Diltiazem tabs 180mg #30

Diltiazem instruction for use

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Composition

Tablets and capsules contain 30, 60, 90 or 180 mg of the active substance diltiazem as hydrochloride.

Form of issue

Tablets and tablets prolonged action.
Capsules of prolonged action.

pharmachologic effect

The blocker of slow calcium channels.

Pharmacodynamics and pharmacokinetics

The basic substance is a benzothiazepine derivative. The drug has antiarrhythmic, anti-anginal and hypotensive effects.
Diltiazem helps reduce intracellular calcium in the smooth muscle tissue of blood vessels, in cardiomyocytes. The drug manifests a negative inotropic effect, reduces heart rate, improves renal, cerebral and coronary blood flow. Diltiazem causes dilatation of small and large arteries, relaxation of smooth muscles of coronary vessels.
Antianginal effect is manifested in the improvement of blood supply to the myocardium, lowering blood pressure, OPSS, increasing the time of diastolic relaxation of the left ventricle, reducing myocardial tone. Antianginal effect is provided by suppression of calcium transport in cardiac tissues, which causes an increase in the refractory, effective period, slowing of atrioventricular conduction. The medication does not affect the intraventricular conduction, the normal atrial action potential. However, the speed and depolarization rate decrease with decreasing amplitude of atrial contractions. It is possible to shorten the effective, anterograde refractory period in bypass, additional fascicles.
With parenteral administration, Diltiazem causes a rapid transition of supraventricular paroxysmal tachycardia to the sinus rhythm, temporarily stops the rapid ventricular rhythm with the development of atrial fibrillation and flutter.
The hypotensive effect is provided by a decrease in OPSS, dilatation of resistive vessels. Correlation of the degree of decrease in blood pressure is made in accordance with the initial index. Diltiazem helps reduce blood pressure in horizontal and vertical positions. Rarely on the background of medication, there is reflex tachycardia, postural arterial hypotension.
At loading, Diltiazem slightly reduces the maximum heart rate. With prolonged treatment there is no increased activity of the renin-angiotensin-aldosterone system, hypercatecholamineemia does not develop.
The drug reduces the peripheral and renal effects of angiotensin-2. With IHD, arterial hypertension, the drug reduces platelet aggregation, has a positive effect on diastolic relaxation of the myocardium.
The preparation affects the smooth muscles of the gastrointestinal tract minimally. Tolerance does not develop even with prolonged therapy. In patients with arterial hypertension, Diltiazem causes regression of left ventricular hypertrophy, has no effect on the lipid profile of the blood.

Indications for use

Diltiazem is prescribed after a previous myocardial infarction, with diabetic retinopathy, arterial hypertension, prinzmetal angina, stress stenocardia, for prophylaxis of coronary spasm in surgical interventions (aortocoronary bypass, coronaroengiography).
Intravenously, the drug is administered with supraventricular tachycardias, paroxysmal tachycardias, atrial flutter, for arresting paroxysms of atrial fibrillation, with hypertension in a small circulatory system.

Contraindications

Diltiazem is not used for atrioventricular blockade, severe arterial hypertension, with intolerance to the main substance, atrial fibrillation, atrial flutter, Laun-Ganong-Levin syndrome, WPW syndrome, SA blockade, breastfeeding.
With renal failure, ventricular tachycardia with QRS complex expansion, with myocardial infarction with left ventricular failure, moderate arterial hypotension, cardiogenic shock, with CHF, severe bradycardia, severe aortic stenosis, atrioventricular blockade of the first degree, children and elderly people Diltiazem appoint with caution .

Side effects

Nervous system: extrapyramidal disorders, parkinsonism, stiffness in arms, legs, shuffling gait, masky face, depression, transient loss of vision, tremor, paresthesia, difficulty swallowing, asthenia, fatigue, fainting, headaches, anxiety, drowsiness, dizziness.
Cardiovascular system: asystole, bradycardia, arrhythmia, angina pectoris, ventricular fibrillation, ventricular flutter, tachycardia, development of heart failure, marked drop in blood pressure, atrioventricular block.
Digestive system: gingival hyperplasia, swelling, tenderness and bleeding gums, increased levels of liver enzymes, diarrhea, constipation, nausea, dry mouth, vomiting, hypercreatinemia.
Possible development of Stevens-Jones syndrome, multiforme exudative erythema, stridorous respiration, coughing, shortness of breath, pulmonary edema, edema of the legs and feet, agranulocytosis, weight gain, galactorrhea.

Instructions for use Diltiazem (Method and dosage)

As an anti-anginal and antihypertensive drug Diltiazem appoint 3-4 times a day for 30 mg, correction of dosing is made individually.
Elderly, patients with pathology of the liver, kidney drug is prescribed twice a day for 30 mg.
Therapy with prolonged forms begins with 2 doses per day for 60-120 mg or 180-240 mg once, in the next 2 weeks a dose correction is performed, a day does not exceed 360 mg. With prolonged therapy with positive dynamics every 3 months, the dosage is reduced.
Tablets should be taken before meals, washed down with water, not chewed, swallowed whole.
With emergency therapy, Diltiazem is administered intravenously. For relief of supraventricular tachycardia intravenous infusion of 0.25 mg / kg is shown for two minutes under the control of pulse, blood pressure. In the absence of positive dynamics, re-infusion after 15 minutes in an amount of 0.35 mg / kg. The combination of 160 mg of propanolol and 120 mg of diltiazem allows the recovery of sinus rhythm. The effect is recorded in half an hour.
For the prevention of supraventricular tachycardia, the appointment of 240-360 mg per day is indicated.
With atrial flutter, a constant form of fibrillation, Diltiazem is prescribed in combination with cardiac glycosides at a dose of 240 mg per day.
Hypertension in the small circle of the circulation: up to 720 mg per day.
nstructions for use Diltiazem Lannacher and Diltiazem Retard are similar.

Overdose

It is manifested by asystole, cardiogenic shock, CHF, violation of atrioventricular conduction, falling of arterial pressure, severe bradycardia.
It requires washing the stomach, causing artificial vomiting, the appointment of enterosorbents.
With the development of bradycardia, isoprenaline, atropine, in case of cardiac insufficiency, diuretics, dobutamine, dopamine, with prescription of pressure vasopressors, in case of severe bradycardia, pacemakers are used.
Peritoneal dialysis and hemodialysis do not bring relief.

Interaction

Combinations with quinidine, beta-adrenoblockers, cardiac glycosides, antiarrhythmics are considered potentially dangerous, causes a decrease in myocardial contractility with the formation of signs of heart failure, slowing of atrioventricular conduction, excessive bradycardia.
Diltiazem can increase the bioavailability of the drug Propanolol.
Quinidine, procainamide promote the prolongation of the QT interval on the ECG.
Thiazide diuretics, agents for inhalation anesthesia, and drugs that lower blood pressure levels contribute to an increase in the antihypertensive effect of the drug.
Diazepam, phenobarbital and rifampicin reduce the concentration of diltiazem in the blood, and cimetidine - increases.
In some cases, nitrates are simultaneously administered, which does not cause side drug interaction.
Diltiazem raises the level of theophylline, carbamazepine, cyclosporine, digoxin, valproic acid, quinidine in the blood. With regard to general anesthetics, there is an increase in cardiodepressive effects.
Lithium drugs increase the neurotoxic effect of the drug (manifested by noise in the ears, ataxia, nausea, diarrhea, vomiting).
The solution of furosemide is pharmaceutically incompatible with drug solutions Diltiazem.
Estrogens, glucocorticosteroids, indomethacin, sympathomimetic drugs reduce the severity of the hypotensive effect.

Storage conditions

In a place inaccessible to children at a temperature of 15-25 degrees Celsius.
Shelf life - Not more than two years.

special instructions

Elderly patients with bradycardia dosing of the drug is performed with extreme caution.
With prolonged intravenous infusion of diltiazem requires regular monitoring of liver function, kidney function, pulse, blood pressure, ECG dynamics. It is not recommended to perform infusion at a rate of more than 15 mg per hour, and also lasting more than a day.
The drug contributes to the prolongation of the PQ interval on the ECG. At the end of therapy, a gradual reduction in dosage is recommended.
In case of necessity of carrying out of operative treatment, an anesthesiologist is advised of the use of the drug with a dose indication.
In elderly people Diltiazem helps to increase the half-life.
In patients with left ventricular failure, the risk of complications from the heart system increases by 40%.
The drug does not affect the mortality rate in the pathology of the cardiovascular system.

Reviews about Diltiazem

The drug is effective in IHD, hypertension, arrhythmias, angina pectoris. In the reviews, patients complain of side effects of the medication, such as, for example, headaches.