Dilcontin CR90 mg

Dilcontin CR 90 mg film-coated tablet is used for the prophylaxis and treatment of chronic stable (classical) and vasopastic angina pectoris and has also been used alone or in combination in the management of hypertension, also, Diltiazem is effective in myocardial infarction, coronary artery spasm ... Read moreDilcontin CR 90 mg film-coated tablet is used for the prophylaxis and treatment of chronic stable (classical) and vasopastic angina pectoris and has also been used alone or in combination in the management of hypertension, also, Diltiazem is effective in myocardial infarction, coronary artery spasm, arrhythmias, Raynaud's phenomenon, oesophageal motility disorder and migraine.Dilcontin CR 90 mg sustained release tablet is indicated in the prophylaxis and treatment of angina pectoris. It is used in the management of classical and vasospastic angina pectoris. It has also been used in the treatment of essential hypertension. It is used for prophylaxis of some selected supraventricular tachyarrhythmias.

Calcium-channel blockers

Diltiazem hydrochloride is a calcium channel antagonist. It is a peripheral and coronary vasodilator with some negative inotropic activity. Diltiazem inhibits cardiac conduction particularly at the sino-atrial and atrioventricular nodes. Diltiazem has the following actions:Antianginal: A direct dilatation of coronary arteries and arterioles proved oxygen supply to myocardial tissues. In addition dilatation of the peripheral vasculature reduces systemic pressure of cardiac "after load" which results in lessened stress and reduced oxygen requirements of the myocardial tissues.Antiarrhythmic: The inhibited influx of calcium ions in cardiac tissues result in slowed electrophysiological activity through the S-A and A-V nodes without affecting accessory bypass conduction or altering normal atrial action potential or intraventricular conduction.Antihypertensive: Reduces peripheral vascular resistance as a result of vasodilatation.

Hypertension: Dosage needs to be adjusted by titration to individual patient needs. When used as monotherapy, usual starting doses are 120 to 240 mg once daily. Maximum antihypertensive effect is usually observed by 14 days of chronic therapy; therefore, dosage adjustments should be scheduled accordingly. The usual dosage range studied in clinical trials was 120 to 540 mg once daily. Current clinical experience with 540 mg dose is limited; however, the dose may be increased to 540 mg once daily.Angina: Dosages for the treatment of angina should be adjusted to each patient's needs, starting with a dose of 120 mg to 180 mg once daily. Individual patients may respond to higher doses of up to 540 mg once daily. When necessary, titration should be carried out over 7 to 14 days.

Film-coated formulation: The usual dose of Dilcontin CR 90 mg film coated tablet is 60 mg thrice daily. However patient's response may vary and dosage requirements can differ significantly between individual patients. If necessary, the divided dose may be increased to 180-300 mg/day. Dosage may be started as 30 mg four times daily and increasing at 1 to 2 days intervals until the optimum response is achieved. Higher doses upto 480 mg/day have been used with benefit in some patients especially in unstable angina. Elderly and patients with impaired hepatic or renal function: The recommended starting dose is 60 mg twice daily. The heart rate should be measured regularly and the dose should not be increased if the heart rate falls below 50 beats per minute.Sustained release formulation: Mild to moderate hypertension: initially 90 mg or 120 mg twice daily (elderly once daily); up to 360 mg daily may be required (elderly upto 240 mg) daily. Angina: initially 90 mg or 120 mg twice daily in divided doses may be required (elderly up to 240 mg daily).

Concomitant prophylactic therapy with short-or long-acting nitrates may be administered safely during diltiazem therapy. Diltiazem recommended caution and careful dosage titration when diltiazem is administered concomitantly with other drugs that can affect cardiac contractility and/ or conduction.

Dilcontin CR 90 mg sustained release tablet is contraindicated in patients with known hypersensitivity to the drug, sick sinus syndrome, second or third degree AV block, severe hypertension or acute myocardial infarction and rediographically documented pulmonary congestion.

Bradycardia, sino-atrial block, atrioventricular block, hypertension, malaise, headache, hot flushes, GIT disturbances, oedema, hepatitis and depression reported.

Pregnancy: There are no adequate and controlled studies to date with diltiazem in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risk to the fetus.Lactation: Because diltiazem is distributed into milk, women receiving the drug should not breastfeed their infants; an alternative method of infant feeding should be used if diltiazem therapy is considered necessary in nursing women.

Patients with mild bradycardia or a prolonged PR interval should be observed closely. Diltiazem does not have a significant myocardial depressant effect and is well tolerated in patients with poor left ventricular function. The drug should be used with caution in patients with impaired hepatic or renal function.

Symptoms: Hypotension, bradycardia, heart block, heart failure, impaired conduction, ECG changes, arrhythmias, shock, altered mental status, cardiac arrest. Management: Symptomatic and supportive treatment. Gastric lavage and admin of activated charcoal may be initiated. Maintain appropriate ventilation. Charcoal hemoperfusion may be useful. Hypotension may be treated with fluids and vasopressor agents. Bradycardia, 2nd- or 3rd-degree AV block may be treated with IV atropine sulfate.

Keep medicine out of the reach of children. Store in a cool and dry place.

Elderly and patients with impaired hepatic or renal function: The recommended starting dose is 60 mg twice daily. The heart rate should be measured regularly in these groups of patients and the dose should not be increased if the heart rate falls below 50 beats per minute.Children: Not recommended.

Dilute with appropriate solution either dextrose 5% in water, normal saline, dextrose 5% in water with NaCl 0.45% to achieve desired vol of concentration.

Calcium-channel blockers

Diltiazem hydrochloride is a calcium channel antagonist. It is a peripheral and coronary vasodilator with some negative inotropic activity. Diltiazem inhibits cardiac conduction particularly at the sino-atrial and atrioventricular nodes. Diltiazem has the following actions:Antianginal: A direct dilatation of coronary arteries and arterioles proved oxygen supply to myocardial tissues. In addition dilatation of the peripheral vasculature reduces systemic pressure of cardiac "after load" which results in lessened stress and reduced oxygen requirements of the myocardial tissues.Antiarrhythmic: The inhibited influx of calcium ions in cardiac tissues result in slowed electrophysiological activity through the S-A and A-V nodes without affecting accessory bypass conduction or altering normal atrial action potential or intraventricular conduction.Antihypertensive: Reduces peripheral vascular resistance as a result of vasodilatation. More than 90% of an oral dose is rapidly absorbed. Protein binding is very high. Peak plasma concentration reaches within 30-60 minutes. It is metabolised in the liver and excreted (60%) through bile.

There are no adequate and controlled studies to date with diltiazem in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risk to the fetus. Because diltiazem is distributed into milk, women receiving the drug should not breastfeed their infants; an alternative method of infant feeding should be used if diltiazem therapy is considered necessary in nursing women.