Cardizem 30 mg

Description

Indications
Cardizem film-coated tablets are used for the prevention and treatment of chronic stable angina (classical angina) and vasospastic angina pectoris. Additionally, they are prescribed alone or in combination for the management of hypertension. Cardizem has also shown effectiveness in conditions such as myocardial infarction, coronary artery spasm, arrhythmias, Raynaud’s phenomenon, esophageal motility disorders, and migraines.

Cardizem sustained-release tablets are indicated for the prevention and treatment of angina pectoris, including classical and vasospastic angina. They are also utilized in the management of essential hypertension and may be used for the prevention of certain supraventricular tachyarrhythmias.

Pharmacology
Diltiazem hydrochloride, the active ingredient in Cardizem, is a calcium channel blocker that functions as both a peripheral and coronary vasodilator with mild negative inotropic properties. It primarily acts by inhibiting cardiac conduction, especially at the sinoatrial (SA) and atrioventricular (AV) nodes. The pharmacological actions of Diltiazem include:

• Antianginal effect: Direct dilation of coronary arteries and arterioles enhances oxygen supply to the myocardial tissues. Additionally, peripheral vasodilation reduces systemic vascular resistance and cardiac afterload, leading to decreased myocardial oxygen demand.
• Antiarrhythmic effect: By inhibiting calcium ion influx in cardiac tissues, Diltiazem slows electrophysiological activity in the SA and AV nodes without affecting accessory pathways or altering normal atrial action potential or intraventricular conduction.
• Antihypertensive effect: Reduction in peripheral vascular resistance due to vasodilation lowers blood pressure.

More than 90% of an orally administered dose is rapidly absorbed. Diltiazem exhibits high protein binding and reaches peak plasma concentration within 30 to 60 minutes. It undergoes hepatic metabolism, with approximately 60% excreted via bile.

Dosage & Administration
Film-coated formulation:

• The usual recommended dose is 60 mg three times daily. However, individual responses may vary, and the dosage may need adjustment. If required, the total daily dose may be increased to 180-300 mg.
• An initial dose of 30 mg four times daily may be prescribed, increasing every 1 to 2 days until an optimal response is achieved. In some cases, doses up to 480 mg per day have been used effectively, particularly for unstable angina.
• Elderly patients and those with hepatic or renal impairment: The recommended starting dose is 60 mg twice daily. Heart rate should be monitored, and the dose should not be increased if the heart rate falls below 50 beats per minute.

Sustained-release formulation:

• Mild to moderate hypertension: An initial dose of 90 mg or 120 mg twice daily (once daily for elderly patients). The total daily dose may be increased up to 360 mg (elderly patients up to 240 mg).
• Angina pectoris: An initial dose of 90 mg or 120 mg twice daily in divided doses. Elderly patients may require a maximum of 240 mg per day.

Drug Interactions
Diltiazem may be used safely alongside short- or long-acting nitrates for angina prophylaxis. However, caution is advised when co-administering Diltiazem with medications that influence cardiac contractility and/or conduction, as dosage adjustments may be necessary.

Contraindications
Diltiazem sustained-release tablets should not be used in patients with:

• Known hypersensitivity to Diltiazem hydrochloride
• Sick sinus syndrome
• Second- or third-degree AV block
• Severe hypotension
• Acute myocardial infarction with radiographically confirmed pulmonary congestion

Side Effects
Potential side effects include:

• Bradycardia
• Sinoatrial and atrioventricular block
• Hypotension
• Fatigue and malaise
• Headache and flushing
• Gastrointestinal disturbances
• Edema
• Hepatitis
• Depression

Pregnancy & Lactation
Adequate, well-controlled studies on the use of Diltiazem in pregnant women are lacking. The medication should only be used if the potential benefits outweigh the risks to the fetus. Since Diltiazem is excreted into breast milk, breastfeeding should be discontinued if treatment is necessary.

Therapeutic Class
Calcium channel blockers

Storage Conditions
Store below 30°C, away from direct light and moisture. Keep out of the reach of children.