![]() ![]() Diltiazem possesses negative inotropic effects and is generally avoided in patients with congestive heart failure, and diltiazem is also on the Beers Criteria. Proper dosage and frequency are essential to enhance patient care and improve outcomes. ĭiltiazem has been widely used in practice for many clinical indications. Clinicians should monitor apixaban anti-Xa assay or heparin anti-Xa assay to decide if patients require dose adjustment to reduce adverse events in patients prescribed apixaban and concomitant p-glycoprotein and CYP3A4 inhibitors like diltiazem with statins. Similarly, serum digoxin levels should be monitored with concurrent administration of diltiazem. If a patient is controlled on diltiazem to treat hypertrophic cardiomyopathy, diltiazem therapy may continue, but additional fetal monitoring is required. Continuous blood pressure and ECG monitoring are necessary during bolus administration.įor the treatment of hypertension during pregnancy, recommendations state that using an alternative agent, since diltiazem has shown adverse fetal effects in animal studies. ![]() When treating arrhythmias, an IV bolus is administered over two minutes. In contrast, subjective findings, such as a patient's frequency and severity of chest pain, are used to evaluate effectiveness when treating chronic angina.Ī comprehensive metabolic panel is also performed at baseline to track potential changes in electrolytes and kidney and liver function.Īdditional monitoring is required when using diltiazem parenterally. When treating hypertension and arrhythmias, objective findings assess the therapy's efficacy. Therapeutic monitoring includes periodic blood pressure assessments, heart rate, and electrocardiograms. The following represent the dosing variances by condition using generic names under various trade names. Hence FDA and ISMP (institute of safe medical practices) have provided the name of these sound-alike look-alike drugs to avoid potential medical errors. The use of tall-man lettering is advised to avoid this medication error as it poses a significant threat to patient safety. Review the package insert for the formulation by brand name because pharmacokinetics vary significantly between different brands.ĭiltiazem may be confused with diazepam. Compounded topical preparations of diltiazem are used off-label. There are numerous brand names for oral diltiazem (capsules and tablets), and available strengths include 30 mg, 60 mg, 90 mg, 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, and 420 mg. In the United States, diltiazem is FDA-approved as an oral immediate-release, extended-release, controlled-release (CD), and intravenous formulation. Įxcretion: The plasma elimination half-life following drug administration is about 3.0 to 4.5 hours. Diltiazem undergoes extensive metabolism in which 2% to 4% of the unchanged drug appears in the urine. Desacetyl diltiazem, the metabolite of diltiazem, also contributes to coronary vasodilatation. Metabolism: Diltiazem is metabolized by the cytochrome P450 system and is an inhibitor of CYP3A4, which can lead to drug-drug interactions. ĭistribution: Diltiazem is 70% to 80% bound to plasma proteins. Ībsorption: Diltiazem is well absorbed from the GIT and undergoes extensive first-pass metabolism resultant bioavailability is approximately 40%. The immediate-release diltiazem tablet has an onset of action of 30 to 60 minutes. Diltiazem is a potent dilator of coronary arteries, both epicardial and subendocardial. This is accomplished via reductions in heart rate and blood pressure at submaximal and maximal workloads. Diltiazem has been shown to increase exercise tolerance, probably due to its ability to reduce myocardial oxygen demand.
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