Dailtiazem hydrochloride

dr.joan

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
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
  • 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.