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Diltiazem Hydrochloride: Brands, Price & Uses in Bangladesh
Diltiazem Hydrochloride is a non-dihydropyridine calcium channel blocker indicated for the following conditions and more.
About Diltiazem Hydrochloride
Indications of Diltiazem Hydrochloride
Diltiazem Hydrochloride is a non-dihydropyridine calcium channel blocker indicated for the following conditions, classified by strength of evidence:
Established / FDA-approved uses
- Hypertension: Extended-release formulations of Diltiazem Hydrochloride are indicated for the management of hypertension, alone or in combination with other antihypertensive agents.
- Chronic stable angina pectoris: Diltiazem Hydrochloride is indicated for the management of chronic stable angina.
- Vasospastic (Prinzmetal's) angina: Diltiazem Hydrochloride is indicated for the management of angina due to coronary artery spasm.
- Rate control in atrial fibrillation/atrial flutter: Intravenous Diltiazem Hydrochloride is indicated for temporary control of rapid ventricular rate in atrial fibrillation or atrial flutter; oral Diltiazem Hydrochloride is used for chronic rate control once the patient is stabilized.
Guideline-supported / adjunct uses
- As an adjunct to conventional antianginal therapy (e.g. nitrates) when a single agent does not provide adequate symptom control.
Use of Diltiazem Hydrochloride should always be individualized and guided by a physician's assessment.
Dosage & Administration of Diltiazem Hydrochloride
Dosage of Diltiazem Hydrochloride must be individualized based on indication, formulation, and patient response. General guidance is summarized below; the prescriber's instructions and product labeling should always be followed.
| Indication | Typical adult dosing |
|---|---|
| Hypertension (extended-release) | Initial 120-180 mg once daily, titrated over 2 weeks as needed; usual maintenance range 120-360 mg once daily (maximum per product labeling, commonly up to 360-540 mg/day depending on formulation). |
| Chronic stable angina (immediate-release) | 30 mg four times daily before meals and at bedtime, titrated over 1-2 days to a usual range of 180-360 mg/day in divided doses. |
| Chronic stable/vasospastic angina (extended-release) | 120-180 mg once daily, titrated to a usual maintenance dose of 120-320 mg once daily. |
| Atrial fibrillation/flutter - acute rate control (IV, hospital setting only) | Initial IV bolus followed by continuous infusion as determined by the treating physician, with continuous cardiac monitoring; not for home/self-administration. |
| Atrial fibrillation/flutter - chronic rate control (oral) | Individualized oral dosing, generally similar to angina/hypertension dosing ranges, guided by heart rate response. |
Renal/hepatic impairment
Diltiazem Hydrochloride is extensively metabolized by the liver; patients with hepatic impairment should be started at the lower end of the dosing range with careful titration and monitoring. Dose adjustment based on renal impairment alone is not well established, but caution and clinical monitoring are advised.
Elderly patients
Elderly patients may show reduced clearance of Diltiazem Hydrochloride; a lower starting dose with careful titration is recommended.
Side Effects of Diltiazem Hydrochloride
Common and serious side effects reported with Diltiazem Hydrochloride include:
Common
- Peripheral edema (swelling of the ankles/legs)
- Headache
- Dizziness or lightheadedness
- Bradycardia (slow heart rate)
- Constipation
- Flushing
- Nausea
Less common but serious
- Hypotension
- AV block (including first-, second-, or third-degree)
- Worsening of heart failure symptoms
- Elevated liver enzymes / rare hepatic injury
- Skin reactions, including rare severe reactions
Patients should seek prompt medical attention for symptoms such as fainting, severe dizziness, very slow heartbeat, or signs of an allergic reaction.
Contraindications of Diltiazem Hydrochloride
Diltiazem Hydrochloride is contraindicated in patients with:
- Known hypersensitivity to diltiazem or any component of the formulation.
- Sick sinus syndrome, except in patients with a functioning artificial pacemaker.
- Second- or third-degree AV block, except in patients with a functioning artificial pacemaker.
- Severe hypotension.
- Acute myocardial infarction with pulmonary congestion documented on examination or X-ray.
- Concomitant use of intravenous beta-blockers with intravenous Diltiazem Hydrochloride (close in time), due to the risk of severe bradycardia and AV block.
- Wolff-Parkinson-White syndrome or short PR interval syndrome with atrial fibrillation/flutter and an accessory bypass tract, due to the risk of accelerated ventricular rate.
Frequently Asked Questions about Diltiazem Hydrochloride
What is Diltiazem Hydrochloride used for?
Diltiazem Hydrochloride is used to treat high blood pressure (hypertension), chronic stable and vasospastic (Prinzmetal's) angina, and to control fast heart rates in atrial fibrillation or atrial flutter.
How should I take Diltiazem Hydrochloride?
Take Diltiazem Hydrochloride exactly as prescribed by your physician, at the same time each day, with or without food. Swallow extended/sustained-release tablets or capsules whole - do not crush, chew, or split them.
Can I stop taking Diltiazem Hydrochloride suddenly?
No. Do not stop Diltiazem Hydrochloride abruptly without consulting your physician, as this may lead to worsening of your underlying heart condition. Any dose changes should be made gradually under medical supervision.
What are the common side effects of Diltiazem Hydrochloride?
Common side effects include swelling of the ankles or legs, headache, dizziness, slow heart rate, constipation, and flushing. Contact your doctor if these are severe or persistent, or if you experience fainting, very slow heartbeat, or signs of an allergic reaction.
Who should not take Diltiazem Hydrochloride?
Diltiazem Hydrochloride should not be used by people with known hypersensitivity to it, sick sinus syndrome or significant AV block (without a pacemaker), severe low blood pressure, acute heart attack with lung congestion, or by those receiving intravenous beta-blockers concurrently. It is also contraindicated in Wolff-Parkinson-White syndrome with atrial fibrillation.
Is Diltiazem Hydrochloride safe during pregnancy or breastfeeding?
Diltiazem Hydrochloride should be used in pregnancy only if clearly needed, as there are no adequate controlled studies and potential fetal risk cannot be ruled out. Diltiazem Hydrochloride passes into breast milk, so breastfeeding mothers should consult their physician about whether to continue breastfeeding or continue the medicine.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.