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Diltiazem Hydrochloride

Pronunciation

Class: Calcium-Channel Blocking Agents, Miscellaneous
VA Class: CV200
CAS Number: 33286-22-5
Brands: Cardizem, Cartia XT, Dilacor XR, Diltia XT, Dilt XR, Taztia XT, Tiazac

For Professionals Side Effects Interactions More...

Introduction

Calcium-channel blocking agent; nondihydropyridine-derivative.271 331

Uses for Diltiazem Hydrochloride

Angina

Used in the management of Prinzmetal variant angina and chronic stable angina pectoris.a 331

Calcium channel blockers considered the drugs of choice in management of Prinzmetal variant angina.a

Appears to be as effective as β-adrenergic blocking agents (e.g., propranolol) and/or oral nitrates in the management of chronic stable angina pectoris; however, generally should be used only when the patient cannot tolerate adequate doses of or is refractory to these drugs.a

Management of unstable angina† in patients who have continuing or ongoing ischemia when therapy with β-blocking agents and nitrates is inadequate, not tolerated, or contraindicated and when severe left ventricular dysfunction, pulmonary edema, or other contraindications are not present.315

Hypertension

Management of hypertension (alone or in combination with other classes of antihypertensive agents).138 140 187 188 189 190 195 271 272

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Only extended-release formulations currently are recommended for management of hypertension.271

One of several preferred initial therapies for hypertensive patients with a high risk of developing coronary artery disease, including those with diabetes mellitus.319

Can be used as monotherapy for initial management of uncomplicated hypertension; however, thiazide diuretics are preferred for monotherapy by JNC 7.319

Supraventricular Tachyarrhythmias

Management of supraventricular tachyarrhythmias, including rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardias (PSVT) (e.g., those associated with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome) and temporary control of rapid ventricular rate in atrial flutter or fibrillation.237 238 239 244 245 247 250 252 253 256 257 258 262 270 331

One of several preferred antiarrhythmic agents for the treatment of stable, narrow-complex supraventricular tachycardias (e.g., paroxysmal supraventricular tachycardia [reentry supraventricular tachycardia], ectopic or multifocal atrial tachycardia†, junctional tachycardia†) if the rhythm is not controlled by vagal maneuvers or adenosine and to control the ventricular response rate in atrial fibrillation or flutter.331

AMI

Calcium-channel blocking agents have not proved beneficial in the early treatment or secondary prevention of AMI† and the possibility that they may be harmful has been raised.270 331

May be used for relief of ongoing ischemia or to control rapid ventricular response with atrial fibrillation after an AMI† when β-adrenergic blocking agents are ineffective or contraindicated, but only in patients in whom there is no evidence of CHF, left-ventricular dysfunction, or AV block and only after weighing carefully the potential benefits versus risks, particularly negative inotropic effects and concerns about short-acting formulations of the drugs.270 331

Hyperthyroidism

Short-term adjunctive therapy in the treatment of tachycardia and tachyarrhythmias in patients with hyperthyroidism† and/or thyrotoxicosis† in whom therapy with β-adrenergic blocking agents is contraindicated or not tolerated.172 173 174

Diltiazem Hydrochloride Dosage and Administration

Administration

Administer by direct IV injection, continuous IV infusion, or orally.138 187 190 237 270 271 323 331

Oral Administration

Conventional Tablets

Administer tablets orally 3–4 times daily before meals and at bedtime.100

Extended-release Capsules

Administer orally; directions for administration (e.g., frequency, whether to administer with or without food, potential for opening capsules and mixing with food) may vary by manufacturer and formulation; consult specific manufacturer’s information for additional information.

Cardizem CD, Dilacor XR, Dilt-XR, Tiazac, Taztia XT, Cartia XT, or Diltia XT may be administered once daily;187 190 271 278 324 325 326 diltiazem hydrochloride extended-release capsules (12 hours) are administered twice daily.b

Cardizem CD and Cartia XT may be administered without regard to meals.188 325 However, Dilacor XR, Diltia XT, and Dilt-XR should be taken on an empty stomach, swallowed whole and not opened, chewed, or crushed.190 278 324

Tiazac and Taztia XT may be opened and the entire contents sprinkled on a small amount of applesauce (not hot) immediately prior to administration; subdividing the contents of capsules is not recommended.305 326 Swallow the entire mixture without chewing.305 326 Immediately drink a glass of cool water to ensure that all of the mixture is swallowed.305 326 Do not store the sprinkle/food mixture for use at a later time.305 326

Extended-release Tablets

Administer orally once daily without regard to meals.323 Tablet should be swallowed whole and not chewed or crushed.323

IV Injection

Monitor ECG and BP continuously during IV administration.237

Reconstitution

Prepare solutions from the powder for injection (Lyo-Ject) according to the manufacturer’s directions.237 293

Dilution

Injection solutions containing 5 mg/mL or powder for injection that has been reconstituted according to manufacturer’s directions may be administered by direct IV injection without any further dilution.237

Rate of Administration

Administer over 2 minutes.237

IV Infusion

Reconstitution

Prepare solutions from the powder for injection (Lyo-Ject) according to the manufacturer’s directions.237 293

Dilution

Dilute 5 mg/mL injection solution or reconstituted powder for injection in the appropriate volume of a compatible infusion solution (i.e., 0.9% sodium chloride, 5% dextrose, or 5% dextrose and 0.45% sodium chloride) to produce a final diltiazem hydrochloride concentration of 1, 0.83, or 0.45 mg/mL, respectively.237

Dilution of Commercially Available Injection or Reconstituted Lyo-Ject 5 mg/mL solution.237

Quantity of 5 mg/mL Solution

Diluent Volume

Final Concentration

25 mL

100 mL

1 mg/mL

50 mL

250 mL

0.83 mg/mL

50 mL

500 mL

0.45 mg/mL
Rate of Administration

Usually 10 mg/hour; however, may range from 5–15 mg/hour.237

Dosage

Available as diltiazem hydrochloride; dosage expressed in terms of the salt.179 236 237

Adults

Prinzmetal Variant Angina
Conventional Tablets
Oral

Initially, 30 mg 4 times daily.100 Increase gradually at 1- to 2-day intervals until optimum control is obtained. Usual maintenance dosage is 180–360 mg daily.100 After manifestations are controlled, reduce dosage to lowest level that will maintain relief of symptoms.a

Extended-release Capsules
Oral

Initially, 120 or 180 mg once daily when administered as extended-release capsules (Cardizem CD, Cartia XT).187 325 Individualize dosage based on response; titrate dosage increases over 7–14 days.187 325 Some patients may respond to higher dosages of up to 480 mg once daily.187 325

Chronic Stable Angina
Conventional Tablets
Oral

Initially, 30 mg 4 times daily.100 Increase gradually at 1- to 2-day intervals until optimum control is obtained. Usual maintenance dosage is 180–360 mg daily.100 After manifestations are controlled, reduce dosage to lowest level that will maintain relief of symptoms.a

Extended-release Capsules
Oral

Initially, 120 (Dilacor XR, Diltia XT, Dilt-XR) or 120–180 mg (Cardizem CD, Cartia XT, Tiazac, Taztia XT) once daily when administered as extended-release capsules.187 190 274 278 324 325 326 Individualize dosage based on response; titrate dosage increases over 7–14 days.187 190 274 278 324 325 326 Some patients may respond to higher dosages of up to 480 (Cardizem CD, Cartia XT, Dilacor XR, Diltia XT, Dilt-XR) to 540 mg (Tiazac, Taztia XT) once daily.187 190 274 278 324 325 326

Extended-release Tablets
Oral

Initially, 180 mg once daily when administered as extended-release tablets (Cardizem LA).323 Individualize dosage based on response; titrate dosage increases over 7–14 days.323 Some patients may respond to higher dosages of up to 360 mg once daily.323

Hypertension
Extended-release Capsules
Oral

Maximum hypotensive effect associated with a given dosage level usually is observed within 14 days.138 187 274 275 325 326

JNC 7 recommends a usual maximum dosage of 420 mg daily for these preparations.319

Recommended Dosages for Management of Hypertension

Preparation

Initial Dosage

Usual Maintenance Dosage

Cardizem LA

180–240 mg once daily323

120–540 mg323

Cardizem CD

180–240 mg once daily187

240–360 mg daily187

Cartia XT

180–240 mg once daily325

240–360 mg daily325

Dilacor XR

180–240 mg once daily190

180–480 mg once daily190

Diltia XT

180–240 mg once daily278

180–480 mg once daily278

Diltiazem hydrochloride extended-release capsules (12 hours)

60–120 mg twice dailyb

240–360 mg dailyb

Dilt-XR

180–240 mg once daily324

180–480 mg once daily324

Tiazac

120–240 mg once daily274

120–540 mg once daily274

Taztia XT

120–240 mg once daily326

120–540 mg once daily326
Switching to Cardizem CD Extended-release Capsules
Oral

Patients whose BP is adequately controlled with diltiazem therapy (as tablets or other extended-release capsules) alone or in combination with another antihypertensive agent may be safely switched to Cardizem CD or Cartia XT extended-release capsules or Cardizem LA extended-release tablets at the nearest equivalent daily dosage.187 323 325 Subsequent titration of dosage is based on the clinical response of the patient.187 323 325

Conventional Tablets†
Oral

Initially, 30 mg 3 times daily; may be increased to a maximum dosage of 360 mg daily given in 3 or 4 divided doses.140 195

Extended-release Tablets
Oral

Initially, 180–240 mg daily; however, some patients may respond to a lower dosage.323 Individualize dosage based on response; maximum hypotensive effect associated with a given dosage level usually is observed within 14 days.323 Usual maintenance dosage is 120–540 mg daily;323 however, JNC 7 recommends a usual maximum dosage of 420 mg daily.319

Supraventricular Tachyarrhythmias
Paroxysmal Supraventricular Tachycardia, Junctional Tachycardia†, Ectopic Tachycardia†, Multifocal Atrial Tachycardia†)
IV

Initially, 15–20 mg (or 0.25 mg/kg) by direct IV injection over 2 minutes.237 256 270 331 If response is inadequate (i.e., conversion to normal sinus rhythm does not occur) give a second dose of 20–25 mg (or 0.35 mg/kg) 15 minutes after the initial dose.237 257 270 331

Maintenance infusion: 5–15 mg/hour; titrate dose to heart rate.331

Patients with low body weights should be dosed on a mg/kg basis.237

Ventricular Rate Control in Atrial Fibrillation and Flutter
IV

Initially, 15–20 mg (or 0.25 mg/kg) by direct IV injection over 2 minutes.237 270 331 If response is inadequate, give 20–25 mg (or 0.35 mg/kg) 15 minutes after the initial dose.237 246 270 331

Maintenance infusion: 5–15 mg/hour; titrate dose to heart rate.331

Prescribing Limits

Adults

Angina
Oral

Cardizem LA extended-release tablets: Maximum 360 mg daily.323

Cardizem CD, Dilacor XR, Diltia XT, Dilt-XR, and Cartia XT extended-release capsules: Maximum 480 mg daily.187 190 278 324 325

Tiazac and Taztia XT extended-release capsules: Maximum 540 mg daily.274 326

Hypertension
Oral

Cardizem conventional tablets†: Maximum 360 mg daily.140 195

Cardizem CD and Cartia XT extended release capsules: Maximum 480 mg daily.187 325

Dilt-XR, Dilacor XR, Diltia XT, Taztia XT, and Tiazac extended-release capsules and Cardizem LA extended-release tablets: maximum 540 mg daily.190 274 278 323 324 326 a

However, JNC 7 recommends a usual maximum dosage of 420 mg daily for these preparations.319

Supraventricular Tachyarrhythmias
IV

Maintenance infusion: Maximum 15 mg/hour for ≤24 hours.237 244 293

Special Populations

Hepatic Impairment

Supraventricular Tachyarrhythmias
Atrial Fibrillation and Flutter
IV

Maintenance infusion: Dosage requirements may be lower.237 245

Geriatric Patients

Angina

Select dosage cautiously; geriatric patients may respond to lower dosages.100 138 187 274 323 326 a

Hypertension

Select dosage cautiously.138 187 274 323 326 The manufacturers of Dilacor XR, Dilt-XR, and Diltia XT state that patients 60 years of age or older may respond to an initial daily dosage of 120 mg.190 278 324

Atrial Fibrillation and Flutter

Maintenance IV infusion: Dosage requirements may be lower.237 245

Cautions for Diltiazem Hydrochloride

Contraindications

  • Contraindicated in patients with known hypersensitivity to the drug.237 252 253 256 258

  • Sick sinus syndrome (unless a functioning ventricular pacemaker is in place).237 252 253 256 258

  • Second- or third-degree AV block (unless a functioning ventricular pacemaker is in place).237 252 253 256 258

  • Severe hypotension (SBP <90 mm Hg).237 252 253 256 258

  • Oral preparations contraindicated in patients with AMI with radiographically documented pulmonary congestion.138 187 190 200 237

  • IV diltiazem contraindicated in patients with cardiogenic shock.237 252 253 256 258

  • IV diltiazem contraindicated in patients with VT.237 257

  • IV diltiazem contraindicated in patients with atrial flutter or fibrillation with an accessory pathway (e.g., those with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome).237 262

  • IV diltiazem contraindicated if concurrent or recent (e.g., within a few hours) administration of IV β-adrenergic blockers.237

Warnings/Precautions

Warnings

Cardiac Conduction

Potential for abnormally slow heart rate (particularly in patients with sick sinus syndrome) or second- or third-degree AV block.100 138 187 237 274 323

Additive effects on cardiac conduction (e.g., prolonging AV node conduction) possible with concomitant use of diltiazem with β-adrenergic blocking agents or digoxin.100 138 187 237 274 323

If high-degree AV block occurs in patients with sinus rhythm receiving IV diltiazem, discontinue the drug and institute appropriate supportive measures.237

CHF

Risk of CHF, especially in those with preexisting ventricular impairment; limited experience in patients with impaired ventricular function receiving concomitant β-adrenergic blocking agents.100 138 187 237 251 254 256 258 274 323 Use with caution.100 138 187 274 323

Hypotension

Possible symptomatic hypotension.100 138 187 237 274 323

Acute Hepatic Injury

Substantial elevations in hepatic function test results (e.g., serum AST [SGOT], ALT [SGPT], LDH, alkaline phosphatase) and phenomena associated with hepatocellular injury rarely reported.100 138 187 237 274 323 Usually occurs early in therapy (e.g., 1–8 weeks); reversible upon discontinuation of therapy.100 138 187 237 274 323

Ventricular Premature Beats

With IV administration, possible transient VPB on conversion of PSVT to sinus rhythm;237 appear to be benign and of little clinical importance.237 250

Sensitivity Reactions

Possible diltiazem-induced skin eruptions with oral preparations; may infrequently progress to severe dermatologic reactions (e.g., erythema multiforme, exfoliative dermatitis).100 138 237 If effects persist during therapy, the drug should be discontinued.100 138 237 Potential for occurrence with IV administration.237

Specific Populations

Pregnancy

Category C.100 138 187 190 274 278 323 324 325 326

Lactation

Distributed into milk;100 101 138 187 190 274 278 323 324 325 326 discontinue nursing.100 138 187 190 274 278 323 324 325 326

Pediatric Use

Safety and efficacy not established.100 138 187 190 274 278 323 324 325 326

Injection in single-use (Lyo-Ject) syringes contains benzyl alcohol as a preservative and should not be used in neonates.237

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.100 138 187 274 323 326 Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.100 138 187 274 323 326

Hepatic Impairment

Use with caution.100 138 187 237 274 323

Renal Impairment

Use with caution.100 138 187 237 274 323

Common Adverse Effects

With oral therapy, edema, headache, dizziness, asthenia, first-degree AV block.138 187 274 323

With IV therapy, hypotension, injection site reactions, vasodilation, arrhythmia.237

Interactions for Diltiazem Hydrochloride

Metabolized principally by CYP3A4.100 138 187 274 Inhibits CYP3A4.274

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors, inducers, and substrates of CYP3A4: potential pharmacokinetic interaction (altered plasma diltiazem concentrations).100 138 187 274 323

Drugs Metabolized by Microsomal Enzymes

Potential pharmacokinetic interaction: altered bioavailability and/or clearance of drugs metabolized by CYP3A4.100 116 132 133 138 187 274

Specific Drugs

Drug

Interaction

Comments

Anesthetics, general

Possible increased depression of cardiac contractility, conductivity, and automaticity as well as vascular dilation100 138 187 237 274 323

Titrate dosage of each drug carefully100 138 187 237 274 323

Atazanavir

Possible increased plasma diltiazem concentrations and additive effect on PR interval prolongation318

Use concomitantly with caution.318 Reduce diltiazem dosage by 50%; monitor ECG318

β-Adrenergic blockers

Potential for additive negative effects on myocardial contractility, heart rate, and prolonging AV conduction100 138 187 190 237 263 264 274 295 323

Increased plasma concentrations of propranolol and metoprolol295 296

Do not administer IV diltiazem and IV β-adrenergic blocking agents within a few hours of each other237

Propranolol dosage adjustment may be necessary when diltiazem is initiated or discontinued100

Benzodiazepines (e.g., midazolam, triazolam)

Possible increased benzodiazepine plasma concentrations and AUC resulting in increased adverse effects (e.g., prolonged sedation, respiratory depression)100 138 187 274 299 300 323

Buspirone

Increased plasma concentration and AUC of buspirone100 138 187

Potential for increased effects and toxicity of buspirone100 138 187

Dosage adjustment of buspirone may be necessary based on clinical assessments100 138 187

Carbamazepine

Possible increased serum or plasma carbamazepine concentrations and associated neurologic and sensory manifestations of carbamazepine toxicity138 200 201 202 203 204 205 206 207 208

Avoid concurrent use, if possible203

Monitor for manifestations of carbamazepine toxicity; adjust carbamazepine dosage accordingly138 200 201 202 203 204 205 206 207 208

Cyclosporine

Possible increased blood cyclosporine concentrations112 113 237 297 298 and consequent nephrotoxicity112 297 298

Monitor cyclosporine concentration in biologic fluid (especially when diltiazem therapy is initiated, adjusted, or discontinued); adjust cyclosporine dosage as needed100 138 187 237 274 275 276 291 292 297 298

Digoxin

Possible increased serum digoxin concentrations102 105 107 108

Potential for additive effects on cardiac conduction (e.g., prolonging AV node conduction)100 138 187 237 274 323

Monitor serum digoxin concentrations carefully and observe the patient closely for signs of digoxin toxicity when administered concomitantly, especially in geriatric patients, patients with unstable renal function, or those with serum digoxin concentrations in the upper therapeutic range before diltiazem is administered103 105 107 108 111

Reduce digoxin dosage if necessary103 105 107 108 111

Histamine H2-receptor antagonists (e.g., cimetidine, ranitidine)

Possible increased plasma diltiazem concentrations with concomitant administration of cimetidine100 125 126 127

Ranitidine coadministration produced smaller and not substantial alterations in diltiazem pharmacokinetics100 125 126 127

Monitor effects of diltiazem carefully when cimetidine therapy is initiated or discontinued in patients receiving diltiazem; adjust diltiazem dosage, if necessary100 126 127

HMG-CoA reductase inhibitors (e.g., lovastatin, pravastatin)

Possible increased mean AUCs and peak plasma concentrations of lovastatin with concomitant use of diltiazem and lovastatin274 301 302

Interaction not observed when diltiazem was used concomitantly with pravastatin274 302

Monitor patients receiving lovastatin concomitantly with diltiazem for evidence of lovastatin toxicity (e.g., rhabdomyolysis, myositis)301 302

Nitrates

Interaction unlikely100 187

Quinidine

Possible increased AUC and decreased clearance of quinidine100 138 187

Monitor for adverse effects of quinidine; adjust dosage accordingly100 138 187

Rifampin

Decreased bioavailability and increased clearance of diltiazem304

Avoid concomitant use; consider alternative therapy100 138 187 274 304

Diltiazem Hydrochloride Pharmacokinetics

Absorption

Bioavailability

Following oral administration of conventional tablets, approximately 80% of a dose is rapidly absorbed from the GI tract.a

Absolute bioavailability is about 40%; undergoes extensive first-pass metabolism.100 138 187 274 323

Time to Peak Serum Concentrations Following Administration

Preparation

Time (hours)

Conventional tablets (e.g., Cardizem)

2–4100

Cardizem CD extended-release capsules

10–14187

Cardizem LA extended-release tablets

11–18323

Diltiazem hydrochloride extended-release capsules (12 hours)

6–11b

Onset

Following direct IV injection, reductions in heart rate usually occur within 3 minutes237 247 252 and hemodynamic effects (e.g., decrease in BP) generally occur within 2 minutes;237 246 247 252 effects on the AV node generally occur within minutes following initiation of a continuous IV infusion.237 242

Duration

Following direct IV injection, reductions in heart rate generally persist for 1–3 hours;237 247 252 blood pressure reductions following direct IV injection generally are short-lived but may last 1–3 hours.237 Effects on the AV node may persist for 0.5–10 hours following a continuous IV infusion.237 242

Food

Rate of absorption may be increased if Tiazac extended-release capsules are taken with a high-fat meal.274 Food may affect the extent of absorption of some extended-release capsules (Dilacor XR, Diltia XT).190 278 294

Distribution

Extent

Rapidly and extensively distributed into body tissues.191 245 259

Distributed into milk, in concentrations approximately equal to maternal serum concentrations.100 101 237

Plasma Protein Binding

About 70–85% is bound to plasma proteins, but only 30–40% is bound to albumin.135 237 259

Elimination

Metabolism

Rapidly and almost completely metabolized in the liver to several active and at least 5 inactive metabolites principally via CYP enzyme system, mainly CYP3A4.100 132 134 135 136 137 182 183 237 241 242

Elimination Route

Excreted principally in urine as metabolites,a with approximately 2–4% of a dose excreted unchanged.135 237 259

Half-life

2–11 hours.191 237

Special Populations

In geriatric patients, plasma half-life of the drug may be increased.191 237 239

In patients with severe renal impairment, pharmacokinetics were unchanged.323

Oral clearance may be reduced and half-life prolonged in patients with liver cirrhosis.237

Stability

Storage

Oral

Conventional Tablets

Tight containers at 25°C (may be exposed to 15–30°C).100 a

Protect from excessive humidity.100

Extended-release Capsules

25°C (may be exposed to 15–30°C).138 187 274

Protect from excessive humidity.138 187 274 325 326

Extended-release Tablets

Tight, light-resistant containers at 25°C (may be exposed to 15–30°C).323

Protect from excessive humidity.323

Parenteral

Powder for Injection

15–30°C.237 Do not freeze.237

Store reconstituted product at 15–30°C; discard 24 hours after reconstitution.237 Discard unused portion.237

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in water

Sodium chloride 0.9%
Drug Compatibility
Y-site CompatibilityHID

Compatible

Albumin human

Alcohol 10% in dextrose 5%

Amikacin sulfate

Amphotericin B

Argatroban

Aztreonam

Bivalirudin

Bretylium tosylate

Bumetanide

Cefazolin sodium

Cefotaxime sodium

Cefoxitin sodium

Ceftazidime

Ceftriaxone sodium

Cefuroxime sodium

Cimetidine HCl

Ciprofloxacin

Clindamycin phosphate

Co-trimoxazole

Dexmedetomidine HCl

Digoxin

Dobutamine HCl

Dopamine HCl

Doxycycline hyclate

Epinephrine HCl

Erythromycin lactobionate

Esmolol HCl

Fenoldopam mesylate

Fentanyl citrate

Fluconazole

Gentamicin sulfate

Hetastarch in lactated electrolyte injection (Hextend)

Hetastarch in sodium chloride 0.9%

Hydromorphone HCl

Imipenem–cilastatin sodium

Labetalol HCl

Lidocaine HCl

Lorazepam

Meperidine HCl

Metoclopramide HCl

Metronidazole

Metronidazole HCl

Midazolam HCl

Milrinone lactate

Morphine sulfate

Multivitamins (M.V.I.-12)

Nicardipine HCl

Nitroglycerin

Norepinephrine bitartrate

Oxacillin sodium

Penicillin G potassium

Pentamidine isethionate

Potassium chloride

Potassium phosphates

Ranitidine HCl

Sodium nitroprusside

Theophylline

Ticarcillin disodium–clavulanate potassium

Tobramycin sulfate

Vancomycin HCl

Vasopressin

Vecuronium bromide

Incompatible

Diazepam

Furosemide

Lansoprazole

Phenytoin sodium

Rifampin

Thiopental sodium

Variable

Acetazolamide sodium

Acyclovir sodium

Aminophylline

Ampicillin sodium

Ampicillin sodium–sulbactam sodium

Heparin sodium

Hydrocortisone sodium succinate

Methylprednisolone sodium succinate

Nafcillin sodium

Procainamide HCl

Sodium bicarbonate

Actions

  • Inhibits transmembrane influx of extracellular calcium ions across the membranes of myocardial cells and vascular smooth muscle cells, without changing serum calcium concentrations.100 138 187 274 323

  • Peripheral arterial vasodilator; acts directly on vascular smooth muscle causing reduction in peripheral vascular resistance (afterload) and BP.100 138 187 274 323

  • Substantial inhibitory effects on the cardiac conduction system, acting principally at the atrioventricular (AV) node to slow conduction time and prolong AV nodal refractoriness.237

Advice to Patients

  • Importance of swallowing extended-release tablets whole; do not chew, crush, or break.323

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.100 138 187 274 323

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.100 138 187 274 323

  • Importance of informing patients of other important precautionary information.100 138 187 274 323 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Diltiazem Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules, extended-release

60 mg*

Diltiazem Hydrochloride Capsules Extended-release (12 hours)

90 mg*

Diltiazem Hydrochloride Capsules Extended-release (12 hours)

120 mg*

Diltiazem Hydrochloride Capsules Extended-release (12 hours)

Cardizem CD (24 hours)

Biovail

Cartia XT (24 hours)

Andrx

Dilt-CD (24 hours)

Apotex

Diltiazem Hydrochloride Capsules Extended-release (12 hours)

Diltiazem Hydrochloride Capsules Extended-release (24 hours)

Mylan, UDL

Taztia XT (24 hours)

Andrx

Tiazac (24 hours)

Forest

180 mg*

Cardizem CD (24 hours)

Biovail

Cartia XT (24 hours)

Andrx

Dilt-CD (24 hours)

Apotex

Taztia XT (24 hours)

Andrx

Tiazac (24 hours)

Forest

240 mg*

Cardizem CD (24 hours)

Biovail

Cartia XT (24 hours)

Andrx

Dilt XR (24 hours)

Apotex

Taztia XT (24 hours)

Andrx

Tiazac (24 hours)

Forest

300 mg*

Cardizem CD (24 hours)

Biovail

Cartia XT (24 hours)

Andrx

Dilt XR (24 hours)

Apotex

Taztia XT (24 hours)

Andrx

Tiazac (24 hours)

Forest

360 mg*

CardizemCD (24 hours)

Biovail

Diltiazem Hydrochloride Capsules Extended-release (24 hours)

Taztia XT (24 hours)

Andrx

Tiazac (24 hours)

Forest

420 mg

Tiazac (24 hours)

Forest

Capsules, extended-release (containing multiple 60-mg tablets)

120 mg

Dilacor XR (24 hours)

Watson

Diltia XT (24 hours)

Andrx

180 mg

Dilacor XR (24 hours)

Watson

Diltia XT (24 hours)

Andrx

240 mg

Dilacor XR (24 hours)

Watson

Diltia XT (24 hours)

Andrx

Tablets

30 mg*

Cardizem

Biovail

Diltiazem Hydrochloride Tablets

60 mg*

Cardizem (scored)

Biovail

Diltiazem Hydrochloride Tablets

90 mg*

Cardizem (scored)

Biovail

Diltiazem Hydrochloride Tablets

120 mg*

Cardizem (scored)

Biovail

Diltiazem Hydrochloride Tablets

Tablets, extended-release

120 mg

Cardizem LA (24 hours)

Biovail

180 mg

Cardizem LA (24 hours)

Biovail

240 mg

Cardizem LA (24 hours)

Biovail

300 mg

Cardizem LA (24 hours)

Biovail

360 mg

Cardizem LA (24 hours)

Biovail

420 mg

Cardizem LA (24 hours)

Biovail

Parenteral

For injection

25 mg

Cardizem Lyo-Ject

Biovail

For injection, for IV infusion only

100 mg*

Diltiazem Hydrochloride for Injection ADD-Vantage

Injection

5 mg/mL (25, 50, and 125 mg)*

Cardizem

Biovail

Diltiazem Hydrochloride Injection

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2013. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Cardizem 30MG Tablets (VALEANT): 90/$125.99 or 270/$359.96

Cardizem CD 120MG 24-hr Capsules (VALEANT): 30/$114.44 or 90/$335.95

Cardizem CD 180MG 24-hr Capsules (VALEANT): 30/$145.08 or 90/$398.07

Cardizem CD 240MG 24-hr Capsules (VALEANT): 30/$199.92 or 90/$557.35

Cardizem CD 300MG 24-hr Capsules (VALEANT): 30/$249.89 or 90/$701.39

Cardizem CD 360MG 24-hr Capsules (VALEANT): 30/$300.00 or 90/$859.94

Cardizem LA 120MG 24-hr Tablets (ABBOTT): 30/$109.99 or 90/$315.98

Cardizem LA 180MG 24-hr Tablets (ABBOTT): 30/$87.99 or 90/$249.97

Cardizem LA 240MG 24-hr Tablets (ABBOTT): 30/$120.00 or 90/$341.95

Cardizem LA 300MG 24-hr Tablets (ABBOTT): 30/$148.24 or 90/$427.27

Cardizem LA 360MG 24-hr Tablets (ABBOTT): 30/$165.98 or 90/$479.96

Cardizem LA 420MG 24-hr Tablets (ABBOTT): 30/$180.00 or 90/$501.98

Dilacor XR 120MG 24-hr Capsules (WATSON LABS): 30/$77.99 or 90/$225.97

Dilacor XR 180MG 24-hr Capsules (WATSON LABS): 30/$98.89 or 90/$267.01

Dilacor XR 240MG 24-hr Capsules (WATSON LABS): 30/$113.21 or 90/$314.52

Diltiazem HCl 120MG Tablets (MYLAN): 90/$29.99 or 270/$65.96

Diltiazem HCl 30MG Tablets (TEVA PHARMACEUTICALS USA): 90/$12.99 or 270/$27.98

Diltiazem HCl 60MG Tablets (TEVA PHARMACEUTICALS USA): 90/$22.50 or 180/$35.98

Diltiazem HCl 90MG Tablets (TEVA PHARMACEUTICALS USA): 90/$22.99 or 270/$49.98

Diltiazem HCl Coated Beads 120MG 24-hr Capsules (ACTAVIS ELIZABETH): 30/$29.99 or 90/$69.96

Diltiazem HCl Coated Beads 180MG 24-hr Capsules (ACTAVIS ELIZABETH): 30/$34.99 or 90/$85.97

Diltiazem HCl Coated Beads 180MG 24-hr Tablets (WATSON LABS): 30/$85.99 or 90/$245.98

Diltiazem HCl Coated Beads 240MG 24-hr Capsules (ACTAVIS ELIZABETH): 30/$43.99 or 90/$120.97

Diltiazem HCl Coated Beads 240MG 24-hr Tablets (WATSON LABS): 30/$94.48 or 90/$262.43

Diltiazem HCl Coated Beads 300MG 24-hr Capsules (ACTAVIS ELIZABETH): 30/$73.99 or 90/$198.97

Diltiazem HCl Coated Beads 300MG 24-hr Tablets (WATSON LABS): 30/$129.99 or 90/$355.96

Diltiazem HCl Coated Beads 360MG 24-hr Tablets (WATSON LABS): 30/$129.99 or 90/$365.98

Diltiazem HCl Coated Beads 420MG 24-hr Tablets (WATSON LABS): 30/$139.99 or 90/$395.95

Diltiazem HCl CR 120MG 12-hr Capsules (MYLAN): 60/$92.87 or 180/$259.97

Diltiazem HCl CR 120MG 24-hr Capsules (MYLAN): 90/$55.99 or 180/$105.97

Diltiazem HCl CR 180MG 24-hr Capsules (MYLAN): 100/$69.98 or 300/$196.97

Diltiazem HCl CR 240MG 24-hr Capsules (MYLAN): 90/$67.99 or 180/$129.98

Diltiazem HCl CR 60MG 12-hr Capsules (MYLAN): 60/$62.99 or 180/$179.97

Diltiazem HCl CR 90MG 12-hr Capsules (MYLAN): 60/$71.99 or 180/$195.96

Diltiazem HCl ER Beads 120MG 24-hr Capsules (INWOOD LABS): 30/$29.99 or 90/$75.97

Diltiazem HCl ER Beads 180MG 24-hr Capsules (INWOOD LABS): 30/$35.99 or 90/$85.97

Diltiazem HCl ER Beads 240MG 24-hr Capsules (INWOOD LABS): 30/$45.99 or 90/$129.97

Diltiazem HCl ER Beads 300MG 24-hr Capsules (INWOOD LABS): 30/$67.99 or 90/$191.97

Diltiazem HCl ER Beads 360MG 24-hr Capsules (ETHEX): 30/$49.99 or 90/$128.97

Diltiazem HCl ER Beads 420MG 24-hr Capsules (INWOOD LABS): 90/$159.98 or 180/$299.97

Matzim LA 180MG 24-hr Tablets (WATSON LABS): 30/$88.99 or 90/$250.98

Matzim LA 240MG 24-hr Tablets (WATSON LABS): 30/$97.99 or 90/$279.98

Matzim LA 300MG 24-hr Tablets (WATSON LABS): 30/$128.00 or 90/$365.99

Matzim LA 420MG 24-hr Tablets (WATSON LABS): 30/$145.99 or 90/$409.97

Taztia XT 120MG 24-hr Capsules (WATSON LABS): 30/$29.99 or 90/$83.97

Taztia XT 180MG 24-hr Capsules (WATSON LABS): 30/$35.99 or 90/$97.97

Taztia XT 240MG 24-hr Capsules (WATSON LABS): 30/$49.99 or 90/$139.97

Taztia XT 360MG 24-hr Capsules (WATSON LABS): 30/$65.99 or 90/$187.97

Tiazac 120MG 24-hr Capsules (FOREST): 30/$50.70 or 90/$137.75

Tiazac 180MG 24-hr Capsules (FOREST): 30/$56.70 or 90/$158.54

Tiazac 240MG 24-hr Capsules (FOREST): 30/$78.65 or 90/$225.66

Tiazac 300MG 24-hr Capsules (FOREST): 30/$92.99 or 90/$259.98

Tiazac 360MG 24-hr Capsules (FOREST): 30/$100.99 or 90/$297.98

Tiazac 420MG 24-hr Capsules (FOREST): 30/$99.99 or 90/$289.97

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2013, Selected Revisions August 1, 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

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201. Brodie MJ, Macphee GJA. Carbamazepine neurotoxicity precipitated by diltiazem. BMJ. 1986; 292:1170-1.

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203. Carbamazepine (Tegretol) drug interaction: Diltiazem (Cardizem). In: Hansten PD, Horn JR. Drug interactions analysis and management. Vancouver, WA: Applied Therapeutics, Inc; 1997: N.7.

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