|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
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
|Major Side Effects||
hypotension, heart block, HF
|Dosage forms and Strengths||
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
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.
- 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.
- Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
- Tarascon Pocket Pharmacopoeia® 2012.