Diltiazem

DEA Class; Rx

Common Brand Names; Cardizem, Cardizem CD, Cardizem LA, Cartia XT, Dilacor, Dilacor XR, Dilatrate, Diltazem, Diltazem CD, Dilt-CD, Diltia XT, Diltiaz, Diltiaz CD, Diltiaz SR, Diltiazem CD, Diltiazem SR, Dilzem, Taztia XT, Tiazac

• Antidysrhythmics, IV; 
• Calcium Channel Blockers; 
• Calcium Channel Blockers, Non-dihydropyridine

Oral and IV, benzothiazepine calcium-channel blocker; primarily used for angina, HTN, PST, and ventricular rate control in AFIB; slows AV conduction; vasodilatory properties; less negative inotropic effects than verapamil or nifedipine.

Indicated for the treatment of hypertension.

Hypersensitivity

Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome, symptomatic severe hypotension (systolic BP <90 mm Hg), sick sinus syndrome (if no pacemaker), 2°/3° (if no pacemaker); heart block

PO: Acute MI and pulmonary congestion

IV: Use in newborns (because of benzyl alcohol), concomitant beta-blocker therapy, cardiogenic shock, ventricular tachycardia (must determine whether origin is supraventricular or ventricular)

May cause abnormally slow heart rates or second- or third-degree AV block’ patients with sick sinus syndrome are at increased risk of bradycardia (risk increases with agents known to slow cardiac conduction

Stevens-Johnson syndrome, toxic epidermal necrolusis, erythema multiforme and/or exfoliative dermatitis reported

Significant elevations in liver enzymes such as alkaline phosphatase, LDH, AST (SGOT), ALT (SGPT) and signs of acute hepatic injury reported; reversible upon discontinuation of drug therapy

Mild elevations of transaminases with and without concomitant elevation in alkaline phosphatase and bilirubin observed; elevations were usually resolved even with continued diltiazem treatment

Symptomatic hypotension with or without syncope reported

Peripheral edema occurs within 2-3 weeks of starting therapy

Use with caution in hypertrophic obstructive cariomyopathy, hepatic/renal impairment, left ventricular dysfunction

Concomitant use of diltiazem with beta-blockers or digitalis may result in additive effects on cardiac conduction; sinus bradycardia resulting in hospitalization reported with concurrent use of clonidine and other agents that slow cardiac conduction

May increase the risk of adverse cardiac events in patients with heart failure due to negative inotropic effects (risk directly related to the severity of baseline HF)

Pregnancy category: C

Lactation: Drug enters breast milk; because of risk for serious adverse reactions in nursing infants from diltiazem, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother