Diltiazem Hydrochloride

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Generic Name of Diltiazem Hydrochloride - Learn More

Diltiazem Hydrochloride

Diltiazem Hydrochloride Precaution - What You Need to Know

Diltiazem Hydrochloride is a calcium channel blocker used primarily for managing hypertension and angina, as well as in certain arrhythmic conditions. While effective, its use requires attention to specific precautions to prevent potential complications.
- Pregnancy and breastfeeding: Diltiazem is classified as a pregnancy category C drug. Its safety in pregnant women has not been well studied, so it should be used only if the potential benefit justifies the potential risk to the fetus. Diltiazem is excreted in breast milk, so it should be used with caution in breastfeeding mothers, weighing the benefits and risks.
- Hepatic impairment: Diltiazem is extensively metabolized by the liver, and patients with hepatic dysfunction may have reduced clearance of the drug, potentially increasing the risk of side effects. In these patients, the dose may need to be adjusted, and close monitoring of liver function is essential.
- Renal impairment: While Diltiazem is not primarily eliminated by the kidneys, patients with renal impairment may require dose adjustments due to altered pharmacokinetics. Caution is advised in this population, and renal function should be monitored during therapy.
- Heart failure: Diltiazem can depress myocardial contractility and may exacerbate heart failure in some patients. It should be used with caution in patients with reduced left ventricular function, and close monitoring is essential to assess for worsening heart failure symptoms.
- Electrolyte imbalances: Patients should be monitored for electrolyte disturbances, particularly in those receiving diuretics or other medications that can affect electrolyte levels, as these can increase the risk of adverse effects.

Diltiazem Hydrochloride Indication - Uses and Benefits

Diltiazem Hydrochloride is primarily used in the management of cardiovascular conditions.
- Hypertension: Diltiazem is indicated as a treatment for hypertension, either as a monotherapy or in combination with other antihypertensive agents. It works by relaxing blood vessels and reducing the workload on the heart, thereby lowering blood pressure.
- Angina pectoris: Diltiazem is used to treat chronic stable angina by improving blood flow to the heart muscle and reducing the heart's oxygen demand. It is also helpful in managing vasospastic (Prinzmetal) angina, where coronary artery spasm occurs.
- Arrhythmias: Diltiazem is indicated for controlling heart rate in conditions like atrial fibrillation and atrial flutter, where it helps to slow down conduction through the AV node, thus reducing rapid heart rates.
- Off-label uses: Diltiazem is occasionally used off-label for other conditions such as migraine prevention or certain types of supraventricular tachycardia (SVT), although these uses are not FDA-approved.

Diltiazem Hydrochloride Contraindications - Important Warnings

Certain medical conditions or factors exclude the safe use of Diltiazem Hydrochloride:
- Severe bradycardia: Diltiazem can further slow the heart rate, so it is contraindicated in patients with severe bradycardia (e.g., heart rate < 40 beats per minute) or sick sinus syndrome unless they have a functioning pacemaker.
- Heart block: Diltiazem should not be used in patients with second- or third-degree AV block unless they have a pacemaker in place, as it can worsen the block.
- Severe hypotension: Diltiazem may cause a significant drop in blood pressure, and it is contraindicated in patients with severe hypotension (systolic blood pressure < 90 mmHg).
- Acute myocardial infarction with pulmonary congestion: Diltiazem can cause negative inotropic effects, potentially exacerbating the condition in patients with recent myocardial infarction complicated by pulmonary congestion or heart failure.
- Hypersensitivity: Individuals with a known allergy or hypersensitivity to Diltiazem or any of its excipients should avoid using this medication.

Diltiazem Hydrochloride Side Effects - What to Expect

Diltiazem is generally well-tolerated, but like all medications, it can cause side effects in some individuals.
- Common side effects:
- Headache
- Dizziness or lightheadedness
- Flushing
- Peripheral edema (swelling of the ankles or feet)
- Fatigue
- Constipation
- Serious side effects:
- Bradycardia: Slow heart rate (bradycardia) may occur, especially in those already predisposed, and can lead to dizziness or fainting.
- Heart block: Diltiazem can cause or worsen AV block, leading to conduction issues and the potential need for a pacemaker in severe cases.
- Hypotension: Excessive lowering of blood pressure, leading to symptoms like dizziness, fainting, or shock, can occur, particularly when starting treatment or with dosage increases.
- Hepatotoxicity: Rarely, liver dysfunction may occur, indicated by elevated liver enzymes or jaundice. Liver function tests should be monitored, especially in patients with preexisting liver conditions.
- Management: If any serious side effects occur, particularly signs of bradycardia or heart block, the dose should be reduced or discontinued, and medical attention should be sought immediately.

Diltiazem Hydrochloride Pregnancy Category ID - Safety Information

3

Diltiazem Hydrochloride Mode of Action - How It Works

Diltiazem is a calcium channel blocker that works by inhibiting the influx of calcium ions into cardiac and smooth muscle cells.
- Pharmacodynamics: By blocking L-type calcium channels, Diltiazem reduces the entry of calcium into vascular smooth muscle and the heart. This results in vasodilation (widening of blood vessels) and a decrease in myocardial contractility. These effects reduce blood pressure and help relieve angina. In the heart, it slows the conduction of electrical impulses through the AV node, which is useful in controlling heart rate in arrhythmias.
- Pharmacokinetics: Diltiazem is absorbed orally and has a bioavailability of around 40-60%. It undergoes extensive first-pass metabolism in the liver and has a half-life of approximately 3-4 hours. Its effects can be prolonged with extended-release formulations, which allow for once-daily dosing.
- Benefits: Diltiazem's ability to reduce both heart rate and blood pressure makes it particularly effective in managing angina, hypertension, and certain arrhythmias, offering a comprehensive approach to cardiovascular management.

Diltiazem Hydrochloride Drug Interactions - What to Avoid

Diltiazem Hydrochloride interacts with various drugs, which may either reduce its effectiveness or increase the risk of side effects.
- Beta-blockers: Combining Diltiazem with beta-blockers (e.g., metoprolol, atenolol) can cause excessive bradycardia or heart block due to the additive effects on slowing the heart rate. This combination should be used with caution and monitored closely.
- Digoxin: Diltiazem can increase plasma levels of digoxin, which may lead to digoxin toxicity. If used together, digoxin levels should be monitored regularly, and the dose may need to be adjusted.
- Anticoagulants: Diltiazem may interact with anticoagulants like warfarin, potentially enhancing their effects. Regular monitoring of INR (International Normalized Ratio) is recommended to prevent bleeding complications.
- CYP3A4 inhibitors/inducers: Diltiazem is metabolized by the liver enzyme CYP3A4, so drugs that inhibit (e.g., ketoconazole, grapefruit juice) or induce (e.g., rifampin) CYP3A4 may alter its levels. If these drugs are used together, careful monitoring and possible dose adjustments are necessary.
- Alcohol: Concurrent use of alcohol with Diltiazem can exacerbate dizziness and orthostatic hypotension, increasing the risk of falls or fainting. Patients should be advised to limit alcohol consumption during treatment.

Diltiazem Hydrochloride Adult Dose - Recommended Dosage

The standard dosing for Diltiazem in adults depends on the condition being treated:
- Hypertension: The usual starting dose is 120-180 mg of the extended-release formulation once daily. The dose can be gradually increased to a maximum of 360 mg daily, depending on response.
- Angina: For chronic stable angina, the initial dose is typically 30 mg 3-4 times per day, which may be increased based on patient response. Extended-release formulations can also be used, with doses ranging from 120-240 mg daily.
- Atrial fibrillation or atrial flutter: The usual starting dose is 120-180 mg of the extended-release formulation once daily. In cases of acute conversion, IV Diltiazem may be administered in a hospital setting.
- Administration: Diltiazem should be taken with or without food. Extended-release formulations should not be crushed or chewed, and they should be taken whole.

Diltiazem Hydrochloride Child Dose - Dosage for Children

Diltiazem is generally not recommended for children unless prescribed for specific conditions like arrhythmias. The exact dosing will depend on the age and condition of the child.
- For pediatric patients with arrhythmias: The typical dose for children is based on body weight. Doses usually start at 0.25-0.5 mg/kg per dose, with the frequency depending on the severity of the condition. Dosing should be individualized.
- Caution in young children: The use of Diltiazem in children under 12 years is not well-studied, and it should only be prescribed when the benefits clearly outweigh the risks. Monitoring for adverse effects is crucial in this population.

Diltiazem Hydrochloride Renal Dose - Dosage for Kidney Conditions

Although Diltiazem is not primarily excreted by the kidneys, renal impairment can still affect the drug’s metabolism and efficacy.
- Renal impairment: No specific dose adjustments are generally required for mild to moderate renal impairment. However, caution is advised, and monitoring is recommended in severe renal dysfunction.
- Monitoring: Kidney function (serum creatinine and estimated glomerular filtration rate) should be monitored periodically, especially in patients with known renal conditions. Adjustments may be necessary in severe cases of renal failure.