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DiltiazemAka: Cardizem, Benzothiazapine

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  1. Mechanism
    1. AV Node effects
      1. Slow AV Node Conduction
      2. Prolong AV Node refractory period
    2. Less negative hemodynamic effects than Verapamil
      1. Potent negative chronotropic effect
      2. Minimal negative inotropic effect
      3. Diltiazem effects Left Ventricular Dysfunction less
    3. Coronary vasodilatation
  2. Pharmacokinetics
    1. Onset in 2-7 minutes after IV infusion
  3. Contraindications
    1. Wolff-Parkinson-White Syndrome with Atrial Fibrillation
      1. Paroxysmal accelerated ventricular response
      2. Risk of progression into Ventricular Fibrillation
    2. Wide Complex Tachycardia (unless supraventricular)
      1. Risk of severe hypotension
      2. May progress into Ventricular Fibrillation
    3. Sinus Node or AV Node dysfunction without Pacemaker
      1. AV Block
      2. Sick Sinus Syndrome
    4. Severe Congestive Heart Failure
    5. Concurrent Intravenous Beta Blocker use
  4. Indications
    1. Atrial Fibrillation with rapid ventricular response
      1. Highly effective at controlling ventricular rate
    2. Paroxysmal Supraventricular Tachycardia
      1. Less studied than Verapamil for PSVT
    3. Supraventricular Tachycardia
      1. Terminates AV Node reentry tachycardias
    4. Hypertension
  5. Dosing
    1. Rapid Atrial Fibrillation
      1. Initial: 0.25 mg/kg (to 20 mg) IV over 2 minutes
      2. Subsequent (after 15 min): 0.35 mg/kg (to 25 mg)
      3. Maintenance
        1. Intravenous: 5-15 mg/h titrated to Heart Rate
        2. Oral: 120-360 mg PO qd in divided doses
      4. Mnemonic: Rule of 15 for patient weight of 70 kg
        1. First: 15 mg IV over 2 minutes
        2. Next: IV infusion at 15 mg/hour
          1. Titrate infusion to ventricular rate
          2. Typical infusion: 5 to 15 mg per hour
    2. Paroxysmal Supraventricular Tachycardia
      1. Initial: 0.25 mg/kg IV over 2 min
      2. Subsequent (after 15 min): 0.35 mg/kg
    3. Hypertension
      1. Regular: 30 mg PO qid (MAX 360 mg/day)
      2. Extended: 180-240 mg qd (MAX 540 mg/day)

Diltiazem (C0012373)

Definition (MSH)A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic.
Definition (CSP)substituted benzothiazepine with specific blocking activity against inward rectifying calcium channel.
Definition (NCI)A benzothiazepine derivative with anti-hypertensive, antiarrhythmic properties. Diltiazem blocks voltage-sensitive calcium channels in the blood vessels, by inhibiting the ion-control gating mechanisms, thereby preventing calcium levels increase by other revenues. Alternatively, it has been suggested that this agent also interferes with the release of calcium from the sarcoplasmic reticulum and inhibits the influx of extracellular calcium across both the myocardial and vascular smooth muscle cell membranes. The overall low calcium levels leads to dilatation of the main coronary and systemic arteries and decreasing myocardial contractility, decreased peripheral arterial resistance, improved oxygen delivery to the myocardial tissue, and decreased cardiac output.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishDiltiazem, DILTIAZEM PREPARATION
Spanishdiltiacem, diltiazem
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Cardizem (C0700940)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishCardizem
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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