP3A4 substrates: Diltiazem may increase the levels/effects of CYP3A4 substrates. Example substrates include benzodiazepines, calcium channel blockers, cyclosporine, eletriptan, eplerenone, mirtazapine, nateglinide, nefazodone, pimecrolimus, sildenafil (and other PDE-5 inhibitors), tacrolimus, and venlafaxine. Selected benzodiazepines (midazolam and triazolam), cisapride, ergot alkaloids, selected HMG-CoA reductase inhibitors (lovastatin and simvastatin), and pimozide are generally contraindicated with strong CYP3A4 inhibitors.
Fosaprepitant: May increase the serum concentration of diltiazem; the active metabolite aprepitant is likely responsible for this effect; diltiazem may increase the serum concentration of fosaprepitant; specifically, diltiazem may increase the concentration of the active metabolite aprepitant; monitor.
HMG-CoA reductase inhibitors: Diltiazem may decrease the metabolism and thus increase the levels/effects of HMG-CoA reductase inhibitors (atorvastatin, lovastatin, simvastatin); if possible avoid concomitant use or consider pravastatin/fluvastatin/rosuvastatin or a second generation dihydropyridine calcium channel blocker as an alternative.
Lithium: Neurotoxicity, as well as decreased lithium levels, may result when used concomitantly with diltiazem. Monitor serum lithium concentrations although effects are not predictable in terms of type of effect (eg, toxicity or reduced efficacy) or severity; serum lithium levels may not be helpful in identifying toxicity.
Macrolide antibiotics: Certain macrolide antibiotics (eg, erythromycin, clarithromycin) may decrease the metabolism of and thus increase the levels/effects of calcium channel blockers. Consider using a noninteracting macrolide antibiotic (eg, azithromycin, spiramycin).
Magnesium salts: Diltiazem may enhance the adverse/toxic effect of magnesium salts; likewise, magnesium salts may enhance the hypotensive effect of diltiazem.
Maraviroc: Diltiazem may increase the levels/effects of maraviroc; dose adjustment of maraviroc may be necessary; monitor.
Midodrine: Diltiazem may enhance the bradycardic effect of midodrine; monitor.
Nafcillin: May increase the metabolism and thus decrease the levels/effects of diltiazem; monitor closely.
Neuromuscular-blocking agents (nondepolarizing): Diltiazem may enhance the neuromuscular-blocking effect of neuromuscular-blocking agents (nondepolarizing).
Nitroprusside: Diltiazem may enhance the hypotensive effect of nitroprusside; dose reduction of nitroprusside may be required in patients receiving diltiazem; monitor blood pressure.
Phenytoin: Diltiazem may decrease the metabolism and thus increase the levels/effects of phenytoin; monitor for phenytoin toxicity if used concomitantly.
Phosphodiesterase type-5 inhibitors (sildenafil, tadalafil, vardenafil): Hypotensive effects may be additive with concomitant use of diltiazem; monitor blood pressure.
Pimecrolimus: Diltiazem may decrease the metabolism of and thus increase the levels/effects of pimecrolimus especially in patients with widespread and/or erythrodermic disease. These patients are likely to experience increased absorption of pimecrolimus.
Protease inhibitors: Protease inhibitors may decrease the metabolism and thus increase the levels/effects of diltiazem; avoid concomitant use if possible; when used concomitantly a dose reduction of diltiazem is warranted (the manufacturer of atazanavir recommends that a 50% dose reduction for diltiazem be considered).
Quinidine: Diltiazem may increase serum levels of quinidine; dosage adjustment of quinidine may be required.
Quinupristin: May decrease the metabolism and thus increase the levels/effects of diltiazem; monitor.
Ranolazine: Diltiazem may decrease the metabolism and thus increase the levels/effects of ranolazine; concomitant use with diltiazem is contraindicated by the manufacturer of ranolazine
Rifamycin derivatives (rifampin): May increase the metabolism and thus decrease the levels/effects of diltiazem; monitor and adjust the dose of diltiazem to maintain efficacy or consider an alternative to the rifamycin derivative.
Salicylates: Diltiazem may enhance the anticoagulant effects of salicylates; monitor for increased antiplatelet effects of salicylates (eg, abnormal bruising/bleeding).
Tacrolimus: Diltiazem may decrease metabolism and thus increase the levels/effects of tacrolimus; concomitant use requires close monitoring of both tacrolimus trough levels and renal function.
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase risk of hypotension or vasodilation).
Food: Diltiazem serum levels may be elevated if taken with food. Serum concentrations were not altered by grapefruit juice in small clinical trials.
Herb/Nutraceutical: St John's wort may decrease diltiazem levels. Avoid bayberry, blue cohosh, cayenne, ephedra, ginger, ginseng (American), kola, licorice, yohimbe (may worsen hypertension). Avoid black cohosh, California poppy, coleus, garlic, golden seal, hawthorn, mistletoe, periwinkle, quinine, shepherd's purse (may have increased antihypertensive effect).
Storage
Capsule, tablet: Store at 15°C to 30°C (59°F to 86°F). Protect from light.
Solution for injection: Store in refrigerator at 2°C to 8°C (36°F to 46°F). May be stored at room temperature for up to 1 month; do not freeze. Following dilution with D51/2NS, D5W, or NS, solution is stable for 24 hours at room temperature or under refrigeration.
Compatibility
Stable in D51/2NS, D5W, NS.
Y-site administration: Compatible: Albumin, amikacin, amphotericin B, aztreonam, bretylium, bumetanide, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, cimetidine, ciprofloxacin, clindamycin, digoxin, dobutamine, dopamine, doxycycline, epinephrine, erythromycin lactobionate, esmolol, fentanyl, fluconazole, gentamicin, hetastarch, hydromorphone, imipenem/cilastatin, labetalol, lidocaine, lorazepam, meperidine, metoclopramide, metronidazole, midazolam, milrinone, morphine, multivitamins, nicardipine, nitroglycerin, norepinephrine, oxacillin, penicillin G potassium, pentamidine, piperacillin, potassium chloride, potassium phosphates, ranitidine, sodium nitroprusside, theophylline, ticarcillin, ticarcillin/clavulanate potassium, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vecuronium. Incompatible: Diazepam, furosemide, phenytoin, rifampin, thiopental. Variable (consult detailed reference): Acetazolamide, acyclovir, aminophylline, ampicillin, ampicillin/sulbactam, cefamandole, cefoperazone, heparin, hydrocortisone sodium succinate, insulin (regular), methylprednisolone sodium succinate, nafcillin, procainamide, sodium bicarbonate.
Mechanism of Action
Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina
Pharmacodynamics/Kinetics
Onset of action: Oral: Immediate release tablet: 30-60 minutes
Absorption: Immediate release tablet: >90%; Extended release capsule: ~93%
Distribution: Vd: 3-13 L/kg
Protein binding: 70% to 80%
Metabolism: Hepatic; extensive first-pass effect; following single I.V. injection, plasma concentrations of N-monodesmethyldiltiazem and desacetyldiltiazem are typically undetectable; however, these metabolites accumulate to detectable concentrations following 24-hour constant rate infusion. N-monodesmethyldiltiazem appears to have 20% of the potency of diltiazem; desacetyldiltiazem is about 25% to 50% as potent as the parent compound.
Bioavailability: Oral: ~40% (undergoes extensive first-pass metabolism)
Half-life elimination: Immediate release tablet: 3-4.5 hours, may be prolonged with renal impairment; Extended release tablet: 6-9 hours; Extended release capsules: 5-10 hours
Time to peak, serum: Immediate release tablet: 2-4 hours; Extended release tablet: 11-18 hours; Extended release capsule: 10-14 hours
Excretion: Urine (2% to 4% as unchanged drug; 6% to 7% as metabolites); feces
Dosage
Children (unlabeled use): Oral: Hypertension: Immediate release tablets: Initial: 1.5-2 mg/kg/day 3 times daily (maximum dose 6 mg/kg/day up to 360 mg/day)
Note: Doses up to 8 mg/kg/day given in 4 divided doses have been used for investigational therapy of Duchenne muscular dystrophy
Adults:
Oral:
Angina:
Capsule, extended release (Cardizem® CD, Cartia XT™, Dilacor® XR, Diltia XT®, Tiazac®): Initial: 120-180 mg once daily (maximum dose: 480 mg/day)
Tablet, extended release (Cardizem® LA), Tiazac® XC [CAN; not available in U.S.]): 180 mg once daily; may increase at 7- to 14-day intervals (maximum recommended dose: 360 mg/day)
Tablet, immediate release (Cardizem®): Usual starting dose: 30 mg 4 times/day; usual range: 180-360 mg/day
Hypertension:
Capsule, extended release (Cardizem® CD, Cartia XT™, Dilacor® XR, Diltia XT®, Tiazac®): Initial: 180-240 mg once daily; dose adjustment may be made after 14 days; usual dose range (JNC 7): 180-420 mg/day; Tiazac®: usual dose range: 120-540 mg/day
Capsule, sustained release: Initial: 60-120 mg twice daily; dose adjustment may be made after 14 days; usual range: 240-360 mg/day
Tablet, extended release (Cardizem® LA, Tiazac® XC [CAN; not available in U.S.]): Initial: 180-240 mg once daily; dose adjustment may be made after 14 days; usual dose range (JNC 7): 120-540 mg/day
Note: Elderly: Patients ?60 years may respond to a lower initial dose (ie, 120 mg once daily using extended release capsule)
I.V.: Atrial fibrillation, atrial flutter, PSVT:
Initial bolus dose: 0.25 mg/kg actual body weight over 2 minutes (average adult dose: 20 mg)
Repeat bolus dose (may be administered after 15 minutes if the response is inadequate.): 0.35 mg/kg actual body weight over 2 minutes (average adult dose: 25 mg)
Continuous infusion (requires an infusion pump; infusions >24 hours or infusion rates >15 mg/hour are not recommended.): Initial infusion rate of 10 mg/hour; rate may be increased in 5 mg/hour increments up to 15 mg/hour as needed; some patients may respond to an initial rate of 5 mg/hour.
If diltiazem injection is administered by continuous infusion for >24 hours, the possibility of decreased diltiazem clearance, prolonged elimination half-life, and increased diltiazem and/or diltiazem metabolite plasma concentrations should be considered.
Conversion from I.V. diltiazem to oral diltiazem:
Oral dose (mg/day) is approximately equal to [rate (mg/hour) x 3 + 3] x 10.
3 mg/hour = 120 mg/day
5 mg/hour = 180 mg/day
7 mg/hour = 240 mg/day
11 mg/hour = 360 mg/day
Dosing comments in renal/hepatic impairment: Use with caution as extensively metabolized by the liver and excreted in the kidneys and bile.
Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.
Administration: Oral
Do not crush long acting dosage forms.
Taztia XT™, Tiazac®: Capsules may be opened and sprinkled on a spoonful of applesauce. Applesauce should be swallowed without chewing, followed by drinking a glass of water.
Tiazac® XC [CAN; not available in U.S.]: Administer at bedtime
Administration: I.V.
Bolus doses given over 2 minutes with continuous ECG and blood pressure monitoring. Continuous infusion should be via infusion pump.
Administration: I.V. Detail
Response to bolus may require several minutes to reach maximum. Response may persist for several hours after infusion is discontinued.
pH: 3.7-4.1
Monitoring Parameters
Liver function tests, blood pressure, ECG
Patient Education
Do not take any new medication during therapy unless approved by prescriber. Oral: Take as directed; do not alter dosage or discontinue therapy without consulting prescriber. Do not crush or chew extended release form. Avoid (or limit) alcohol and caffeine. May cause dizziness or lightheadedness (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea or vomiting (small, frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); constipation (increased exercise, fluids, fruit, or fiber may help); or diarrhea (buttermilk, boiled milk, or yogurt may help). Report chest pain, palpitations, irregular heartbeat; unusual cough, respiratory difficulty; swelling of extremities; muscle tremors or weakness; confusion or acute lethargy; skin rash; or other adverse reactions. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.
Geriatric Considerations
Elderly may experience a greater hypotensive response; constipation may be more of a problem in elderly; calcium channel blockers are no more effective in elderly than other therapies; however, they do not cause significant CNS effects which is an advantage over some antihypertensive agents.
Anesthesia and Critical Care Concerns/Other Considerations
Diltiazem may be administered intravenously in the acute setting to attain ventricular rate control in patients with atrial fibrillation or flutter. Patients who respond, defined in general as at least a 20% decrease in ventricular response rate or attaining a rate <100 beats/minute, can be continued on oral therapy to maintain control.
Cardiovascular Considerations
Diltiazem is an effective antihypertensive alone or in combination with other agents. Antihypertensive therapy should be individualized with consideration given to the patient's concomitant diseases and compelling indications for therapy.
In the treatment of acute myocardial infarction, diltiazem may be used to treat hypertension or ongoing ischemia if beta-blocker therapy is ineffective or contraindicated and in the absence of left ventricular dysfunction, pulmonary congestion, or AV block. In this setting, diltiazem may be beneficial. Diltiazem should be avoided in patients with left ventricular dysfunction or pulmonary congestion.
Diltiazem may be administered intravenously in the acute setting to attain ventricular rate control in patients with atrial fibrillation or flutter. Patients who respond, defined in general as at least a 20% decrease in ventricular response rate or attaining a rate <100 beats/minute, can be continued on oral therapy to maintain control. It is important to consider the potential drug interaction with digoxin, as these agents are both used in this setting.
In the treatment of unstable angina/non-ST-segment elevation MI, a nondihydropyridine calcium antagonist (diltiazem or verapamil) may be considered in patients with continuing or frequently recurring ischemia when beta-blockers are contraindicated (Class I). Oral long-acting calcium antagonists may also be considered in addition to beta-blockers and nitrates (Class IIa).
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Diltiazem has been reported to cause >10% incidence of gingival hyperplasia; usually disappears with discontinuation (consultation with physician is suggested).
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause dizziness, insomnia, nervousness, or sedation
Mental Health: Effects on Psychiatric Treatment
May produce leukopenia; use caution with clozapine and carbamazepine; lithium levels may be increased or decreased; monitor serum lithium levels; benzodiazepines (midazolam, triazolam), buspirone, and carbamazepine levels may be increased; monitor for increased side effects
Nursing: Physical Assessment/Monitoring
Assess other pharmacological or herbal products patient may be taking for potential interactions (eg, increased risk of bradycardia, conduction delays, decreased cardiac output). I.V. requires use of infusion pump and continuous cardiac and hemodynamic monitoring. Assess therapeutic effectiveness according to purpose for use (hypertension, angina, atrial fib/flutter or PSVT) and adverse reactions when beginning therapy, when changing dose, and periodically during long-term therapy. Teach patient appropriate use (oral), interventions to reduce side effects, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [CAN] = Canadian brand name
Capsule, extended release, as hydrochloride [once-daily dosing]: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg
Cardizem® CD: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg
Cartia XT™: 120 mg, 180 mg, 240 mg, 300 mg
Dilacor® XR, Dilt-XR, Diltia XT®: 120 mg, 180 mg, 240 mg
Taztia XT™: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg
Tiazac®: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg
Capsule, sustained release, as hydrochloride [twice-daily dosing]: 60 mg, 90 mg, 120 mg
Injection, solution, as hydrochloride: 5 mg/mL (5 mL, 10 mL, 25 mL)
Injection, powder for reconstitution, as hydrochloride:
Cardizem®: 25 mg
Tablet, as hydrochloride: 30 mg, 60 mg, 90 mg, 120 mg
Cardizem®: 30 mg, 60 mg, 90 mg, 120 mg
Tablet, extended release, as hydrochloride:
Cardizem® LA: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg
Tiazac® XC [CAN; not available in U.S.]: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg
Pricing: U.S. (www.drugstore.com)
Capsule, 12-hour (Diltiazem HCl CR)
60 mg (60): $35.99
90 mg (60): $45.99
120 mg (60): $71.51
Capsule, 24-hour (Cardizem CD)
120 mg (30): $80.49
180 mg (30): $94.29
240 mg (30): $129.94
300 mg (30): $145.99
360 mg (30): $178.24
Capsule, 24-hour (Cartia XT)
120 mg (30): $23.99
180 mg (30): $27.99
240 mg (30): $43.99
300 mg (30): $58.99
Capsule, 24-hour (Dilacor XR)
120 mg (30): $60.47
180 mg (30): $69.84
240 mg (30): $79.99
Capsule, 24-hour (Diltia XT)
120 mg (30): $27.99
180 mg (30): $32.99
240 mg (30): $34.99
Capsule, 24-hour (Diltiazem HCl Coated Beads)
120 mg (30): $29.99
180 mg (30): $34.99
300 mg (30): $58.99
Capsule, 24-hour (Diltiazem HCl CR)
240 mg (90): $65.99
Capsule, 24-hour (Diltiazem HCl ER Beads)
120 mg (30): $25.99
180 mg (30): $29.99
240 mg (30): $38.99
300 mg (30): $46.99
360 mg (30): $47.99
420 mg (90): $136.98
Capsule, 24-hour (Tiazac)
120 mg (30): $47.83
180 mg (30): $53.50
240 mg (30): $74.20
300 mg (30): $93.68
360 mg (30): $94.89
Tablet, 24-hour (Cardizem LA)
120 mg (30): $65.93
180 mg (30): $69.99
240 mg (30): $89.99
300 mg (30): $124.29
360 mg (30): $131.15
420 mg (30): $140.09
Tablets (Cardizem)
30 mg (90): $50.99
60 mg (90): $76.00
90 mg (90): $105.99
Tablets (Diltiazem HCl)
30 mg (90): $12.99
60 mg (100): $19.99
90 mg (90): $22.00
120 mg (90): $29.99
Extemporaneously Prepared
A 12 mg/mL oral liquid preparation made from tablets (regular, not sustained release) and 3 different vehicles (cherry syrup, a 1:1 mixture of Ora-Sweet® and Ora-Plus®, or a 1:1 mixture of Ora-Sweet® SF and Ora-Plus®) was stable for 60 days when stored in amber plastic prescription bottles in the dark at room temperature (25°C) or under refrigeration (5°C); grind sixteen 90 mg tablets in a mortar into a fine powder; add 10 mL of the vehicle and mix well to form a uniform paste; mix while adding the vehicle in geometric proportions to almost 120 mL; transfer to a calibrated bottle and qs ad with vehicle to 120 mL; label “shake well” and “protect from light”.
Allen LV and Erickson MA, “Stability of Baclofen, Captopril, Diltiazem Hydrochloride, Dipyridamole, and Flecainide Acetate in Extemporaneously Compounded Oral Liquids,” Am J Health Syst Pharm, 1996, 53(18):2179-84.
References
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International Brand Names
Lexi-Comp.com
Last full review/revision May 2008
Content last modified May 2008
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