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Black Box Warning*  

Mechanism of Action

Blocks calcium - dependent contractions in cardiac and peripheral smooth muscle leading to vasodilation; slows cardiac conduction through the AV node

Dosing

Acute setting: 0.25 mg/kg (average 20 mg) IV over 2 min; may give 2 nd bolus ( 0.35 mg/kg, average 25 mg) can be given 15 minutes later if HR > 100 bpm), then 5 to 15 IV mg/hr .

Continuous IV therapy should not be administered for longer than 24 hours

Non-acute setting or maintenance: 120 to 480 mg PO daily.

Can switch to slow-release drug, which is available and preferred.

Elderly: Initiate dosage at the lower end of the adult range

Hepatic Impairment: May accumulate; dose based on clinical response

Renal Impairment: No dosage adjustment needed

Contraindications
  • acute MI and pulmonary congestion
  • hypotension (SBP <90)
  • sick sinus syndrome without pacemaker
  • 2nd or 3rd degree AV block without pacemaker
  • Major Side Effects

    hypotension, heart block, HF

    Dosage forms and Strengths

    PO:
    30 mg, 60 mg, 90 mg, 120 mg immediate - release tablets
    120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg extended - release capsules 120 mg, 180 mg, 240 mg extended-release tablets

    IV:
    100 mg powder for injection
    125 mg/25 mL, 50 mg/10 mL, 25 mg/5 mL, 5 mg/mL solution for injection

    Special Notes

    Many diltiazem products are not equivalent on a mg:mg basis ; monitor response and side effects when interchanging between products.

    Cardizem LA is a chronotherapeutic product; give at bedtime to blunt early morning surge in blood pressure

    Counseling

    Contents of extended-release capsules may be sprinkled over food, but do not chew or crush contents

    * Refer to prescribing information for more complete information.
    †Dosages given in the table may differ from those recommended by the manufacturers.


    Sources:

    1. American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC). ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Washington, DC: American College of Cardiology.
    2. Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
    3. Tarascon Pocket Pharmacopoeia® 2012.