Uses of Diltiazem: - Hypertension (high blood pressure) - Angina (heart-related chest pain) - Arrhythmia Supraventricular tachycardia, Hypertension, Angina, Atrial fibrillation, Arrhythmias, Atrial flutter Sick-sinus syndrome; 2nd or 3rd ° AV block; porphyria. Severe congestive cardiac failure; marked bradycardia. Pregnancy and lactation.

Calcium-channel blockers

Diltiazem hydrochloride is a calcium channel antagonist. It is a peripheral and coronary vasodilator with some negative inotropic activity. Diltiazem inhibits cardiac conduction particularly at the sino-atrial and atrioventricular nodes. Diltiazem has the following actions:Antianginal: A direct dilatation of coronary arteries and arterioles proved oxygen supply to myocardial tissues. In addition dilatation of the peripheral vasculature reduces systemic pressure of cardiac "after load" which results in lessened stress and reduced oxygen requirements of the myocardial tissues.Antiarrhythmic: The inhibited influx of calcium ions in cardiac tissues result in slowed electrophysiological activity through the S-A and A-V nodes without affecting accessory bypass conduction or altering normal atrial action potential or intraventricular conduction.Antihypertensive: Reduces peripheral vascular resistance as a result of vasodilatation.

How to use Diltiazem Hydrochloride: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Diltiazem Hydrochloride may be taken with or without food, but it is better to take it at a fixed time. Administration: May be taken with or without food. The capsules should be swallowed whole with a drink of water. They should not be crushed or chewed Adult Dose: Angina Conventional tablet: 30 mg PO q6hr; increased every 1 or 2 days until angina controlled (usually 180-360 mg/day PO divided q6-8hr); not to exceed 360 mg/day SR: 120 mg/day PO; titrate after 7-14 days; maintenance range usually 120-320 mg/day; not to exceed 540 mg/day Hypertension Conventional tablet: Initial: 60-120 mg twice daily. Max: 360 mg/day. SR: Twice-daily dosing: 60-120 mg PO q12hr; may be adjusted after 14 days; maintenance range usually 240-360 mg/day Hepatic Impairment Use caution Renal Dose: Renal Impairment Use caution

Increased AV blocking effect w/ clonidine. May increase serum levels of statins (e.g. atorvastatin, lovastatin), carbamazepine, phenytoin. May increase bradycardic affect of amiodarone, digoxin, mefloquine. May enhance antihypertensive effect w/ other antihypertensives (e.g. aldesleukin), antipsychotic. Increased serum levels w/ cimetidine. Decreased serum levels w/ rifampicin, phenobarbital. Potentially Fatal: IV: May enhance hypotensive effect of IV ?-blockers.

Sick-sinus syndrome; 2nd or 3rd ° AV block; porphyria. Severe congestive cardiac failure; marked bradycardia. Pregnancy and lactation.

Common - Headache - Constipation - Dizziness - Fatigue - Flushing (sense of warmth in the face, ears, neck and trunk) - Nausea - Rash >10% Edema (2-15%),Headache (5-12%) 1-10% Dizziness (3-10%),AV block (2-8%),Peripheral edema (2-8%),Bradyarrhythmia (2-6%),Headache (1-5%),Hypotension (2-4%),Nausea (3%),Vomiting (2%),Vasodilation (2-3%),Extrasystoles (2%),Flushing (1-2%),Drug-induced gingival hyperplasia (<2%),Myalgia (2%),Diarrhea (1-2%),Constipation (2-4%),Bronchitis (1-4%),Sinus congestion (1-2%),Dyspnea (1-6%),Congestion (1-2%) < 1% Increased Alkaline phosphatase as well as ALT and AST,CHF,Thrombocytopenia,Toxic epidermal necrolysis,Hemolytic anemia,Photosensitivity,Extrapyramidal symptoms,Syncope

Pregnancy: There are no adequate and controlled studies to date with diltiazem in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risk to the fetus.Lactation: Because diltiazem is distributed into milk, women receiving the drug should not breastfeed their infants; an alternative method of infant feeding should be used if diltiazem therapy is considered necessary in nursing women.

Precaution: Elderly. Hepatic or renal impairment; impaired left ventricular function; prolonged AV periods; DM; hypotension. Avoid abrupt withdrawal and long-term use. Patients with sick-sinus syndrome, preexisting AV block, bradycardia and those taking beta-blockers or digitalis are at risk of developing AV block, bradycardia, asystole or sinus arrest. 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

Symptoms: Hypotension, bradycardia, heart block, heart failure, impaired conduction, ECG changes, arrhythmias, shock, altered mental status, cardiac arrest. Management: Symptomatic and supportive treatment. Gastric lavage and admin of activated charcoal may be initiated. Maintain appropriate ventilation. Charcoal hemoperfusion may be useful. Hypotension may be treated with fluids and vasopressor agents. Bradycardia, 2nd- or 3rd-degree AV block may be treated with IV atropine sulfate.

Keep medicine out of the reach of children. Store in a cool and dry place.

Calcium-channel blockers

Diltiazem relaxes coronary vascular smooth muscles by inhibiting influx of calcium ions during depolarisation of the vascular smooth muscles and myocardium. It increases myocardial O2 delivery in patients with vasospastic angina and inhibits cardiac conduction, particularly at the SA and AV nodes.

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