Diltiazem, tablets 60 mg 30 pcs

Antianginal, antihypertensive, vasodilator, antiarrhythmic.

Blocking calcium channels, reduces the flow of calcium ions into myocardial cells.

Diltiazem-Teva causes dilation of coronary arteries, thereby increasing coronary blood flow.

Limits smooth muscle tone of peripheral arteries and OPPS.

Indications

Stenocardia (attack prevention), arterial hypertension, prevention of attacks of supraventricular arrhythmias (paroxysmal tachycardia, atrial fibrillation or flutter, extrasystole).

Active ingredient

How to take, the dosage

Diltiazem is taken orally before meals, without chewing, with a little water.

The dose is set individually. 1 tablet 3 times a day.

If the therapeutic effect is not strong enough, then up to 2 tablets 3 times a day.

The maximum daily dose is 360 mg.

Interaction

In concomitant use with beta-adrenoblockers (including propranololol, atenolol, metoprolol, pindolol, sotalol) an additive cardiodepressant effect is possible along with enhancement of antianginal action in most patients. Patients with prior left ventricular dysfunction or conduction abnormalities have an increased risk of severe and threatening bradycardia.
Diltiazem inhibits the metabolism of propranololol, metoprolol, but not atenolol.

Concomitant use with amiodarone increases negative inotropic effects, bradycardia, conduction disturbances, AV-blockade.

Since diltiazem inhibits CYP3A4 isoenzyme, which is involved in metabolism of atorvastatin, lovastatin and simvastatin, in theory there can be cases of drug interaction caused by increasing of concentrations of statins in plasma. Cases of rhabdomyolysis have been described.

Concomitant use with buspirone increases the concentration of buspirone in plasma and its therapeutic and side effects.

Concomitant use with vecuronium chloride may increase the duration of neuromuscular blockade.

Concomitant use with digoxin, digitoxin may increase plasma concentrations of digoxin and digitoxin.

Concomitant use with imipramine increases the concentration of imipramine in plasma and there is a risk of adverse ECG changes.

Trimipramine and nortriptyline plasma concentrations have been reported to increase with diltiazem.
Diltiazem increases bioavailability of imipramine by reducing its clearance. ECG changes are due to increased concentration of imipramine in blood plasma and additive suppressive effect of diltiazem and imipramine on AV conductivity. Diltiazem is believed to interact similarly with trimipramine and nortriptyline.

A case of decreased efficacy of insulin has been described when used concomitantly with insulin.

Due to inhibition of metabolism of anticonvulsants in liver under the influence of diltiazem and decrease of their clearance from the body concentration of carbamazepine and phenytoin in plasma may increase with the risk of development of toxic effect.

In concomitant use with lithium carbonate there have been described cases of acute parkinsonism syndrome and psychosis.

Simultaneous use with midazolam and triazolam leads to increased plasma concentrations of midazolam and triazolam and greater effect due to inhibition of CYP3A4 isoenzyme under the influence of diltiazem, which metabolizes these benzodiazepines.

Concurrent use with sodium amidotrizoate may increase antihypertensive effect of diltiazem.

Concomitant use with sodium nitroprusside may significantly increase efficacy in controlled arterial hypotension.

Concurrent use with nifedipine increases the antihypertensive effect.

Rifampicin induces liver enzyme activity, accelerating metabolism of diltiazem, which leads to decrease of its effectiveness.
Simultaneous use with theophylline may slightly decrease metabolism of theophylline in liver, probably due to inhibition of CYP1A2 isoenzyme by diltiazem.

In concomitant use with cisapride there has been a case of impaired consciousness, apparently due to a pronounced prolongation of the QT interval. It is believed that diltiazem inhibits the activity of CYP3A4 isoenzyme, which leads to increased concentration of cisapride in blood plasma and, possibly, to its increased cardiotoxicity.

In concomitant use diltiazem inhibits metabolism of cyclosporine in the liver, which leads to decreased excretion and increased plasma concentrations. At the same time, a decrease in nephrotoxicity and increased immunosuppressive effect have been noted.

Concomitant use with cimetidine increases plasma concentration of diltiazem due to inhibition of its oxidative metabolism in the liver under the influence of cimetidine. The effects of diltiazem may be enhanced.

In concomitant use with enflurane there have been cases of myocardial AV conduction disturbances.

Special Instructions

With caution is used in Grade I AV-blockade, intraventricular conduction disorders, patients prone to arterial hypotension, chronic heart failure, myocardial infarction with left ventricular failure, ventricular tachycardia with QRS complex dilation, liver failure, renal failure, elderly patients, children (effectiveness and safety of use are not studied).

Concurrent use of beta-adrenoblockers and diltiazem for parenteral administration is not recommended.

Sudden discontinuation of diltiazem may result in the development of an anginal attack.

Patients with impaired hepatic and/or renal function and the elderly require correction of the dosing regimen.

Contraindications

Hypersensitivity, sinus node weakness syndrome, AV block of degree II-III, cardiogenic shock, acute heart failure, chronic heart failure, marked bradycardia, arterial hypotension, severe hepatic and renal failure, children.

Side effects

Weakness, dizziness, headaches, sinus bradycardia, AV conduction disorders, symptoms of heart failure, arterial hypotension, nausea, constipation or diarrhea, flatulence, transient increase in liver transaminases, skin redness, itching.

Similarities