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

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

Pharmacological effect

Antianginal, antihypertensive, vasodilator, antiarrhythmic.

By blocking calcium channels, it reduces the flow of calcium ions into myocardial cells.

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

Reduces the tone of smooth muscles of peripheral arteries and peripheral vascular resistance.

Special instructions

Use with caution in 1st degree AV blockade, intraventricular conduction disorders, in patients prone to arterial hypotension, chronic heart failure, myocardial infarction with left ventricular failure, ventricular tachycardia with widening of the QRS complex, liver failure, renal failure, in elderly patients, in children (the effectiveness and safety of use have not been studied).

The simultaneous use of beta-blockers and diltiazem for parenteral administration is not recommended.

Sudden withdrawal of diltiazem may lead to an anginal attack.

Patients with impaired liver and/or kidney function and the elderly require dosage adjustment.

Active ingredient

Diltiazem

Composition

One tablet contains:

Contraindications

Hypersensitivity, sick sinus syndrome, AV block II-III degree, cardiogenic shock, acute heart failure, chronic heart failure, severe bradycardia, arterial hypotension, severe hepatic-renal failure, childhood.

Side Effects

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

Interaction

When used simultaneously with beta-blockers (including propranolol, atenolol, metoprolol, pindolol, sotalol), an additive cardiodepressive effect is possible along with an increase in the antianginal effect in most patients. Patients with pre-existing left ventricular dysfunction or conduction abnormalities are at increased risk of developing severe and life-threatening bradycardia.
Diltiazem inhibits the metabolism of propranolol, metoprolol, but not atenolol.

When used simultaneously with amiodarone, the negative inotropic effect, bradycardia, conduction disturbances, and AV block are enhanced.

Since diltiazem inhibits the CYP3A4 isoenzyme, which is involved in the metabolism of atorvastatin, lovastatin and simvastatin, drug interactions due to increased plasma concentrations of statins are theoretically possible. Cases of rhabdomyolysis have been described.

When used simultaneously with buspirone, the concentration of buspirone in the blood plasma increases, its therapeutic and side effects increase.

When used simultaneously with vecuronium chloride, the duration of neuromuscular blockade may be increased.

When used simultaneously with digoxin and digitoxin, it is possible to increase the concentrations of digoxin and digitoxin in the blood plasma.

When used simultaneously with imipramine, the concentration of imipramine in the blood plasma increases and there is a risk of developing undesirable changes on the ECG.

Cases of increased plasma concentrations of trimipramine and nortriptyline when used simultaneously with diltiazem have been described.
Diltiazem increases the bioavailability of imipramine by reducing its clearance. Changes in the ECG are due to an increase in the concentration of imipramine in the blood plasma and the additive inhibitory effect of diltiazem and imipramine on AV conduction. Diltiazem is believed to interact in the same way with trimipramine and nortriptyline.

When used simultaneously with insulin, a case of decreased insulin effectiveness has been described.

Due to the inhibition of the metabolism of anticonvulsants in the liver under the influence of diltiazem and a decrease in their clearance from the body, it is possible to increase the concentrations of carbamazepine and phenytoin in the blood plasma with the risk of developing toxic effects.

When used simultaneously with lithium carbonate, cases of the development of acute parkinsonism syndrome and psychosis have been described.

When used simultaneously with midazolam, triazolam, the concentration of midazolam and triazolam in the blood plasma increases and their effects are enhanced due to the inhibition of the CYP3A4 isoenzyme under the influence of diltiazem, with the participation of which the metabolism of these benzodiazepines is carried out.

When used simultaneously with sodium amidotrizoate, the antihypertensive effect of diltiazem may be enhanced.

When used simultaneously with sodium nitroprusside, a significant increase in effectiveness in controlled arterial hypotension is possible.

When used simultaneously with nifedipine, the antihypertensive effect is enhanced.

Rifampin induces the activity of liver enzymes, accelerating the metabolism of diltiazem, which leads to a decrease in its effectiveness.
When used simultaneously with theophylline, a slight decrease in the metabolism of theophylline in the liver is possible, apparently due to inhibition of the CYP1A2 isoenzyme under the influence of diltiazem.

When used concomitantly with cisapride, a case of impaired consciousness has been described, apparently due to a pronounced prolongation of the QT interval. It is believed that diltiazem inhibits the activity of the CYP3A4 isoenzyme, which leads to increased plasma concentrations of cisapride and possibly increased cardiotoxicity.

With simultaneous use, diltiazem inhibits the metabolism of cyclosporine in the liver, which leads to a decrease in its elimination and an increase in plasma concentrations. At the same time, a decrease in the manifestations of nephrotoxicity and an increase in the immunosuppressive effect were noted.

When used simultaneously with cimetidine, the concentration of diltiazem in the blood plasma increases due to inhibition of its oxidative metabolism in the liver under the influence of cimetidine. The effects of diltiazem may be enhanced.

When used simultaneously with enflurane, cases of impaired AV conduction of the myocardium have been reported.

Storage conditions

The drug should be stored out of the reach of children at a temperature not exceeding 25°C.

Manufacturer

Alkaloid AD Skopje, Republic of North Macedonia