Diltiazem

Sick sinus syndrome, 2nd- or 3rd-degree AV block (without a functioning pacemaker), severe bradycardia (<50 beats/min), hypotension (systolic <90 mm Hg), decompensated cardiac failure, acute MI and pulmonary congestion. Lactation. Concomitant use with ivabradine. IV: Cardiogenic shock, atrial flutter or fibrillation associated with accessory bypass tract (e.g. Wolff-Parkinson-White syndrome or short PR syndrome), ventricular tachycardia (with wide-complex tachycardia [QRS ≥0.12 seconds]); concomitant use with or within a few hours of IV β-blockers.

Patient with reduced left ventricular function, bradycardia, 1st-degree AV block, prolonged PR interval (detected on ECG), risk factors for developing intestinal obstruction. Various formulations of diltiazem are available to meet individual requirements of the patient; refer to specific product guidelines when switching formulations. Renal and hepatic impairment. Elderly. Pregnancy. Monitoring Parameters Monitor blood pressure, ECG, heart rate, LFTs, and kidney function. For IV use, frequently measure blood pressure and continuously monitor ECG.

Significant: AV block, sinus bradycardia, mood changes (e.g. depression), bronchospasm. Rarely, symptomatic hypotension with or without syncope, increased hepatic enzymes (e.g. AST, ALT, lactate dehydrogenase, alkaline phosphatase), hepatic injury, severe cutaneous adverse reactions (e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, acute generalised exanthematous pustulosis). Cardiac disorders: Palpitations. Gastrointestinal disorders: Nausea, dyspepsia, constipation, gastric pain, vomiting, diarrhoea. General disorders and administration site conditions: Peripheral oedema, malaise; inj site reactions (e.g. itching, burning). Nervous system disorders: Dizziness, headache. Psychiatric disorders: Nervousness, insomnia. Vascular disorders: Flushing.

May potentiate the depression of cardiac contractility, conductivity, automaticity, and vascular dilatation induced by anaesthetics. Increased antihypertensive effect with α-antagonists. May increase the depression of cardiac conduction, risk of bradycardia and AV block with β-blockers, amiodarone, or digoxin. Increases plasma concentrations of phenytoin, theophylline, cilostazol, methylprednisolone, carbamazepine, ciclosporin, midazolam, triazolam, buspirone, quinidine. Concomitant use with clonidine may result in sinus bradycardia leading to hospitalisation and insertion of pacemaker. May increase the CV effects (e.g. hypotension) of IV bolus ionic X-ray contrast media. Increased plasma concentrations with cimetidine. May decrease plasma concentrations with CYP3A4 inducers (e.g. rifampicin). May increase the risk of lithium-induced neurotoxicity. Increased risk of myopathy and rhabdomyolysis with statins metabolised by CYP3A4 (e.g. atorvastatin, fluvastatin, simvastatin).

Anti-Anginal Drugs / Calcium Antagonists

C05AE03 - diltiazem ; Belongs to the class of muscle relaxants. Used in the topical treatment for the treatment of hemorrhoids and anal fissures.
C08DB01 - diltiazem ; Belongs to the class of benzothiazepine derivative selective calcium-channel blockers with direct cardiac effects. Used in the treatment of cardiovascular diseases.