Diltiazem Dosage

Usual Adult Dose for Hypertension

Initial dose: 30 to 60 mg orally 3 to 4 times a day.
Maintenance dose: 180 to 360 mg orally/day in divided doses.
SR initial dose: 60 to 120 mg orally twice a day.
SR maintenance dose: 240 to 360 mg orally/day.
CD or XR initial dose: 120 to 240 mg orally once a day.
CD maintenance dose: 240 to 360 mg orally once a day.
XR maintenance dose: 240 to 480 mg orally once a day.
LA initial dose: 120 to 240 mg orally once a day.
LA maintenance dose: 240 to 420 mg orally once a day.

IV Dosing:
Initial bolus doses: 0.25 mg/kg as a bolus administered over 2 minutes. A second bolus of 0.35 mg/kg may be used if necessary.
Initial infusion dose: 5 mg/hr.
Maintenance infusion dose: The infusion rate may be increased in 5 mg/hr increments up to 15 mg/hr.

Usual Adult Dose for Atrial Fibrillation

Initial dose (oral): 30 to 60 mg orally 3 to 4 times a day
Maintenance dose: 180 to 360 mg orally/day in divided doses.
SR initial dose: 60 to 120 mg orally twice a day
SR maintenance dose: 240 to 360 mg orally/day.
CD or XR initial dose: 120 to 240 mg orally once a day.
CD maintenance dose: 240 to 360 mg orally once a day.
LA initial dose: 120 to 240 mg orally once a day.
LA maintenance dose: 240 to 420 mg orally once a day.

Initial dose (IV): 0.25 mg/kg actual body weight bolus over 2 minutes. If necessary, a second bolus of 0.35 mg/kg ABW may be given. In some cases, an infusion of diltiazem 5 mg/hour may be started, and advanced in 5 mg/hour increments to 15 mg/hour for up to 24 hours.

Usual Adult Dose for Atrial Flutter

Initial dose (oral): 30 to 60 mg orally 3 to 4 times a day
Maintenance dose: 180 to 360 mg orally/day in divided doses.
SR initial dose: 60 to 120 mg orally twice a day
SR maintenance dose: 240 to 360 mg orally/day.
CD or XR initial dose: 120 to 240 mg orally once a day.
CD maintenance dose: 240 to 360 mg orally once a day.
LA initial dose: 120 to 240 mg orally once a day.
LA maintenance dose: 240 to 420 mg orally once a day.

Initial dose (IV): 0.25 mg/kg actual body weight bolus over 2 minutes. If necessary, a second bolus of 0.35 mg/kg ABW may be given. In some cases, an infusion of diltiazem 5 mg/hour may be started, and advanced in 5 mg/hour increments to 15 mg/hour for up to 24 hours.

Usual Adult Dose for Supraventricular Tachycardia

Initial dose (oral): 30 to 60 mg orally 3 to 4 times a day
Maintenance dose: 180 to 360 mg orally/day in divided doses.
SR initial dose: 60 to 120 mg orally twice a day
SR maintenance dose: 240 to 360 mg orally/day.
CD or XR initial dose: 120 to 240 mg orally once a day.
CD maintenance dose: 240 to 360 mg orally once a day.
LA initial dose: 120 to 240 mg orally once a day.
LA maintenance dose: 240 to 420 mg orally once a day.

Initial dose (IV): 0.25 mg/kg actual body weight bolus over 2 minutes. If necessary, a second bolus of 0.35 mg/kg ABW may be given. In some cases, an infusion of diltiazem 5 mg/hour may be started, and advanced in 5 mg/hour increments to 15 mg/hour for up to 24 hours.

Usual Adult Dose for Angina Pectoris Prophylaxis

Initial dose: 30 to 60 mg orally 3 to 4 times a day
Maintenance dose: 180 to 360 mg orally/day in divided doses.
SR initial dose: 60 to 120 mg orally twice a day
SR maintenance dose: 240 to 360 mg orally/day.
CD or XR initial dose: 120 to 240 mg orally once a day.
CD maintenance dose: 240 to 360 mg orally once a day.
LA initial dose: 120 to 240 mg orally once a day.
LA maintenance dose: 240 to 360 mg orally once a day.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 30 to 60 mg orally 3 to 4 times a day
Maintenance dose: 180 to 360 mg orally/day in divided doses.
SR initial dose: 60 to 120 mg orally twice a day
SR maintenance dose: 240 to 360 mg orally/day.
CD or XR initial dose: 120 to 240 mg orally once a day.
CD maintenance dose: 240 to 360 mg orally once a day.
LA initial dose: 120 to 240 mg orally once a day.
LA maintenance dose: 240 to 360 mg orally once a day.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

SR, CD, LA, and XR dose forms not recommended as initial therapy. These forms may be used if the patient tolerated the short-acting forms and may be switched on a mg per mg basis.

Dose Adjustments

Orally administered diltiazem may be titrated upward as tolerated and needed approximately every one to two days (tablets) or every one to two weeks (long-acting forms).

Precautions

Use with caution in patients with sinus bradycardia < 50 beats/min.

Dialysis

Diltiazem does not appear to be removed by peritoneal or hemodialysis.

Other Comments

Maximum antihypertensive effects are usually achieved after 14 days of therapy.

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