diltiazem hydrochloride

(dil tye' a zem)

Alti-Diltiazem (CAN), Apo-Diltiaz (CAN), Cardizem, Cardizem CD, Cardizem
LA, Cardizem SR, Cartia XT, Dilacor XR, Diltia XT, Gen-Diltiazem (CAN),
Novo-Diltiazem (CAN), Nu-Diltiaz (CAN), Tiamate, Tiazac

Pregnancy Category C

Drug classes
Calcium channel blocker
Antianginal
Antihypertensive

Therapeutic actions
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 beta-
adrenergic blockers, nitrates
• Sustained- and extended-release forms: Essential hypertension
• Parenteral: Paroxysmal supraventricular tachycardia, atrial fibrillation, atrial
flutter

Contraindications and cautions

• Allergy to diltiazem, impaired hepatic or renal function, sick sinus syndrome,
heart block (second or third degree), lactation.

Available forms
Tablets—30, 60, 90, 120 mg; ER tablets—180, 240, 300, 360, 420 mg; SR tablets—60,
90, 120 mg; ER capsules—60, 90, 120, 180, 240, 300, 360, 420 mg; injection—5 mg/mL;
powder for injection—25, 100 mg

Dosages
Evaluate patient carefully to determine the appropriate dose of this drug.
ADULTS
Initially, 30 mg PO qid before meals and hs; gradually increase dosage at 1- to 2-day
intervals to 180–360 mg PO in three to four divided doses.
Sustained and extended release
Cardizem SR: Initially, 60–120 mg PO bid; adjust dosage when maximum
antihypertensive effect is achieved (around 14 days); optimum range is 240–360 mg/day.
Cardizem CD and Cartia XT: 180–240 mg daily PO for hypertension; 120–180 mg daily
PO for angina.
Dilacor XR and Diltia XT: 180–240 mg daily PO as needed; up to 480 mg has been used.
Tiazac: 120–240 mg daily PO for hypertension—once daily dose; 120–180 mg PO once
daily for angina.
IV
Direct IV bolus: 0.25 mg/kg (20 mg for the average patient); second bolus of 0.35 mg/kg.
Continuous IV infusion: 5–10 mg/hr with increases up to 15 mg/hr; may be continued for
up to 24 hr.
PEDIATRIC PATIENTS
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak
Oral 30–60 min 2–3 hr
SR, ER 30–60 min 6–11 hr
IV Immediate 2–3 min

Metabolism: Hepatic; T1/2: 3.5–6 hr; 5–7 hr (SR)

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts
Preparation: For continuous infusion, transfer to normal saline, D5W, D5W/0.45% NaCl
as below. Mix thoroughly. Use within 24 hr. Keep refrigerated.
Diluent Volume (mL) Quantity of Injection) Final conc. Dose (mg/hr) Infusion Rate
(mg/mL) (mL/hr)
100 125 mg 1 10 10
(25 mL) — 15 15
250 250 mg 0.83 10 12
(50 mL) — 15 18
500 250 mg 0.45 10 22
(50 mL) — 15 33
Infusion: Administer bolus dose over 2 min. For continuous infusion, rate of 10 mL/hr is
the recommended rate. Do not use continuous infusion longer than 24 hr.
Incompatibilities: Do not mix in the same solution with furosemide solution.

Adverse effects
• CNS: Dizziness, light-headedness, headache, asthenia, fatigue
• CV: Peripheral edema, hypotension, arrhythmias, bradycardia, AV block, asystole
• Dermatologic: Flushing, rash
• GI: Nausea, hepatic injury, reflux

Interactions
Drug-drug
• Increased serum levels and toxicity of cyclosporine if taken concurrently with
diltiazem
 • Possible depression of myocardial contractility, AV conduction if combined with
beta blockers; use caution and monitor patient closely
Drug-food
• Decreased metabolism and increased risk of toxic effects if taken with grapefruit
juice; avoid this combination

Nursing considerations
Assessment
• History: Allergy to diltiazem, impaired hepatic or renal function, sick sinus
syndrome, heart block, lactation, pregnancy
• Physical: Skin lesions, color, edema; P, BP, baseline ECG, peripheral perfusion,
auscultation; R, adventitious sounds; liver evaluation, normal output; liver and
renal function tests, urinalysis

Interventions
• 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.
• Ensure patient swallows ER and SR preparations whole; do not cut, crush, or
chew.

Teaching points
• Swallow SR, ER, and LA preparations whole; do not cut, crush, or chew; do not
drink grapefruit juice while using this drug.
• These side effects may occur: Nausea, vomiting (eat frequent small meals);
headache (regulate light, noise, and temperature; medicate if severe).
• Report irregular heart beat, shortness of breath, swelling of the hands or feet,
pronounced dizziness, constipation.

Adverse effects in Italic are most common; those in Bold are life-threatening.