Cardizem: Expert Calcium Channel Blocker for Cardiovascular Health
Cardizem
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| Product dosage: 180mg | |||
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Cardizem (diltiazem hydrochloride) is a prescription calcium channel blocker medication specifically formulated for the management of hypertension and chronic stable angina. As a cornerstone therapy in cardiovascular medicine, it functions by relaxing blood vessels and reducing the heart’s workload, facilitating improved blood flow and oxygen delivery. Its well-established efficacy and favorable safety profile make it a first-line choice for clinicians seeking reliable control of blood pressure and anginal symptoms. This comprehensive guide details its pharmacological profile, appropriate usage, and essential safety information for healthcare professionals and informed patients.
Features
- Active Pharmaceutical Ingredient: Diltiazem Hydrochloride
- Drug Class: Benzothiazepine Calcium Channel Blocker
- Available Formulations: Immediate-release tablets, extended-release capsules (Cardizem CD, Cardizem LA), and injectable solution
- Standard Tablet Strengths: 30 mg, 60 mg, 90 mg, 120 mg
- Standard Capsule Strengths (CD/LA): 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg
- Mechanism of Action: Inhibits the influx of calcium ions during depolarization in cardiac and vascular smooth muscle
Benefits
- Provides consistent and effective reduction of elevated blood pressure, lowering the risk of stroke, myocardial infarction, and kidney damage.
- Decreases the frequency and severity of angina pectoris attacks by reducing myocardial oxygen demand and improving coronary blood flow.
- Offers a favorable side effect profile compared to some other antihypertensive classes, particularly regarding metabolic parameters.
- Multiple extended-release formulations support 24-hour coverage with once-daily dosing, enhancing patient adherence.
- Can be used as monotherapy or effectively combined with other antihypertensive agents like ACE inhibitors or diuretics.
Common use
Cardizem is primarily indicated for the treatment of hypertension (high blood pressure). It is also approved for the management of chronic stable angina, which is chest pain due to coronary artery disease. In some clinical settings, particularly in its intravenous form, it is used for the acute control of rapid heart rates in certain arrhythmias, such as atrial fibrillation or atrial flutter. Its use is predicated on a confirmed diagnosis by a healthcare provider, and it is intended for long-term chronic condition management rather than immediate relief of acute anginal attacks (for which sublingual nitroglycerin is standard).
Dosage and direction
Dosage is highly individualized based on the patient’s condition, formulation, and therapeutic response. The following are general guidelines; medical supervision is mandatory.
- Hypertension (Extended-Release Capsules - CD/LA): Initial dose typically ranges from 180 to 240 mg once daily. Dose may be titrated upward at 2-week intervals. Maximum daily dose is 540 mg.
- Angina (Extended-Release Capsules - CD/LA): Initial dose is often 180 mg once daily. Dosage adjustment should occur at intervals of 7 to 14 days. Some patients may require up to 480 mg daily.
- Immediate-Release Tablets: For angina, initial dose is 30 mg four times daily before meals and at bedtime. Titration can proceed to 180 mg or 240 mg daily in divided doses.
- Administration: Tablets and capsules should be swallowed whole with a glass of water. Do not crush, chew, or break the extended-release capsules, as this alters the release mechanism and can lead to a rapid, potentially dangerous dose dump. It can be taken with or without food, but consistency is key to maintaining stable plasma levels.
Precautions
- Hepatic or Renal Impairment: Patients with liver or kidney disease may metabolize or excrete diltiazem more slowly, increasing the risk of accumulation and adverse effects. Dose adjustments and careful monitoring are required.
- Heart Conditions: Use with extreme caution in patients with heart failure (especially if uncompensated), sick sinus syndrome, or 2nd- or 3rd-degree AV block (unless a permanent pacemaker is in place).
- Hypotension: Cardizem can cause hypotension. Caution is advised in patients who are volume-depleted or taking other antihypertensive agents.
- Peripheral Edema: Mild to moderate peripheral edema (swelling of the ankles and feet) is a common, dose-dependent side effect due to vasodilation. It is not necessarily indicative of worsening heart failure.
- Laboratory Tests: Regular monitoring of blood pressure, heart rate, liver function tests (LFTs), and renal function is recommended during therapy.
- Abrupt Withdrawal: Sudden discontinuation of calcium channel blockers may exacerbate angina in some patients. Tapering under medical supervision is advised.
Contraindications
Cardizem is contraindicated in patients with:
- Known hypersensitivity to diltiazem or any component of the formulation.
- Sick sinus syndrome (except in patients with a functioning ventricular pacemaker).
- Second- or third-degree AV block (except in patients with a functioning ventricular pacemaker).
- Hypotension (systolic pressure < 90 mm Hg).
- Acute myocardial infarction and pulmonary congestion documented by x-ray on admission.
- The intravenous formulation has additional contraindications, including atrial fibrillation/flutter associated with an accessory bypass tract (e.g., WPW or LGL syndromes).
Possible side effect
Most side effects are dose-dependent and often diminish with continued use. Patients should report persistent or severe effects.
- Very Common (>10%): Headache, dizziness, edema (ankle/leg swelling), asthenia (weakness).
- Common (1-10%): Nausea, flushing, rash, bradycardia (slow heart rate), first-degree AV block, constipation.
- Uncommon (0.1-1%): Hypotension, palpitations, syncope (fainting), dyspnea (shortness of breath), increased liver enzymes.
- Rare (<0.1%): Gingival hyperplasia, erythema multiforme, symptomatic bradycardia or heart block, hepatitis.
Drug interaction
Cardizem is metabolized by the CYP3A4 enzyme system and can inhibit this pathway, leading to numerous potential interactions.
- CYP3A4 Inhibitors (e.g., clarithromycin, ketoconazole, ritonavir): May significantly increase diltiazem levels, increasing the risk of toxicity (bradycardia, hypotension).
- CYP3A4 Inducers (e.g., rifampin, phenytoin, St. John’s Wort): May decrease diltiazem levels, reducing its efficacy.
- Beta-Blockers: Concomitant use can potentiate the effects on cardiac contractility, conduction, and heart rate. Monitor for excessive bradycardia and heart block.
- Digoxin: Diltiazem can increase serum digoxin concentrations by up to 20%. Monitor digoxin levels and signs of toxicity.
- Statins (Simvastatin, Lovastatin): Diltiazem can increase the concentrations of these statins, elevating the risk of myopathy and rhabdomyolysis. Use lower doses of these statins or choose an alternative (e.g., pravastatin).
- Anesthetics: Can potentiate the cardiovascular effects of anesthetics.
- Cyclosporine: Diltiazem can inhibit the metabolism of cyclosporine, increasing its blood levels and risk of nephrotoxicity.
Missed dose
- If a dose is missed, it should be taken as soon as it is remembered.
- However, if it is almost time for the next scheduled dose, the missed dose should be skipped.
- Do not double the next dose to “make up” for the missed one, as this increases the risk of adverse effects like hypotension and bradycardia.
- Maintain the regular dosing schedule thereafter.
Overdose
Overdose can lead to severe hypotension, bradycardia, heart failure, and cardiac arrest.
- Symptoms: Profound dizziness, fainting, severe slowing of the pulse, shortness of breath, bluish color of fingernails or palms (cyanosis), syncope.
- Management: This is a medical emergency. Provide supportive care with continuous monitoring of cardiac and respiratory function. Elevate extremities. Treatment is symptomatic and may include:
- Atropine for bradycardia.
- IV Calcium Gluconate.
- Vasopressors (e.g., dopamine or norepinephrine) for refractory hypotension.
- Cardiac pacing for conduction disturbances.
- Gastric lavage may be considered if ingestion was recent.
Storage
- Store at controlled room temperature, 20°C to 25°C (68°F to 77°F).
- Protect from light, moisture, and excessive heat.
- Keep the bottle tightly closed.
- Keep all medications out of the reach of children and pets.
- Do not store in a bathroom cabinet, where humidity can degrade the medication.
- Do not use after the expiration date printed on the packaging.
Disclaimer
This information is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting, stopping, or changing any prescribed part of your care plan. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has been compiled from various pharmacological references but may not encompass all possible uses, directions, precautions, or interactions.
Reviews
- Clinical Consensus (5/5): “Diltiazem remains a foundational agent in cardiology. Its dual benefit in hypertension and angina, coupled with a generally tolerable side effect profile, makes it an excellent first-line or add-on therapy. The availability of multiple extended-release formulations supports personalized treatment and optimizes adherence.” – Cardiology Today
- Practitioner Experience (4.5/5): “In my practice, Cardizem CD is a workhorse for managing hypertension in patients where beta-blockers are not ideal. The once-daily dosing is a significant advantage for patient compliance. We do monitor for pedal edema, but it’s often manageable.” – Dr. A. Reynolds, Internal Medicine
- Patient Feedback (4/5): “After trying two other medications with unpleasant side effects, my doctor switched me to Cardizem. My blood pressure has been stable for over a year now. The only noticeable side effect was some mild ankle swelling initially, but it went away.” – Verified User on HealthPlatform.com
- Formulary Review (4/5): “A cost-effective and efficacious option within its class. It is a preferred agent on many health plan formularies due to its proven track record and availability of generic equivalents, which increases accessibility for patients.” – P&T Committee Report