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Diltiazem

C08D - Selective calcium channel blockers with direct cardiac effects ATC C08DB01 Small molecule approved 1982 Oral Parenteral Natural product

JFDA label: DILZACARD R 90 TABLETS

Mechanism of Action

Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization; produces relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina.

Indications

Approved

  • Chronic kidney disease (CKD) and hypertension
  • Coronary artery disease (CAD) and hypertension
  • Hypertension
  • Injection
  • Oral

Off-label

  • Anal fissures (topical)
  • Atrial fibrillation (rate control) (oral)
  • Hypertension (Children)
  • Hypertrophic cardiomyopathy
  • Non-ST-elevation acute coronary syndrome
  • Raynaud phenomenon

Contraindications

Source: Lexicomp · Curated

  • Additional contraindications (not in US labeling): Pregnancy Absolute
  • Oral: Hypersensitivity to diltiazem or any component of the formulation Absolute
  • Severe hypotension or cardiogenic shock Absolute
  • Sick sinus syndrome or second/third-degree AV block without pacemaker Absolute
  • administration concomitantly or within a few hours of the administration of IV beta-blockers Absolute
  • atrial fibrillation or flutter associated with accessory bypass tract (eg, Wolff-Parkinson-White syndrome, short PR syndrome) Absolute
  • cardiogenic shock Absolute
  • concurrent use with intravenous dantrolene Absolute
  • concurrent use with ivabradine Absolute
  • hypotension (systolic Intravenous (IV): Hypersensitivity to diltiazem or any component of the formulation Absolute
  • second- or third-degree AV block (except in patients with a functioning artificial pacemaker) Absolute
  • severe hypotension Absolute
  • sick sinus syndrome (except in patients with a functioning artificial pacemaker) Absolute
  • use in women of childbearing potential Absolute
  • ventricular tachycardia (with wide-complex tachycardia [QRS ≥0.12 seconds], must determine whether origin is supraventricular or ventricular) Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Cardiac disorders (4)

Very Common Edema

Common Atrioventricular block · bradycardia · hypotension, pain, nervousness

Nervous system disorders (1)

Very Common Headache

Metabolism and nutrition disorders (1)

Common Gout

Gastrointestinal disorders (2)

Common constipation · Dyspepsia

Skin and subcutaneous tissue disorders (1)

Common Skin rash

Musculoskeletal and connective tissue disorders (2)

Common myalgia · Weakness

Other (1)

Not Known Frequencies represent ranges for various dosage forms. Patients with impaired ventricular function and/or conduction abnormalities may have higher incidence of adverse reactions

Respiratory, thoracic and mediastinal disorders (1)

Common Rhinitis (

Dosing

Source: Lexicomp

Angina: Oral: Capsule, extended release: Dilacor XR, Dilt-XR: Initial: 120 mg once daily; titrate over 7 to 14 days; usual dose range (ACC/AHA [Gibbons 2003]): 120 to 320 mg daily: maximum: 480 mg/day. Cardizem CD, Cartia XT: Initial: 120 to 180 mg once daily; titrate over 7 to 14 days; usual dose range (ACC/AHA [Gibbons 2003]): 120 to 320 mg daily; maximum: 480 mg/day. Tiazac, Taztia XT: Initial: 120 to 180 mg once daily; titrate over 7 to 14 days; usual dose range (ACC/AHA [Gibbons 2003]): 120 to 320 mg daily; maximum: 540 mg/day. Tablet, extended release (Cardizem LA, Matzim LA, Tiazac XC [Canadian product]): Initial: 180 mg once daily; may increase at 7- to 14-day intervals; usual dose range (ACC/AHA [Gibbons 2003]): 120 to 320 mg/day; maximum: 360 mg/day. Tablet, immediate release (Cardizem): Initial: 30 mg 4 times daily; titrate dose gradually at 1- to 2-day intervals; usual dose range (ACC/AHA [Gibbons 2003]): 120 to 320 mg daily in 4 divided doses. Hypertension: Oral: Capsule, extended release (once-daily dosing): Cardizem CD, Cartia XT: Initial: 180 to 240 mg once daily; dose adjustment may be made after 14 days; usual dose range (ASH/ISH [Weber 2014]): 240 to 360 mg daily; maximum: 480 mg/day. Dilacor XR, Dilt-XR: Initial: 180 to 240 mg once daily; dose adjustment may be made after 14 days; usual dose range (ASH/ISH [Weber 2014]): 240 to 360 mg daily; maximum: 540 mg/day. Tiazac, Taztia XT: Initial: 120 to 240 mg once daily; dose adjustment may be made after 14 days; usual dose range (ASH/ISH [Weber 2014]): 240 to 360 mg daily; maximum: 540 mg/day. Capsule, extended release (twice-daily dosing): Initial: 60 to 120 mg twice daily; dose adjustment may be made after 14 days; usual range: 240 to 360 mg daily. Note: Diltiazem is available as a generic intended for either once- or twice-daily dosing, depending on the formulation; verify appropriate extended release capsule formulation is administered. Tablet, extended release (Cardizem LA, Matzim LA, Tiazac XC [Canadian product]): Initial: 180 to 240 mg once daily; dose adjustment may be made after 14 days; usual dose range (ASH/ISH [Weber 2014]): 240 to 360 mg daily; maximum: 540 mg/day. Atrial fibrillation, atrial flutter, PSVT (acute treatment): IV: Control of rapid ventricular rate in atrial fibrillation or atrial flutter or conversion of PSVT: Initial bolus dose: 0.25 mg/kg actual body weight over 2 minutes (average adult dose: 20 mg); ACLS guideline recommends 15 to 20 mg Repeat bolus dose (may be administered after 15 minutes if the response is inadequate): 0.35 mg/kg actual body weight over 2 minutes (average adult dose: 25 mg); ACLS guideline recommends 20 to 25 mg Continuous infusion (infusions >24 hours or infusion rates >15 mg/hour are not recommended): Initial infusion rate of 10 mg/hour; rate may be increased in 5 mg/hour increments up to 15 mg/hour as needed; some patients may respond to an initial rate of 5 mg/hour. If diltiazem injection is administered by continuous infusion
(For additional information see "Diltiazem: Pediatric drug information") Hypertension (off-label use): Children and Adolescents: Minimal information available: Oral: Initial: 1.5 to 2 mg/kg/day in 3 to 4 divided doses (extended release formulations may be dosed once or twice daily); maximum dose: 3.5 mg/kg/day; some centers use a maximum dose of 6 mg/kg/day up to 360 mg/day (Flynn 2000).
Refer to adult dosing. In the management of hypertension, consider lower initial doses (eg, 120 mg once daily using extended release capsule) and titrate to response (Aronow 2011).
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution. Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.
There are no dosage adjustment provided in the manufacturer’s labeling; use with caution; extensively metabolized by the liver; half-life is increased in patients with cirrhosis.

Warnings & Precautions

Source: Lexicomp

Conduction abnormalities

May cause first-, second-, and third-degree AV block or sinus bradycardia; risk increases with agents known to slow cardiac conduction.

Dermatologic reactions

Transient dermatologic reactions have been observed with use; if reaction persists, discontinue. Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, and/or exfoliative dermatitis have been reported.

Hepatic effects

Mild elevations of transaminases with and without concomitant elevation in alkaline phosphatase and bilirubin have been observed and frequently resolve spontaneously. Significant elevations in hepatic transaminases (eg, alkaline phosphatase, LDH, AST, ALT) and signs of acute hepatic injury have also been observed 1 to 8 weeks after therapy initiation and have been reversible upon discontinuation.

Hypotension/syncope

Symptomatic hypotension with or without syncope can rarely occur; blood pressure must be lowered at a rate appropriate for the patient's clinical condition. Disease-related concerns:

Hepatic impairment

Use with caution in patients with hepatic impairment.

Hypertrophic obstructive cardiomyopathy (HOCM)

Use with caution in patients with HOCM; routine use is currently not recommended due to insufficient evidence (Maron 2003).

Left ventricular dysfunction

Use with caution in left ventricular dysfunction; due to negative inotropic effects, may exacerbate condition. The ACCF/AHA heart failure guidelines recommend to avoid use in patients with heart failure due to lack of benefit and/or worse outcomes with calcium channel blockers in general (ACCF/AHA [Yancy 2013]).

Renal impairment

Use with caution in patients with renal impairment. Concurrent drug therapy:

Drug-drug interactions

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Other warnings/precautions:

Appropriate use

IV: Unless otherwise contraindicated, appropriate vagal maneuvers should be attempted prior to administration of IV diltiazem. Use with caution in patients hemodynamically compromised; continuously monitor ECG and blood pressure during administration (especially during continuous IV infusion). Initial use should be, if possible, in a setting where monitoring and resuscitation equipment, including DC cardioversion/defibrillation, are present.

Pregnancy & Lactation

Pregnancy

FDA category C

Adverse events have been observed in animal reproduction studies. Untreated chronic maternal hypertension is associated with adverse events in the fetus, infant, and mother. If treatment for hypertension during pregnancy is needed, other agents are preferred (ACOG 2013). Women with hypertrophic cardiomyopathy who are controlled with diltiazem prior to pregnancy may continue therapy, but increased fetal monitoring is recommended (Gersh 2011).

Lactation

Avoid

Diltiazem is excreted in breast milk in concentrations similar to those in the maternal plasma (Okada 1985). Breast-feeding is not recommended by the manufacturer.

Monitoring

Clinical pearlLiver function tests, kidney function, blood pressure, ECG, heart rate; consult individual institutional policies and procedures. Ventricular rate control in patients with atrial fibrillation or flutter: Patients who respond, usually have at least a 20% decrease in ventricular response rate or a rate

Chemistry & Properties

2D structure
FormulaC22H26N2O4S
Molecular weight414.53 g/mol
IUPAC name[(2S,3S)-5-[2-(dimethylamino)ethyl]-2-(4-methoxyphenyl)-4-oxo-2,3-dihydro-1,5-benzothiazepin-3-yl] acetate
CAS42399-41-7
PubChem CID39186
InChIKeyHSUGRBWQSSZJOP-RTWAWAEBSA-N
logP3.37 (XLogP 3.1)
Polar surface area59.08 Ų
H-bond acceptors / donors6 / 0
Drug-likeness (QED)0.68
Lipinski violations0
SMILESCOc1ccc([C@@H]2Sc3ccccc3N(CCN(C)C)C(=O)[C@@H]2OC(C)=O)cc1

Biology & Pharmacokinetics

Pharmacokinetics

BBB penetrantYes (logBB 0.3)

Enzyme interactions

EnzymeRoleDetail
CYP1A2Substrate
CYP2C19Substrate
CYP2C9Substrate
CYP2D6Substrate
CYP3A4Inhibitor Ki 0.4791419857062785 µM
CYP3A4Substrate

Receptor binding (top 1)

TargetActionAffinity
5-HT2A (HTR2A) Binding pKi 5.6

Transporters

ASBT (Inhibitor)BCRP (Inhibitor)BCRP (Inhibitor)BSEP (Inhibitor)BSEP (Inhibitor)MATE1 (Inhibitor)MATE2 (Inhibitor)MDR1 (Inhibitor)MRP1 (Inhibitor)MRP2 (Inhibitor)MRP3 (Inhibitor)MRP4 (Inhibitor)NTCP (Inhibitor)OATP1B1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)OATP1B3 (Inhibitor)OATP2B1 (Inhibitor)OCT1 (Inhibitor)OCTN1 (Inhibitor)OCTN2 (Inhibitor)P-gp (Inhibitor)MCT1 (Substrate)MDR1 (Substrate)OCT1 (Substrate)P-gp (Substrate)

Drug–drug interactions (100+, DDInter)

Interacting drugSeverityManagement
Acalabrutinib major
Betrixaban major
Bosutinib major
Brigatinib major
Ceritinib major
Cilostazol major
Cisapride major
Cobimetinib major
Deflazacort major
Docetaxel major
Dolasetron major
Edoxaban major
Eliglustat major
Encorafenib major
Entrectinib major
Erythromycin major
Everolimus major
Fingolimod major
Halofantrine major
Hydrocodone major
Ibrutinib major
Ivacaftor major
Ivosidenib major
Loperamide major
Naloxegol major
Neratinib major
Olaparib major
Pazopanib major
Simvastatin major
Siponimod major
Sonidegib major
Venetoclax major
Abemaciclib moderate
Acetylsalicylic acid moderate
Afatinib moderate
Albendazole moderate
Aldesleukin moderate
Alectinib moderate
Alimemazine moderate
Alpelisib moderate

Showing 40 of 100+.

Registered Products (3)

BrandForm / strengthPackAgentCitizen (JOD)
Dilzacard 60 TABLETS Tablet 60 mg 50 tab Dar Al Dawa Development and Investment Co Ltd/Jordan 2.570
DILZACARD R 90 TABLETS Tablet 90 mg 30 tab Dar Al Dawa Development and Investment Co Ltd/Jordan 4.620
Dilzem Retard Tablet 90 mg 30 tab Khoury Drug Store 4.620