How and when to take diltiazem. Diltiazem lannacher - instructions for use Dosage and regimen of Diltiazem

"Diltiazem" is a drug for the treatment of heart diseases, which belongs to the group of calcium channel blockers. Medicines of this group are calcium antagonists, since they slow down the release of calcium ions and their penetration into the cellular structure through calcium channels. The drug is produced at pharmaceutical factories in France and Macedonia, has a low cost and is often prescribed as part of combination therapy for patients with cardiac and vascular pathologies.

"Diltiazem" has antianginal activity, reduces myocardial oxygen demand and improves blood supply to the heart muscle, so this drug is often prescribed after a myocardial infarction. The antihypertensive effect allows the drug to be used to treat primary and secondary hypertension.

Properties of the preparation:

• reduces the amount of calcium in the smooth muscle fibers of blood vessels and capillaries, as well as cardiomyocytes - muscle cells that make up the bulk of the myocardium;
• reduction of heart rate and prevention of angina pectoris;
• improvement of renal, cerebral and coronary blood flow by relaxing the smooth muscle tissue of the coronary arteries and blood vessels;
• an increase in the relaxation time of left ventricular diastole;
• reduction of platelet aggregation (fusion) and prevention of blood clots.

"Diltiazem" can be used prophylactically in surgical treatment to prevent spasm of the coronary vessels. This is necessary for coronary artery bypass grafting, coronary angiography (a method for diagnosing coronary artery disease using contrast agents) and other surgical interventions with a high risk of developing coronary spasm.

Antiarrhythmic and antianginal effects allow the drug to be used to treat exertional angina and a rare type of angina caused by vasospasm through which blood enters the heart muscle (spontaneous angina or Prinzmetal's angina).

If necessary, "Diltiazem" can be prescribed to people with diabetes mellitus for the treatment of diabetic retinopathy - severe damage to the retina of the eye caused by systemic vascular disease.

Forms of issue

Diltiazem is available in the form of tablets and capsules for oral administration. In total, there are four dosage forms of the drug on the pharmaceutical market:

• prolonged-release tablets;
• tablets with prolonged action, film-coated gastrointestinal;
• tablets;
• extended release capsules.

Depending on the form of release, the drug may contain 30 mg, 60 mg, 90 mg or 180 mg of the active ingredient - diltiazem hydrochloride. It is necessary to store the medicine at room temperature for no more than 2 years from the production date indicated on the carton.

Instructions for use

Tablets and capsules must be taken before meals (about 10-15 minutes) - this will improve the absorption of the active substance and increase the effectiveness of therapy. You do not need to chew the tablets or open the capsules - they should be swallowed whole with a little water.

Price

The cost of Diltiazem in online pharmacies is:

• 60 mg tablets - 70-105 rubles;
• 90 mg tablets - 80-110 rubles;
• sustained-release capsules 180 mg - 270 rubles;
• prolonged-release tablets 90 mg - 115 rubles.

All prices are for a pack of 30 tablets or capsules.

Analogs

The selection of drugs with a similar composition or pharmacological properties may be necessary in case of an allergic reaction or intolerance to any component that is part of the drug. Replacement of the drug may also be required in the absence of pronounced positive dynamics during treatment. The most effective and popular analogs of Diltiazem are listed below.

• "Diltiazem retard"(110-220 rubles). The drug is from the group of calcium channel blockers, which contains the same active ingredient. It is available in the form of capsules with a dosage of 90 mg and 180 mg.
• "Cardil"(320 rubles). The drug is in pill form, used to treat hypertension, angina pectoris and cardiac arrhythmias.
• "Diakordin"(290 rubles). A drug based on diltiazem, available in three dosages: 60 mg, 90 mg and 120 mg. It has a fairly small list of side effects and, according to patients, is better tolerated than other drugs in this pharmacological group.

Self-replacement of drugs and termination of treatment without consulting a doctor are not allowed.

The list of contraindications and side effects even for structural analogs may be different due to the auxiliary components that are added to drugs to create a base, to give a certain color or odor, therefore, only a doctor should select an analogue of Diltiazem, if necessary.

Contraindications

"Diltiazem" has a fairly large list of contraindications, which must be familiarized with before starting treatment. The absolute contraindications for prescribing the drug include:

• arterial hypertension 4 degrees;
• violation of the conduction of electrical impulses from the atria to the ventricles;
• atrial fibrillation and flutter with atrial fibrillation;
• violations in the structure of the heart muscle, accompanied by a syndrome of premature excitation of the ventricles;
• weakness of the sinus node;
• chronic heart failure;
• aortic valve stenosis;
• cardiogenic shock.

The appointment of preparations containing diltiazem is contraindicated for pregnant and lactating women. In case of severe violations of the sinus rhythm (bradycardia), the drug should be prescribed with increased caution. The same applies to the elderly, as well as patients with complete or partial dysfunctions of the renal and hepatic systems.

Dosage

For the treatment of arterial hypertension, the drug is prescribed in a dosage of 30 mg. For patients with delayed creatinine clearance, as well as for the elderly, the drug is prescribed 2 times a day. Patients in other groups should take tablets 3-4 times a day.

For the treatment of atrial fibrillation, as well as for the prevention of supraventricular tachycardia, "Diltiazem" is prescribed in the form of tablets or capsules with prolonged release according to the following scheme:

• within 14 days - 60-120 mg 2 times a day or 180-240 mg once;
• in the next two weeks - 120 mg 3 times a day or 180 mg 2 times a day.

If the drug is used for a long period of time, every three months it is necessary to adjust the prescribed dosage regimen downward.

In case of hypertension in a small circle of circulation, "Diltiazem" can be taken in the maximum daily dosage, which is 720 mg (4 tablets of 180 mg).

Side effects

During treatment with Diltiazem, it is important to follow the prescribed dosage regimen, as the drug can cause a large number of side effects. Most of them are associated with the functioning of the cardiovascular system. The patient may experience an uncontrolled drop in blood pressure, as well as a change in heart rate. With self-correction of the dosage, atrial fibrillation, angina pectoris, tachycardia and bradycardia may occur.

Often, side effects are manifested on the part of the nervous system and digestive organs. It can be:

• nausea and vomiting, independent of food intake;
• a decrease in the activity of the salivary glands and the resulting dryness of the mucous membranes of the oral cavity;
• soreness during bowel movements and a change in the nature of the stool;
• headache;
• depressive disorders;
• asthenic syndrome (chronic fatigue);
• sleep disturbances;
• tremors and seizures;
• violation of motor coordination;
• incoherent speech.

In rare cases, patients were diagnosed with disturbances in the functioning of the organs of vision, as well as signs of gingival hyperplasia. Changes can also be observed on the part of the hematopoietic system. Thrombocytopenia and agranulocytosis were recorded in 4% of patients during treatment.

Compatibility

The appointment of "Diltiazem" with the simultaneous administration of lithium preparations is contraindicated due to the increased neurotoxic effect on the body. This combination can cause auditory-vestibular disorders, manifested by headache and tinnitus, as well as signs of body intoxication: nausea, vomiting, chills.

Some drugs can reduce the effectiveness of antihypertensive treatment, so they also cannot be combined with Diltiazem. These drugs include:

• glucocorticosteroid hormones;
• oral contraceptives that contain estrogens;
• "Indomethacin".

Thiazide diuretics, drugs used for anesthesia using inhalation spray, and antihypertensive drugs, on the contrary, enhance the hypotensive properties of Diltiazem, therefore their simultaneous use requires mandatory correction of the regimen.

Combinations of "Diltiazem" with certain medicinal substances can be fatal to the patient. These drugs include: cardiac glycosides, beta-blockers, quinidine, and antiarrhythmic drugs.

Overdose

An overdose of "Diltiazem" can have serious consequences for the health and life of the patient, so it is important to follow the prescribed dosage and intake regimen. In case of accidental intake of an increased amount of the drug, the patient may have a violation of antrioventricular conduction, the development of cardiogenic shock, heart failure and asystole.

For treatment, it is necessary to rinse the patient's stomach and give any sorbing drug (Polysorb, Activated Carbon, Smecta). Further treatment depends on the complications manifested.

Diltiazem hydrochloride (diltiazem)

Composition and release form of the drug

10 pieces. - contour cell packaging (3) - cardboard packs.

pharmachologic effect

Selective class III, benzothiazepine derivative. It has antianginal, hypotensive and antiarrhythmic effects. Reduces myocardial contractility, slows down AV conduction, decreases heart rate, reduces myocardial oxygen demand, dilates coronary arteries, increases coronary blood flow. Reduces the tone of smooth muscles of peripheral arteries and OPSS.

Reduces the intracellular content of calcium ions in cardiomyocytes and cells of smooth muscles of blood vessels, reduces heart rate, may have a slight negative inotropic effect, increases coronary, cerebral and renal blood flow. At concentrations at which there is no negative inotropic effect, it causes relaxation of the smooth muscles of the coronary vessels and dilatation of both large and small arteries.

The antianginal effect is due to an improvement in the blood supply to the myocardium and a decrease in its oxygen demand as a result of a decrease in systemic vascular resistance, systemic blood pressure (afterload), a decrease in myocardial tone and an increase in the time of diastolic relaxation of the left ventricle.

The antiarrhythmic effect is due to the suppression of the transport of calcium ions in the heart tissues, which leads to a lengthening of the effective refractory period and a slowdown in conduction in the AV node (in patients with SSS, elderly people, in whom blockade of calcium channels can interfere with the generation of an impulse in the sinus node and cause sinoatrial blockade). Normal atrial action potential or intraventricular conduction does not change (normal sinus rhythm is usually not affected), but when the amplitude of atrial contraction decreases, the rate of depolarization and conduction rate decrease. The anterograde effective refractory period in additional bypass conduction bundles can be shortened. When administered parenterally, it causes a rapid transition of paroxysmal supraventricular tachycardia (including those associated with additional bypass conduction bundles) into sinus rhythm, as well as a temporary cessation of ventricular tachycardia with atrial flutter or atrial fibrillation.

The antihypertensive effect is due to the dilatation of resistive vessels and a decrease in the systemic vascular resistance. The degree of decrease in blood pressure correlates with its initial level (with fluctuations in blood pressure within the normal range, there is a minimal effect on blood pressure). Reduces blood pressure both in a horizontal and vertical position. Rarely causes postural arterial hypotension and reflex tachycardia. Does not change or slightly reduces the maximum heart rate during exercise. Long-term therapy does not lead to hypercatecholaminemia, an increase in the activity of the RAAS. Reduces the renal and peripheral effects of angiotensin II. Promotes diastolic relaxation of the myocardium in arterial hypertension, ischemic heart disease, hypertrophic obstructive cardiomyopathy, reduces platelet aggregation. Able to cause regression of left ventricular hypertrophy in patients with arterial hypertension.

Slightly affects the smooth muscles of the gastrointestinal tract. During long-term (8 months) therapy, tolerance does not develop. Does not affect blood lipid profile.

The onset and duration of action depends on the dosage form used.

Pharmacokinetics

After oral administration, diltiazem is almost completely absorbed from the gastrointestinal tract. Undergoes intensive metabolism during the "first pass" through the liver. Bioavailability is about 40%. Plasma concentration is variable.

Protein binding is about 80%. Diltiazem is excreted in breast milk. It is extensively metabolized in the liver with the participation of the cytochrome P 450 enzyme system. One of the metabolites - desacetyldylthiazem - has 25-50% activity of the unchanged substance.

T 1/2 diltiazem is 3-5 hours. It is excreted mainly in the form of metabolites in the bile and urine, approximately 2-4% is excreted in the urine unchanged.

Diltiazem is poorly cleared by dialysis.

Indications

Prevention of angina attacks (including Prinzmetal's angina). Arterial hypertension. Prevention of supraventricular arrhythmias (paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, extrasystole).

For intravenous administration: relief of acute attacks of angina pectoris, prevention of spasm of coronary arteries during coronary angiography or coronary artery bypass grafting, paroxysmal ventricular tachycardia, for arresting rapid ventricular rhythm with atrial fibrillation or flutter (except for WPW syndrome).

Contraindications

Severe bradycardia, AV block II and III degree (except for patients with a pacemaker), SSS, cardiogenic shock, atrial fibrillation in WPW and Laun-Ganog-Levin syndrome, myocardial infarction with congestion in the lungs, arterial hypotension, chronic II B failure -III stage, acute heart failure, hemodynamically significant aortic stenosis, impaired liver and kidney function, pregnancy, lactation, hypersensitivity to benzothiazepine derivatives.

Dosage

For oral administration, the initial dose is 60 mg 3 times / day or 90 mg 2 times / day. In case of insufficient effectiveness, the dose is increased to 180 mg 2 times / day. Prolonged forms are used 1-2 times / day, depending on the dose.

Maximum daily dose when taken orally is 360 mg.

When administered intravenously, a single dose is 300 mcg / kg.

For intravenous drip, the dose is 2.8-14 μg / kg / min. Maximum daily dose is 300 mg.

Side effects

From the side of the central nervous system and peripheral nervous system: headache, dizziness, fainting, increased fatigue, asthenia, sleep disturbances, drowsiness, anxiety, extrapyramidal (parkinsonism) disorders (ataxia, mask-like face, shuffling gait, stiff arms or legs, trembling of hands and fingers, difficulty swallowing), depression ; when used in high doses - paresthesia, tremor, visual impairment (transient loss of vision).

On the part of the cardiovascular system: asymptomatic decrease in blood pressure; rarely - angina pectoris, arrhythmia (including flutter and fibrillation of the ventricles), bradycardia (less than 50 beats / min) or tachycardia, AV block II and III degrees up to asystole, development or worsening of heart failure; when used in high doses and with intravenous administration - angina pectoris, bradycardia, AV blockade, a pronounced decrease in blood pressure, aggravation of chronic heart failure.

From the digestive system: dry mouth, increased appetite, nausea, vomiting, constipation or diarrhea, increased activity of hepatic transaminases, gingival hyperplasia (bleeding, soreness, swelling).

From the hematopoietic system: rarely - thrombocytopenia, agranulocytosis.

Allergic reactions: hyperemia of the facial skin, skin rash, arthritis, erythema multiforme exudative (including Stevens-Johnson syndrome).

Others: when used in high doses - pulmonary edema (shortness of breath, cough, stridor breathing); peripheral edema (edema of the lower extremities - ankles, feet, legs), increased serum creatinine; rarely - galactorrhea, weight gain.

Drug interactions

With simultaneous use with (including propranolol, atenolol, metoprolol, pindolol, sotalol), an additive cardiodepressant effect is possible, along with an increase in antianginal action in most patients. Patients with preexisting left ventricular dysfunction or conduction abnormalities are at increased risk of developing severe and threatening bradycardia.

Diltiazem inhibits the metabolism of propranolol, but not atenolol.

With simultaneous use with amiodarone, the negative inotropic effect, bradycardia, conduction disturbances, AV blockade are enhanced.

Since diltiazem inhibits the isoenzyme CYP3A4, which is involved in the metabolism of atorvastatin, lovastatin and simvastatin, drug interactions are theoretically possible due to an increase in plasma concentrations of statins. Cases of the development of rhabdomyolysis are described.

With simultaneous use with buspirone, the concentration of buspirone in the blood plasma increases, its therapeutic and side effects increase.

With simultaneous use with vecuronium chloride, an increase in the duration of neuromuscular blockade is possible.

With simultaneous use with digitoxin, an increase in the concentration of digoxin and digitoxin in blood plasma is possible.

With simultaneous use with imipramine, the concentration of imipramine in the blood plasma increases and there is a risk of developing unwanted changes on the ECG.

Cases of increased plasma concentrations of trimipramine and nortriptyline with simultaneous use with diltiazem have been described.

Diltiazem increases the bioavailability of imipramine by decreasing its clearance. Changes in the ECG are due to an increase in the concentration of imipramine in the blood plasma and the additive inhibitory effect of diltiazem and imipramine on AV conduction. It is believed that diltiazem interacts in the same way with trimipramine and nortriptyline.

With simultaneous use with insulin, a case of a decrease in the effectiveness of insulin has been described.

Due to the inhibition of the metabolism of anticonvulsants in the liver under the influence of diltiazem and a decrease in their clearance from the body, it is possible to increase the concentration of carbamazepine and phenytoin in the blood plasma with the risk of developing a toxic effect.

With simultaneous use with lithium carbonate, cases of the development of acute parkinsonism syndrome, psychosis have been described.

With simultaneous use with midazolam, triazolam, the concentration of midazolam and triazolam in the blood plasma increases and their effects are enhanced due to the inhibition of the CYP3A4 isoenzyme under the influence of diltiazem, with the participation of which these benzodiazepines are metabolized.

With simultaneous use with sodium amidotrizoate, an increase in the antihypertensive effect of diltiazem is possible.

With simultaneous use with sodium nitroprusside, a significant increase in efficacy in controlled arterial hypotension is possible.

With simultaneous use with nifedipine, the antihypertensive effect is enhanced.

Rifampicin induces the activity of liver enzymes, accelerating the metabolism of diltiazem, which leads to a decrease in its effectiveness.

With simultaneous use with theophylline, a slight decrease in the metabolism of theophylline in the liver is possible, apparently due to inhibition of the CYP1A2 isoenzyme under the influence of diltiazem.

With simultaneous use with cisapride, a case of impaired consciousness has been described, apparently due to a pronounced lengthening of the QT interval. It is believed that diltiazem inhibits the activity of the isoenzyme CYP3A4, which leads to an increase in the concentration of cisapride in the blood plasma and, possibly, to an increase in its cardiotoxicity.

With simultaneous use, diltiazem inhibits the metabolism of cyclosporine in the liver, which leads to a decrease in its excretion and an increase in plasma concentration. At the same time, a decrease in the manifestations of nephrotoxicity and an increase in the immunosuppressive effect were noted.

With simultaneous use with cimetidine, the concentration of diltiazem in the blood plasma increases due to the inhibition of its oxidative metabolism in the liver under the influence of cimetidine. The effects of diltiazem may be enhanced.

With simultaneous use with enflurane, cases of violation of the AV conduction of the myocardium have been noted.

special instructions

It is used with caution in case of AV blockade of I degree, intraventricular conduction disorders, in patients prone to arterial hypotension, chronic heart failure, myocardial infarction with left ventricular failure, ventricular tachycardia with expansion of the QRS complex, liver failure, renal failure, in elderly patients, in children (efficacy and safety of use have not been studied).

IV is used only for emergency therapy, but if necessary, it can be administered for several days. With the introduction of diltiazem, careful monitoring of the function of the cardiovascular system is necessary. Against the background of regular intake of beta-blockers, the indications for intravenous administration of diltiazem should be strictly clarified and used only after ECG monitoring in the intensive care unit, while taking into account the possible need to use a pacemaker.

Abrupt withdrawal of diltiazem can lead to the development of an anginal attack.

Patients with impaired liver and / or kidney function and the elderly require dosage adjustment.

Pregnancy and lactation

Use in the elderly

Use with caution in elderly patients.

Diltiazem is a drug used to treat diseases of the cardiovascular system.

Release form and composition

Diltiazem is produced in the form of round white tablets, on one of the sides of which there is a risk, in blisters of 10 pcs.

One tablet contains 60 or 90 mg of diltiazem chloride and excipients such as:

• Gelatin;
• Colloidal silicon dioxide;
• Lactose;
• Calcium phosphate dibasic;
• Magnesium stearate;
• Corn starch;
• Povidone;
• Microcrystalline cellulose;
• Talc;
• Hydroxypropyl methylcellulose;
• Sodium benzoate.

Also, dry substance Diltiazem is produced, intended for the preparation of a solution for injection, in transparent vials. One bottle contains 10 or 25 mg of diltiazem chloride.

Indications for use

Diltiazem is prescribed for patients with arterial hypertension and stable angina pectoris.

Contraindications

The use of Diltiazem is contraindicated in case of hypersensitivity to its constituent components, as well as in the following cases:

• Severe arterial hypotension;
• Pregnancy and during the period of breastfeeding;
• Severe bradycardia;
• Laun-Ganong-Levin syndrome in combination with atrial fibrillation or atrial flutter;
• AV block II-III degree;
• WPW Syndrome;
• SA blockade;
• Sick sinus syndrome.

With caution, Diltiazem is prescribed for children under 18 years of age and elderly patients, as well as for chronic heart failure, myocardial infarction, AV blockade of the 1st degree, severe stenosis of the aortic opening, cardiogenic shock, mild or moderate arterial hypotension, ventricular tachycardia, hepatic and renal failure.

Method of administration and dosage

The tablets are taken orally before meals with a small amount of water. The dosage of Diltiazem is 30 mg three or four times a day, with a possible gradual increase in the dose at intervals of 1-2 days.

Diltiazem solution is administered intravenously. The dose of the drug is determined on an individual basis. On average, when supraventricular tachycardia is stopped, 0.15-0.25 mg of solution per 1 kg of body weight is administered for 2 minutes.

Side effects

The instructions for Diltiazem indicate that the agent can cause side effects from some organs and body systems, namely:

• Dryness of the oral mucosa, thirst, taste disturbances, anorexia, hepatitis, constipation or diarrhea, dyspepsia, vomiting, increased body weight, moderate increase in the activity of alkaline phosphatase, aminotransferases, alanine aminotransferase and lactate dehydrogenase (digestive system);
• Arrhythmia, angina pectoris, bundle branch block, bradycardia, palpitations, tachycardia, orthostatic hypotension, AV block, fainting, ECG changes, marked decrease in blood pressure, development or worsening of heart failure, ventricular extrasystole and circulatory system (cardiovascular) ;
• Itching, urticaria, petechiae, erythema and photosensitivity (skin and skin appendages);
• Sleep disturbances, hallucinations, depression, insomnia, personality changes, amnesia, gait disturbances, paresthesia, tremors, nervousness and drowsiness (nervous system).

Diltiazem can cause asthenia, shortness of breath, headache, dizziness, polyuria, nausea, and:

• Increased CPK activity;
• Impotence;
• Agranulocytosis;
• Exfoliative dermatitis;
• Sexual dysfunction;
• Osteoarticular pain;
• Allergic reactions;
• Nose bleed;
• Thrombocytopenia
• Extrapyramidal syndrome;
• Hyperplasia of the gums;
• Prolongation of bleeding time.

Symptoms of an overdose of Diltiazem are chronic heart failure, severe bradycardia, cardiogenic shock, decreased blood pressure, asystole, and abnormal AV conduction.

In such cases, gastric lavage, the appointment of activated charcoal and symptomatic therapy are required.

special instructions

The dosage regimen of Diltiazem for elderly patients with bradycardia should be selected with extreme caution.

In cases of prolonged intravenous administration of the solution, the heart rate, electrocardiography, renal and liver function, and the patient's blood pressure should be constantly monitored. Infusions longer than 1 day or at a rate of 15 mg per hour are not recommended.

If during the period of use of Diltiazem there is a need for surgical intervention, the anesthesiologist should be warned in advance about taking the drug.

The antihypertensive effect of Diltiazem is enhanced by hydrocarbon derivatives, thiazide diuretics and other drugs that lower blood pressure.

Simultaneous administration of the drug with quinidine, beta-blockers, cardiac glycosides is potentially dangerous and can lead to the development of heart failure.

Diazepam, phenobarbital and rifampicin reduce the concentration of the drug in the blood, while cimetidine increases it.

The drug can be used simultaneously with nitrates.

Diltiazem increases the concentration in the blood of carbamazepine, quinidine, cyclosporine, valproic acid, digoxin and theophylline, and also enhances the cardiodepressant effect of general anesthetics.

The drug in the form of a solution is incompatible with furosemide.

Analogs

Diazem and Cardil are synonyms for the drug. Diltiazem analogues include Cortiazem, Amlodak, Tiakem, Isoptin, Nifebene, Amlodak and Breinal.

Terms and conditions of storage

The instructions for Diltiazem indicate that the drug should be stored in a dark, dry place out of the reach of children, at a temperature not exceeding 25 ºС.

From pharmacies, the drug is dispensed with a doctor's prescription. The shelf life of tablets, subject to the manufacturer's recommendations, is two years, dry matter - five years.

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Name:

Diltiazem

Pharmacological
action:

Calcium ion antagonist, used for angina pectoris (including Prinzmetal's angina pectoris) and hypertension (high blood pressure).
Has a negative chronotropic effect (reduces heart rate).
It can slow down atrioventricular conduction (conduction of excitation through the conducting system of the heart) and reduce the excitability of the atrioventricular node (atrial ventricular node).
Reduces vascular tone and general peripheral resistance in hypertension (persistent increase in blood pressure).

Antianginal (anti-ischemic) action is associated with a decrease in preload (a decrease in end-diastolic pressure due to the expansion of peripheral veins and a decrease in blood flow to the right atrium) to the myocardium (heart muscle), dilatation of the coronary vessels (expansion of the lumen of the heart vessels) and an improvement in the supply of oxygen to the heart.
It also has antiarrhythmic activity.
In terms of action, diltiazem is close to verapamil, but has a slightly stronger effect on vascular smooth muscles.
Compared with nifedipine, the peripheral vasodilatory effect (expansion of the vascular lumen) and reflex tachycardia (increased heart rate) are less pronounced.

Indications for
application:

Prevention of angina attacks (including Prinzmetal's angina);
- arterial hypertension;
- prevention of supraventricular arrhythmias (paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, extrasystole).

Mode of application:

Diltiazem is prescribed inside.
Doses are selected individually from 0.03 g (30 mg) 3-4 times a day to 0.18-0.3 g (180-300 mg) per day.
Prolonged (long-acting) tablets are prescribed 1 tablet (sometimes 2 tablets) 1-2 times a day.

Side effects:

From the central nervous system and peripheral nervous system: headache, dizziness, fainting, increased fatigue, asthenia, sleep disturbances, drowsiness, anxiety, extrapyramidal (parkinsonism) disorders (ataxia, mask-like face, shuffling gait, stiff arms or legs, trembling of hands and fingers, difficulty swallowing), depression; when used in high doses - paresthesia, tremor, visual impairment (transient loss of vision).
On the part of the cardiovascular system: asymptomatic decrease in blood pressure; rarely - angina pectoris, arrhythmia (including flutter and fibrillation of the ventricles), bradycardia (less than 50 beats / min) or tachycardia, AV block II and III degrees up to asystole, development or worsening of heart failure; when used in high doses and with intravenous administration - angina pectoris, bradycardia, AV blockade, a pronounced decrease in blood pressure, aggravation of chronic heart failure.

From the digestive system: dry mouth, increased appetite, nausea, vomiting, constipation or diarrhea, increased activity of hepatic transaminases, gingival hyperplasia (bleeding, soreness, swelling).
From the hematopoietic system: rarely - thrombocytopenia, agranulocytosis.
Allergic reactions: facial flushing, skin rash, arthritis, erythema multiforme exudative (including Stevens-Johnson syndrome).
Other: when used in high doses - pulmonary edema (difficulty breathing, cough, wheezing); peripheral edema (edema of the lower extremities - ankles, feet, legs), increased serum creatinine; rarely - galactorrhea, weight gain.

Contraindications:

Severe bradycardia;
- sick sinus syndrome (heart disease, accompanied by a violation of the rhythm of its contractions);
- cardiogenic shock;
- atrioventricular block II-III degree;
- Wolff-Parkinson-White syndrome (congenital heart disease, characterized by recurrent disturbances in the number and rhythm of heart contractions);
- arterial hypotension;
- chronic heart failure NB-III stage;
- acute heart failure;
- severe violations of liver and / or kidney function;
- pregnancy, lactation (breastfeeding);
- childhood;
- hypersensitivity to the drug.

Use with caution with AV blockade of the 1st degree, intraventricular conduction disorders, in patients prone to arterial hypotension, chronic heart failure, myocardial infarction with left ventricular failure, ventricular tachycardia with expansion of the QRS complex, liver failure, renal failure, in elderly patients, in children ( efficacy and safety of use have not been investigated).
Abrupt withdrawal of diltiazem can lead to the development of an anginal attack.
Patients with impaired liver and / or kidney function and the elderly require dosage adjustment.

Interaction
other medicinal
by means of:

With simultaneous use with beta-blockers (including propranolol, atenolol, metoprolol, pindolol, sotalol), an additive cardiodepressant effect is possible along with an increase in antianginal action in most patients. Patients with preexisting left ventricular dysfunction or conduction abnormalities are at increased risk of developing severe and threatening bradycardia.
Diltiazem inhibits propranolol metabolism, metoprolol, but not atenolol.
With simultaneous use with amiodarone, the negative inotropic effect, bradycardia, conduction disturbances, AV blockade are enhanced.
Since diltiazem inhibits the isoenzyme CYP3A4, which is involved in the metabolism of atorvastatin, lovastatin and simvastatin, drug interactions are theoretically possible due to an increase in plasma concentrations of statins. Cases of the development of rhabdomyolysis are described.
With simultaneous use with buspirone, the concentration of buspirone in the blood plasma increases, its therapeutic and side effects increase.

With simultaneous use with vecuronium chloride possible increase in the duration of neuromuscular blockade.
With simultaneous use with digoxin, digitoxin, an increase in the concentration of digoxin and digitoxin in blood plasma is possible.
With simultaneous use with imipramine, the concentration of imipramine in the blood plasma increases and there is a risk of developing unwanted changes on the ECG.
Cases of increased plasma concentrations of trimipramine and nortriptyline with simultaneous use with diltiazem have been described.
Diltiazem increases the bioavailability of imipramine by decreasing its clearance. Changes in the ECG are due to an increase in the concentration of imipramine in the blood plasma and the additive inhibitory effect of diltiazem and imipramine on AV conduction. It is believed that diltiazem interacts in the same way with trimipramine and nortriptyline.
When used simultaneously with insulin described a case of decrease in the effectiveness of insulin.
Due to the inhibition of the metabolism of anticonvulsants in the liver under the influence of diltiazem and a decrease in their clearance from the body, it is possible to increase the concentration of carbamazepine and phenytoin in the blood plasma with the risk of developing a toxic effect.

With simultaneous use with lithium carbonate, cases of the development of acute parkinsonism syndrome, psychosis have been described.
With simultaneous use with midazolam, triazolam, the concentration of midazolam and triazolam in the blood plasma increases and their effects are enhanced due to the inhibition of the CYP3A4 isoenzyme under the influence of diltiazem, with the participation of which these benzodiazepines are metabolized.
With simultaneous use with sodium amidotrizoate possible enhancement of the antihypertensive effect of diltiazem.
With simultaneous use with sodium nitroprusside, a significant increase in efficacy in controlled arterial hypotension is possible.
With simultaneous use with nifedipine, the antihypertensive effect is enhanced.
Rifampicin induces the activity of liver enzymes, accelerating the metabolism of diltiazem, which leads to a decrease in its effectiveness.
With simultaneous use with theophylline, a slight decrease in the metabolism of theophylline in the liver is possible, apparently due to inhibition of the CYP1A2 isoenzyme under the influence of diltiazem.

With simultaneous use with cisapride described a case of impaired consciousness, apparently due to a pronounced lengthening of the QT interval. It is believed that diltiazem inhibits the activity of the isoenzyme CYP3A4, which leads to an increase in the concentration of cisapride in the blood plasma and, possibly, to an increase in its cardiotoxicity.
With simultaneous use, diltiazem inhibits the metabolism of cyclosporine in the liver, which leads to a decrease in its excretion and an increase in plasma concentration. At the same time, a decrease in the manifestations of nephrotoxicity and an increase in the immunosuppressive effect were noted.
With simultaneous use with cimetidine increases the concentration of diltiazem in the blood plasma due to inhibition of its oxidative metabolism in the liver under the influence of cimetidine. The effects of diltiazem may be enhanced.
With simultaneous use with enflurane, cases of violation of the AV conduction of the myocardium have been noted. : lactose, corn starch, microcrystalline cellulose, dibasic calcium phosphate, sodium benzoate, magnesium stearate, povidone, gelatin, hydroxypropyl methylcellulose, talc, colloidal silicon dioxide.

Selective calcium antagonists are a promising group of drugs included in the list of first-line drugs for hypertensive patients. One of the most popular drugs in this group is Diltiazem, which is used to effectively lower blood pressure and prevent the development of complications of hypertension.

The main active ingredient of the drug is diltiazem hydrochloride. The drug is available in pill form. Auxiliary and shaping agents differ depending on the manufacturer.

Diltiazem Lannacher is a drug from an Austrian pharmaceutical company. It is available in two dosages - 90 or 180 mg of active ingredient in one tablet. Diltiazem Lannacher also contains lactose, talc, titanium dioxide and other excipients. The drug has a prolonged action and is a small light-colored film-coated tablets.

The long-acting drug Diltiazem Lannacher is available in two dosages

Diltiazem Retard - extended-release tablets, which are produced in the Donetsk region and Romania. Available in three dosages: 60, 90 and 120 mg of active ingredient in one tablet. The mechanism of slow release of the active substance is carried out due to the following auxiliary components:

• microcrystalline cellulose;
• glycolic wax;
• lactose monohydrate;
• mineral oil;
• magnesium stearate.

Diltiazem Retard tablets are packaged in 12 pieces in a blister. The medicine is sold in 1-10 blisters per pack. Diltiazem Lannacher is available in 10 tablets in a blister, two blisters in a package.

Diltiazem is a prescription drug that can be purchased in pharmacies, but you must first take a prescription from your doctor.

What is the difference between different forms of the drug?

Diltiazem Lannacher and Diltiazem Retard are long-acting drugs. They differ in a two-stage scheme for the release of the active substance. The drug begins to act several hours after taking the pill, the peak of its work is noted 7-8 hours after taking, and then the effect slowly decreases. This feature allows you to take the medicine only twice a day.

Unlike other prolonged-release drugs, the effect of Diltiazem lasts not 24, but 12 hours, so the tablets are drunk in the morning and in the evening.

On the shelves of pharmacies, you can find the drug Diltiazem without any prefixes and explanatory words in the name. This medication works like a regular tablet. After taking it, a rapid release of the active substance begins, the peak of action occurs two hours later, and then the process of removing the agent from the body begins. Such tablets must be taken several times a day, but in smaller doses than Diltiazem Retard.

As a rule, slow-release tablets are more expensive, but due to the peculiarities of their metabolism, Diltiazem Retard and Diltiazem Lannacher are less likely to cause side effects.

Long-acting drugs are more easily tolerated by the body

Indications for use

Diltiazem is a selective calcium antagonist with a predominant effect on the heart. Taking the drug Diltiazem is indicated for lowering blood pressure while monitoring cardiac performance.

The main indications for the use of Diltiazem are arterial hypertension of any type with the risk of developing complications in the heart. According to the doctor's prescription, the drug can be taken for angina pectoris, coronary heart disease, during the recovery period after a heart attack.

The drug reduces the risks of developing heart failure and other disorders of the myocardium against the background of hypertension.

Diltiazem can be taken with a steady increase in blood pressure, both as an independent agent (mono-therapy), and in combination with other antihypertensive drugs.

As the only drug for blood pressure control, Diltiazem Retard is prescribed when the pressure rises within 150 mm Hg. If the tonometer readings are significantly higher, it is necessary to additionally take diuretics or other medications.

At the initial stage of hypertension, Diltiazem can be prescribed to patients at risk of developing complications and disruption of the heart.

How to take Diltiazem?

Diltiazem is taken in the morning and evening, at the same time. The instruction for Diltiazem contains a detailed description of all possible reception regimens. It is recommended to take the drug immediately after a meal. In this case, the tablet must be swallowed, violation of its integrity leads to a deterioration in the therapeutic effect.

The dosage of the drug is selected individually for each patient. Typically, therapy is started with Diltiazem 60 mg twice daily. After a week of therapy, the effectiveness of the drug for the patient's body is evaluated, and the dosage can be increased to taking Diltiazem 90 mg.

Diltiazem, the indication of which is hypertension, is intended for long-term use. Moreover, if therapy is carried out with high doses, after a few weeks or months they must be reduced in order to minimize the risk of side effects.

Patients with angina pectoris or coronary artery disease should stop taking the drug by gradually reducing the dosage.

Treatment with the drug begins with a minimum dosage.

Use in pregnancy, children and the elderly

The drug is not intended for use during the period of gestation, since no studies of its effect on the fetus have been carried out. You can start therapy with this medicine only after pregnancy has been ruled out.

The main active ingredient penetrates into breast milk, and therefore the drug is not allowed to be used during lactation.

The drug is well tolerated, therefore, elderly patients can take the drug in standard dosages.

Diltiazem is not used in pediatric practice and is intended for the treatment of adult patients only.

Side effects

Side effects while taking Diltiazem are rare. The listed symptoms were observed in one out of 10 thousand patients:

• nervousness;
• sleep disturbance;
• confusion of consciousness;
• headache;
• dizziness;
• tremor;
• hot flashes;
• light sensitivity of the eyes;
• pain and pain in the eyes;
• noise in ears;
• dyspnea;
• bleeding from the nose;
• gynecomastia and impotence in men.

In the first days of taking the drug, hypotension may develop due to high dosages of the drug. Usually, the symptoms of low blood pressure go away as the body gets used to it. If after 3-4 days there is dizziness, loss of strength, pallor of the skin, you should consult your doctor about reducing the amount of the drug taken.

Contraindications

The instructions for use prohibit taking Diltiazem in the following cases:

• hypersensitivity to the active substance;
• hypotension;
• cardiogenic shock;
• bradycardia;
• period of gestation and lactation;
• childhood;
• acute heart failure.

The drug does not affect the functioning of the liver and kidneys, therefore it can be used for renal and hepatic insufficiency. The action of the medicinal pill does not affect drugs to lower blood sugar, so Diltiazem can be prescribed to patients with type 2 diabetes.

special instructions

Patients with renal insufficiency do not need to adjust the dosage of the drug, except in cases of severe renal impairment. It is recommended that you consult with your doctor about reducing the number of pills.

In hepatic insufficiency, dosage reduction is not required, except for severe forms of impairment, while treatment is advisable to carry out the drug in a dosage of 60 mg.

In case of heart failure, the drug should be taken under the supervision of a specialist. It is recommended to regularly monitor changes in the work of the myocardium. The drug is prescribed with caution for bradycardia, left ventricular failure, aortic stenosis.

In case of heart disease, regular monitoring is required during the period of taking the drug.

Overdose

Taking large doses of the drug (over 1.5 g) leads to the development of severe intoxication. This is manifested by a number of symptoms: irritability, nervousness, loss of strength, respiratory failure, nausea, decreased pressure. There are known cases of cardiac arrest due to an overdose of this drug, which can be fatal.

There is no specific antidote, symptomatic treatment and, if necessary, resuscitation measures are used. If you suspect an overdose, it is recommended not to wait, but to immediately call an ambulance to your home.

Drug interactions

Any medication must be taken correctly. Despite its seeming safety, Diltiazem can cause negative reactions when taken with other drugs.

1. Despite the fact that Diltiazem can be taken with other antihypertensive drugs, only a doctor should make the decision to prescribe ancillary drugs. Self-therapy with several different drugs for hypertension entails a strong decrease in blood pressure, the development of hypotension and bradycardia.
2. Drugs that reduce heart rate are not recommended to be taken together with Diltiazem. Due to the potentiation of their action, the use of Diltiazem tablets with such drugs can lead to cardiac arrhythmias and bradycardia.
3. Diltiazem increases the toxicity of cyclosporine and carbamazepine. If it is necessary to take them together, the dosage of these drugs should be halved.
4. Diltiazem increases the concentration of buspirone in the blood, which leads to severe side effects from taking the latter.
5. Cases of a decrease in the action of the injected insulin when taking Diltiazem have been recorded, which must be taken into account in patients with type 1 diabetes mellitus.
6. Diltiazem should not be taken with lithium preparations, since such a combination of drugs can lead to the development of mental disorders and parkinsonism.

It is important to remember that while taking Diltiazem, you should refrain from drinking alcoholic beverages, in order to avoid increasing the load on the liver.

Cost and analogues

With the constant use of the drug Diltiazem, price plays an important role. The medicine is affordable for everyone - Diltiazem Lannacher will cost 150 rubles for a pack of 90 mg tablets, or 310 rubles at a dosage of 180 mg.

Ukrainian Diltiazem Retard in a dosage of 60 mg costs about 90 rubles per pack, a Romanian drug with the same name will cost 230 rubles, but already in a dosage of 180 mg.

There are no complete analogues of the drug. To date, pharmacies have only two prolonged-release drugs based on diltiazem. If necessary, a cardiologist will help you to choose analogs to replace Diltiazem, but you will have to look for substitutes among drugs based on other active ingredients.