Diltiazem

When ATH:
C08DB01

Characteristic.

Benzothiazepine derivative. White or off-white crystalline powder with a bitter taste. Insensitive to light. Soluble in water, methanol, xloroforme.

Pharmacological action.
Antianginalnoe, gipotenzivnoe, antiarrhythmic.

Application.

Angina (stable, vasospastic); prevention of coronary spasm during coronary angiography or bypass surgery; arterial hypertension (monotherapy or in combination with other antihypertensive drugs): after myocardial infarction (mostly retard form, when beta-blockers are contraindicated), in patients with concomitant angina (in the presence of contraindications to beta-blockers), in patients with diabetic nephropathy (when ACE inhibitors are contraindicated).

In/in-shimmer and ventricular fibrillation, paroxysms of atrial fibrillation (in combination with digoxin), paroxysmal supraventricular tachycardia. The Transplantation: after kidney transplantation (prevention of graft failure), during immunosuppressive therapy (to reduce the nephrotoxicity of cyclosporin A).

Contraindications.

Hypersensitivity, cardiogenic shock, left ventricular systolic dysfunction (Clinical and radiological signs of pulmonary congestion, left ventricular ejection fraction less than 35-40%), incl. in acute myocardial infarction, sinusovaya bradycardia (less 55 u. / min), sick sinus syndrome (if not implanted pacemaker), синоатриальная и AV блокада II–III степени (without pacemaker), vыrazhennыy aortalnыy stenosis, WPW-syndrome and syndrome of Launa-Ganonga-Levine with paroxizmami flicker or flutter, pregnancy, lactation.

Restrictions apply.

Синоатриальная и AV блокада I степени, violation of intraventricular conduction of excitation (blockade of the left or right bundle branch block), Sad less than 90 mm Hg. Art., the liver and kidneys, advanced age, children's (efficacy and safety have not been determined) age.

Pregnancy and breast-feeding.

Contraindicated in pregnancy.

Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

At the time of treatment should stop breastfeeding.

Side effects.

Cardio-vascular system and blood (hematopoiesis, hemostasis): transient hypotension; bradycardia, I degree conduction disturbances, decrease in cardiac output, heartbeat, fainting, eozinofilija.

From the nervous system and sensory organs: headache, dizziness, weakness, feeling tired.

With the genitourinary system: peripheral edema, violation of potency (individual cases).

From the digestive tract: dyspepsia (constipation or diarrhea, nausea, heartburn and others., more frequently in elderly patients), gingival hyperplasia mucosa (rarely).

For the skin: Sweating, erythema.

Allergic reactions: skin rash and itching, rarely mnogoformnaya Erythema ekssoudatus.

Other: increase in transaminases (GOLD, IS), LDH and alkaline phosphatase, giperglikemiâ (individual cases).

Cooperation.

Increases plasma levels of carbamazepine, teofillina, Cyclosporin A, digoksina. Can dampening influence of anesthetics on contractility, conductivity and automaticity of the heart. It weakens the nephrotoxic effects of cyclosporine A. Cimetidine diltiazem increases plasma, digoxin — potenziruet effectiveness in tahisistolicheskoj form of atrial fibrillation. Antiarrhythmic drugs and beta-blockers contribute to the development of bradycardia, AV conduction disorders, symptoms of heart failure. Antihypertensive drugs increase the hypotensive effect. The solution is compatible with a solution of diltiazem, furosemide.

Overdose.

Symptoms: bradycardia, gipotenziya, intracardiac blockade and heart failure.

Treatment: gastric lavage, appointment of activated carbon, plasmapheresis and hemoperfusion with activated charcoal. The properties have an antidote calcium supplements (kalytsiya gluconate) at / in the introduction, symptomatic therapy is the introduction of atropine, isoproterenol, dopamine or dobutamine, diuretics, infusion zhidkostey. At high degrees of AV block may conduct electrical cardioversion.

Dosing and Administration.

Inside, not liquid on 30 mg 3-4 times a day; if necessary - up 240 mg / day. Against the backdrop of renal or hepatic function, in the elderly initial dose 60 mg / day 2 admission. Formulations depot: by 90 mg 2-3 times a day or 120-180 mg 2 times a day at intervals of 12 no, either by 200-300 mg 1 once a day. The maximum daily dose - 360 mg. B / slowly, within 2-3 minutes at a dose of 250-300 mg/kg, if necessary, again after 15-30 minutes. B/drip in the dose of 0.2-1 mg/min (2,8-14 mcg/kg/min), but not more 300 mg / day. As long as (to 24 no) i / v infusion at a dose of 5-10 (to 15) mg / h.

Precautions.

In patients receiving long-acting formulations are not recommended in / introduction of beta-blockers. Caution should be used to normalize heart rhythm in patients with hemodynamic disorders or with drugs, reduces round, myocardial contractility and conductivity. Parenteral administration is possible with vehicles and equipment (including defibrillator) for emergency. Prolonged / introduction requires constant monitoring of ECG and blood pressure.

Cooperation