Generic Diltiazem (Diltiazem Hcl)

Introduction

Diltiazem is a medication belonging to the calcium channel blocker class. It is primarily used to manage high blood pressure (hypertension) and certain heart rhythm disorders (arrhythmias). It is also prescribed to alleviate symptoms of angina (chest pain). Diltiazem works by relaxing blood vessels and slowing the heart rate. The active ingredient is Diltiazem Hcl, and it is typically available as a pill in various dosages including 30mg, 60mg, 90mg, and 120mg. Diltiazem is the generic version of medications that were originally marketed under brand names such as Cardizem and Tiazac.

Quick Reference Facts

Active Ingredient

Diltiazem Hcl

Form

Pill (30mg, 60mg, 90mg, 120mg)

Primary and Off-Label Uses

Hypertension

Angina Pectoris

Atrial Fibrillation and Atrial Flutter

Supraventricular Tachycardia (Off-label)

What is Diltiazem?

Diltiazem is a pharmaceutical compound classified as a non-dihydropyridine calcium channel blocker. Its primary application in medicine is for the treatment of cardiovascular conditions. The active pharmaceutical ingredient is Diltiazem hydrochloride (Diltiazem Hcl). It is available in various oral dosage forms, most commonly as pills such as tablets and capsules, with available strengths of 30mg, 60mg, 90mg, and 120mg. Diltiazem is the generic version of medications that were initially developed and marketed under specific brand names. As a generic medication, Diltiazem offers the same therapeutic benefits and is bioequivalent to its branded counterparts, often providing a more cost-effective treatment option for patients.

How Diltiazem Works

Diltiazem functions by inhibiting the influx of calcium ions into the cells of the heart muscle and the smooth muscle of blood vessel walls. This process is crucial because calcium plays a vital role in muscle contraction. By blocking calcium from entering these cells, Diltiazem achieves several therapeutic effects. Firstly, it causes vasodilation, which means it relaxes and widens the blood vessels. This reduced resistance in the arteries lowers blood pressure (hypertension). Secondly, Diltiazem slows down the electrical conduction in the heart, particularly through the atrioventricular (AV) node. This effect helps to control rapid heart rates associated with certain arrhythmias like atrial fibrillation. The combination of relaxed blood vessels and a controlled heart rate also reduces the workload on the heart, which is beneficial in treating angina. Different formulations of Diltiazem can have varying onsets and durations of action, with immediate-release versions offering faster but shorter effects, and extended-release versions providing a more sustained therapeutic level throughout the day.

Conditions Treated with Diltiazem

Diltiazem is approved for several significant cardiovascular conditions:

• Hypertension (High Blood Pressure): Diltiazem helps to lower blood pressure by relaxing the smooth muscles in the walls of blood vessels. This widening of the arteries reduces the pressure exerted by the blood against the vessel walls, thereby decreasing overall blood pressure. Lowering blood pressure is critical in reducing the risk of serious cardiovascular events such as stroke, heart attack, and kidney disease over the long term.

• Chronic Stable Angina (Chest Pain): In individuals with angina, Diltiazem is used to prevent chest pain caused by reduced blood flow to the heart muscle. By dilating the coronary arteries, it increases blood supply to the heart. Additionally, by slowing the heart rate and reducing the force of contraction, it decreases the heart's demand for oxygen, which helps to prevent the pain associated with insufficient blood flow during physical exertion or stress.

• Certain Arrhythmias (Irregular Heartbeats): Diltiazem is effective in controlling rapid ventricular rates in patients with atrial fibrillation and atrial flutter, common types of supraventricular tachycardias. It acts on the heart's electrical system, specifically by slowing conduction through the AV node, which prevents the ventricles from beating too rapidly in response to abnormal signals from the atria. This can improve symptoms such as palpitations, shortness of breath, and dizziness.

Is Diltiazem the Right Medication for You?

Diltiazem is generally considered a suitable treatment option for adult patients diagnosed with hypertension, chronic stable angina, or specific atrial arrhythmias. It is particularly beneficial for individuals who have not responded adequately to other classes of blood pressure medications or for whom a calcium channel blocker is therapeutically indicated. Patients experiencing chest pain due to coronary artery spasm may also find Diltiazem effective.

However, Diltiazem is not appropriate for everyone. Individuals with certain pre-existing medical conditions must exercise caution or avoid this medication. This includes those with severe hypotension (low blood pressure) or a history of certain heart conditions like sick sinus syndrome or second- or third-degree AV block without a functioning pacemaker. Patients with congestive heart failure or severe left ventricular dysfunction should also discuss this with their healthcare provider. Furthermore, individuals with known hypersensitivity to Diltiazem or its components should not take this medication. A thorough discussion with a healthcare professional is essential to determine if Diltiazem aligns with an individual's specific health profile, other medications they are taking, and overall treatment goals.

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Use: Dosing, Missed Dose, Overdose

Dosing Information

The typical dosage of Diltiazem varies depending on the condition being treated and the specific formulation (immediate-release or extended-release pills). Common starting doses for adults are often:

• Hypertension: Immediate-release Diltiazem might start at 30mg three to four times daily, or an extended-release form might start at 60mg to 120mg once daily.
• Angina: Similar starting doses as for hypertension are common, with adjustments made based on symptom control.
• Arrhythmias: Diltiazem for controlling heart rate in atrial fibrillation often begins at 30mg to 60mg three times daily for immediate-release forms, or 90mg to 120mg once daily for extended-release.

Dosages are typically adjusted gradually by a healthcare provider based on individual response and tolerance. It is crucial to follow the prescribed dosage and never alter it without medical advice. Do not chew or crush extended-release capsules; they must be swallowed whole. Some immediate-release tablets may be scored and can be split if directed by a healthcare provider.

Missed Dose

If you miss a dose of Diltiazem, take it as soon as you remember, provided it is not close to the time of your next scheduled dose. If it is nearly time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are unsure about how to proceed, consult your healthcare provider or pharmacist.

Overdose

An overdose of Diltiazem can lead to serious adverse effects. Symptoms of an overdose may include significant hypotension, a very slow heart rate (bradycardia), heart block, dizziness, fainting, irregular heartbeat, and potentially respiratory distress. If you suspect an overdose, seek immediate medical attention by calling your local emergency services or going to the nearest emergency department. It is helpful to have the medication packaging or bottle with you so medical professionals know exactly what was taken.

Practical Precautions

• Alcohol: Avoid or limit alcohol consumption while taking Diltiazem, as it can increase the risk of side effects such as dizziness and low blood pressure.
• Operating Machinery: Diltiazem can cause dizziness or affect concentration. Avoid driving or operating heavy machinery until you know how this medication affects you.
• Administration: Diltiazem pills can generally be taken with or without food. However, extended-release formulations should ideally be taken consistently, either with or without food as directed.

Safety Information

⚠️ Who Should Not Take Diltiazem

Certain individuals should not take Diltiazem due to the risk of severe adverse effects. These absolute contraindications include:

• Hypersensitivity: Known allergy or hypersensitivity to Diltiazem or any of its inactive ingredients.
• Severe Hypotension: Uncontrolled low blood pressure where systolic pressure is significantly below normal.
• Cardiogenic Shock: A life-threatening condition where the heart suddenly can't pump enough blood to the body.
• Recent Myocardial Infarction (Heart Attack): Especially if complicated by hypotension or congestive heart failure.
• Ventricular Tachycardia: A specific type of rapid heart rhythm originating from the lower chambers of the heart.
• Sick Sinus Syndrome: A condition affecting the heart's natural pacemaker, leading to abnormal heart rhythms.
• Second- or Third-Degree Atrioventricular (AV) Block: Unless a functioning pacemaker is in place, as Diltiazem can worsen this conduction abnormality.
• Congestive Heart Failure: Particularly in patients with a severely reduced ejection fraction.

Relative contraindications or situations requiring caution include moderate to severe hepatic (liver) or renal (kidney) impairment, and concurrent administration with certain other medications.

Common Side Effects

Like all medications, Diltiazem can cause side effects, although not everyone will experience them. Common side effects are generally mild and often resolve as your body adjusts to the medication. These can include:

• Dizziness or Lightheadedness: Primarily due to the blood pressure-lowering effect.
• Headache
• Nausea
• Edema (Swelling): Especially in the ankles and feet, due to fluid retention.
• Rash
• Constipation
• Fatigue or Weakness

If any of these side effects are persistent or bothersome, discuss them with your healthcare provider.

Serious Side Effects (Seek Immediate Medical Help)

Although rare, Diltiazem can cause serious side effects that require immediate medical attention. Contact your healthcare provider or seek emergency medical assistance if you experience any of the following:

• Severe Dizziness or Fainting: Indicating significantly low blood pressure.
• Very Slow Heart Rate (Bradycardia): If your pulse is significantly below your usual rate or below 50-60 beats per minute.
• Irregular Heartbeat or Palpitations: Particularly a new or worsening irregular rhythm.
• Chest Pain: Especially if it is new, worsening, or different from your usual angina.
• Difficulty Breathing or Shortness of Breath
• Severe Swelling (edema) in the legs or feet
• Signs of Liver Problems: Such as yellowing of the skin or eyes (jaundice), dark urine, persistent nausea or vomiting, stomach pain, or loss of appetite.
• Severe Allergic Reactions: Including rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing.

Drug & Food Interactions

Diltiazem can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. It is crucial to inform your healthcare provider and pharmacist of all medications, supplements, and herbal products you are taking. Significant interactions include:

• Other Blood Pressure Medications: Concurrent use can lead to additive hypotensive effects.
• Beta-Blockers (e.g., Propranolol, Atenolol): Increased risk of bradycardia, heart block, and heart failure.
• Digoxin: Diltiazem can increase digoxin blood levels, potentially leading to toxicity.
• Statins (e.g., Atorvastatin, Simvastatin): Diltiazem can increase the blood levels of certain statins, raising the risk of muscle-related side effects.
• Cyclosporine, Tacrolimus, Sirolimus: Diltiazem can increase the blood levels of these immunosuppressants, requiring dose adjustments and careful monitoring.
• Carbamazepine, Phenytoin: Diltiazem can increase the blood levels of these anti-epileptic drugs.
• Grapefruit Juice: Consuming large amounts of grapefruit juice can increase Diltiazem blood levels, potentially enhancing its effects and side effects. It is advisable to avoid significant intake of grapefruit products.
• Certain Antifungal Medications (e.g., Ketoconazole, Itraconazole): Can increase Diltiazem levels.
• Rifampin: Can decrease Diltiazem levels.

Always consult your healthcare provider or pharmacist before combining medications.

Off-Label and Investigational Uses of Diltiazem

Beyond its officially approved indications, Diltiazem has been explored and sometimes used clinically for other conditions, although these uses are considered "off-label." This means regulatory bodies have not formally approved Diltiazem for these specific purposes, and their efficacy and safety may be less established than for approved uses.

• Supraventricular Tachycardia (SVT): While Diltiazem is approved for controlling the rate of atrial fibrillation, it is also frequently used intravenously or orally to manage other types of SVT, such as orthodromic AV reciprocating tachycardia. Clinical studies have demonstrated its effectiveness in terminating these episodes by slowing conduction through the AV node. However, its use in certain types of SVT, like atrioventricular nodal reentrant tachycardia (AVNRT), may be less straightforward and require careful consideration.

• Cerebral Vasospasm: Following subarachnoid haemorrhage, vasospasm (narrowing of blood vessels in the brain) can occur, leading to stroke. Some evidence suggests that Diltiazem, administered intrathecally (into the cerebrospinal fluid) or intravenously, may help to prevent or treat this complication by relaxing the smooth muscle of cerebral arteries. This application is investigational and typically managed in specialized neurocritical care settings.

• Pulmonary Hypertension: Limited research has investigated Diltiazem's role in certain forms of pulmonary hypertension, particularly associated with left heart disease. Its vasodilating properties, if effective in the pulmonary vasculature, could potentially offer benefit. However, its use in pulmonary hypertension is not a standard treatment and is generally considered experimental or for specific complex cases.