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Cardizem
Generic Name: Diltiazem
Brand Name: Cardizem
Indications
Cardizem is used to treat hypertension (high blood pressure), angina pectoris (chest pain), and certain heart rhythm disorders (supraventricular tachycardia, atrial fibrillation). It works by slowing the electrical conduction in the heart, slowing heart rate, and/or normalizing heart rhythm.
Dosage and Administration
Cardizem tablets, for oral administration, are formulated as a once-a-day extended release tablet containing 120 mg, 180 mg, 240 mg, 300 mg, 360 mg or 420 mg of diltiazem hydrochloride.
Normal Dosage:
Hypertension: Dosage needs to be adjusted by titration 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, dosage adjustments should be scheduled accordingly. The dosage range studied in clinical trials was 120 to 540 mg once daily. The dosage may be titrated to a maximum of 540 mg daily. Cardizem tablets should be taken about the same time once each day either in the morning or at bedtime. The time of dosing should be considered when making dose adjustments based on trough effects.
Angina: Dosage for the treatment of angina should be individualized based on response. The initial dose of 180 mg once daily may be increased at intervals of 7 - 14 days if adequate response is not obtained. Cardizem doses above 360 mg appear to confer no additional benefit. Cardizem can be given once daily, either in the evening or in the morning.
Overdose?
Symptoms of a diltiazem overdose may include slow heartbeat, weakness, chest pain, shortness of breath, feeling light-headed, or fainting. Seek emergency medical help.
Drug Description
Diltiazem hydrochloride is a calcium ion cellular influx inhibitor (slow channel blocker or calcium antagonist). Chemically, diltiazem hydrochloride is 1,5-benzothiazepin-4(5H)one,3-(acetyloxy)-5-[2- (dimethylamino)ethyl]-2, 3-dihydro-2-(4-methoxyphenyl)-, monohydrochloride, (+)-cis-. The structural formula is:
Diltiazem hydrochloride is a white to off-white crystalline powder with a bitter taste. It is soluble in water, methanol and chloroform. It has a molecular weight of 450.99.
Side Effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
- fast or slow heartbeats;
- feeling light-headed, fainting;
- fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
- feeling short of breath, even with mild exertion;
- swelling, rapid weight gain; or
- Nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Less serious side effects may include:
- stuffy nose;
- skin rash or itching;
- dizziness, headache, tired feeling;
- nausea; or
- warmth, itching, redness, or tingly feeling under your skin.
Precautions
- Diltiazem can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
- Avoid drinking alcohol while taking diltiazem.
- Grapefruit and grapefruit juice may interact with diltiazem and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
- Do not use this medication if you are allergic to diltiazem, or if you have certain heart conditions, especially "sick sinus syndrome" or "AV block" (unless you have a pacemaker); low blood pressure; if you have recently had a heart attack.
- Before taking diltiazem, tell your doctor if you are allergic to any drugs, or if you have kidney disease; liver disease; congestive heart failure.
- This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.
- Diltiazem can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
- Cardizem should be used cautiously in patients with cardiac conduction abnormalities, congestive heart failure, hypotension, and prescribing practitioner should be aware that use of Cardizem has been associated with acute hepatic injury in clinical studies.
Drug Interactions
Before taking diltiazem, tell your doctor if you are using any of the following drugs:
- amiodarone (Cordarone, Pacerone);
- cimetidine (Tagamet, Tagamet HB);
- cyclosporine (Gengraf, Neoral, Sandimmune);
- dexamethasone (Decadron, Hexadrol);
- digoxin (digitalis, Lanoxin, Lanoxicaps);
- lovastatin (Mevacor);
- midazolam (Versed) or triazolam (Halcion);
- rifampin (Rifadin, Rimactane, Rifater) or rifabutin (Mycobutin);
- St. John's wort;
- antibiotics such as ciprofloxacin (Cipro), griseofulvin (Fulvicin, Grifulvin, Grisactin), metronidazole (Flagyl, Protostat), azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S., Ery-Tab, Erythrocin), itraconazole (Sporanox), or ketoconazole (Nizoral);
- antidepressants such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft);
- HIV /AIDS medicine such as amprenavir (Agenerase), delavirdine (Rescriptor), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), or saquinavir (Invirase, Fortovase);
- seizure medication such as carbamazepine (Carbatrol, Tegretol), or phenobarbital (Luminal, Solfoton); or
- a beta-blocker such as atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), timolol (Blocadren), and others.
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