DILTIAZEM

Indications & Dose:

• BY MOUTH

Angina,

Adult: 60mg 3 times daily (elderly initially twice daily) before meals and at bed time. incerased if necessary to 360mg daily.

Hypertension:

Adult: 60-120mg 2-3 times daily. SR:60-120mg once or twice daily

.Children Not recommended.

Contraindications:

Sick sinus syndrome or 2nd or 3rd degree heart block (except with a functioning pacemaker), hypotension <90 mm Hg systolic, acute MI with pulmonary congestion, atrial fibrillation or atrial flutter associated with an accessory bypass tract such as in WPW syndrome or short PR syndrome (IV), ventricular tachycardia (IV)

Side Effects:

CNS: Abnormal dreams, amnesia, depression, dizziness, gait abnormality, hallucinations, headache, insomnia, nervousness, paresthesia, personality change, somnolence, tremor

CV: Angina, arrhythmia, AV block (1st degree), AV block (2nd or 3rd degree), bradycardia, bundle branch block, congestive heart failure, edema, flushing, hypotension, palpitations, syncope, tach ycardia

GI: Anorexia, constipation, diarrhea, dysgeusia, dyspepsia,

GERD; mild elevations of LFTs; nausea, thirst, vomiting; weight increase

METAB: Metabolic acidosis

SKIN: Petechiae, photosensitivity, pruritus, rash, urticaria

Cautions:

Precautions:

CHF, hypotension, hepatic injury, children, impaired renal or hepatic function, use caution in nursing mothers & pregnancy.

Interaction:

Drugs

Alpha blockers: Additive increased antihypertensive effect

Amiodarone: Cardiotoxicity with bradycardia and decreased cardiac output

Antipyrine: Increased antipyrine concentrations

Aspirin: Enhanced antiplatelet activity Azole antifungals: Possible increased calcium channel blocker effects

Beta-blockers: Inhibition of metabolism of propranolol and metoprolol (not atenolol); additive effects on cardiac conduction and hypotension

Carbamazepine: Increase in carbamazepine toxicity

Cyclosporine, tacrolimus: Increased blood concentrations, renal toxicity

Digitalis glycosides: Reduced elimination, increased digitalis levels, toxicity

Ecainide: Increased ecainide level

Erythromycin, troleandomycin: Increased levels calcium channel blocke  Fentanyl: Severe hypotension or increased fluid volume requirements

H2-receptor antagonists: Serum diltiazem concentrations increased

Lithium: Neurotoxicity Neuromuscular blockers: Prolonged blockade by vecuronium and pancuronium

Nitroprusside: Enhanced hypotension

Phenobarbital: Reduced calcium channel blocker concentratio

Phenytoin: Increased phenytoin levels

Rifampin: Decreased diltiazem concentrations

Tricyclic antidepressants: Increased TCA levels

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: