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Cardi B vs Cardizem

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Diltiazem Hydrochloride

Common Brand Names: Cardizem

Therapeutic Class: A calcium channel blocking agent

Common Injectable Dosage Forms:

Injection: 5 mg/mL in 5-, 10-, and 25-mL vials

Powder for Injection: 25 mg in single-use containers

Dosage Ranges:

For atrial flutter or fibrillation or for paroxysmal supraventricular tachycardia: A bolus dose of 0.25 mg/kg (or 20 mg) is given, with a repeated dose of 0.35 mg/kg (25 mg) in 15 minutes if needed. Subsequent boluses should be individualized as needed. For constant control of heart rate, continuous infusions of 10 mg/hour (range of 5-15 mg) for up to 24 hours have been used following a bolus dose of 0.25-0.35 mg/kg (20-25 mg).

For control of severe hypertension: Continuous infusion at a rate of 10 mcg/kg/minute has been reported effective.

Administration and Stability: The drug may be given undiluted (5 mg/mL) by direct IV injection over a period of 2 minutes for bolus dose. For continuous infusions, the drug may be diluted with a compatible solution (D5W) to a concentration of 1 mg/mL and infused at the appropriate dose with continuous ECG and BP monitoring. Stable for 24 hours at room temperature in D5W or NS. pH 3.5-4.3

Pharmacology/Pharmacokinetics: Diltiazem inhibits the transmembrane influx of extracellular calcium ions across the membranes of myocardial cells and vascular smooth muscle cells, without changing the serum calcium concentrations. This action can dilate the main coronary and systemic arteries, and also slows the cardiac conduction system.

Drug and Lab Interactions: Concomitant use with beta-adrenergic blocking agents may exacerbate CHF, arrhythmias, and cause severe hypotension. May have additive effects or potentiate the hypotensive effects of other antihypertensive agents. Diltiazem may competitively inhibit the cytochrome P-450 metabolism system, and concomitant use with drugs metabolized with this system (I.e., cimetidine, antipyrine, etc.) should be done cautiously with careful monitoring. Diltiazem has been reported by some studies to elevate serum digoxin levels, and concomitant use should include monitoring of these levels.

Contraindications/Precautions: Contraindicated in patients with severe left ventricular dysfunction, severe or moderate cardiac failure, severe hypotension, radiographically documented pulmonary congestion, sick sinus syndrome, or second- or third-degree AV block. Caution should be used in patients with renal or hepatic diseases or in those with severe congestive heart failure. The IV form should only be used in a clinical setting with proper supportive measures including hemodynamic monitoring and resuscitation equipment. Pregnancy Category C.

Monitoring Parameters: Liver function tests, blood pressure, ECG

Adverse Effects: The main adverse effects with IV use are hypotension, heart failure (with concomitant beta-blockers), peripheral edema, and fatigue. Other reported effects include headaches, nausea, and skin reactions.

Common Clinical Applications: Used for the treatment of atrial fibrillation or atrial flutter, PSVT, and essential hypertension.

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