Angimil
Generic Name
Diltiazem
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| angimil 80 mg tablet | ৳ 4.25 | N/A |
Description
Overview of the medicine
Diltiazem is a calcium channel blocker used to treat high blood pressure, chronic stable angina, and certain heart rhythm disorders (e.g., atrial fibrillation/flutter). It helps relax blood vessels and slows heart rate, reducing the workload on the heart.
Uses & Indications
Dosage
Adults
For hypertension or angina (conventional tablet): Initial dose 30-60 mg three to four times daily. Dose may be increased gradually based on response to a maximum of 360 mg/day in divided doses. For Angimil-80, typical dose is 80 mg two to three times daily.
Elderly
Start with lower doses (e.g., 30 mg three times daily) and titrate carefully, as elderly patients may have reduced renal or hepatic function.
Renal_impairment
Use with caution. Dose adjustment may be necessary. Monitor for increased diltiazem effects.
Hepatic_impairment
Use with caution. Dose adjustment may be necessary due to extensive hepatic metabolism. Monitor for increased diltiazem effects.
How to Take
Angimil-80 mg tablet should be taken orally with water, with or without food. Do not crush or chew the tablet if it is an extended-release formulation (though Angimil-80 mg is usually immediate release).
Mechanism of Action
Diltiazem blocks the influx of extracellular calcium ions across the myocardial and vascular smooth muscle cell membranes through voltage-dependent L-type calcium channels. This causes peripheral and coronary vasodilation, reduces myocardial contractility, and slows conduction through the AV node.
Pharmacokinetics
Onset
Within 30-60 minutes after oral administration.
Excretion
Excreted mainly in urine (60-65% as metabolites) and feces (35% as metabolites and unchanged drug).
Half life
Approximately 3.5 to 9 hours for conventional tablets.
Absorption
Well absorbed orally (80-90%), but undergoes extensive first-pass metabolism. Absolute bioavailability is about 40-65% for conventional tablets. Peak plasma concentrations are reached in 2-4 hours.
Metabolism
Primarily hepatic, largely via CYP3A4, to several metabolites including desacetyldiltiazem (N-demethylated metabolite), which has 20-50% of the activity of diltiazem.
Side Effects
Contraindications
- Sick sinus syndrome (unless a functional ventricular pacemaker is present)
- Second- or third-degree AV block (unless a functional ventricular pacemaker is present)
- Severe hypotension (systolic blood pressure < 90 mmHg)
- Cardiogenic shock
- Acute myocardial infarction and pulmonary congestion
- Known hypersensitivity to diltiazem or any component of the formulation
Drug Interactions
Digoxin
May increase plasma digoxin levels, leading to increased risk of digitalis toxicity. Monitor digoxin levels.
Amiodarone
Increased risk of bradycardia, AV block, and hypotension.
Grapefruit Juice
Increases diltiazem plasma levels.
Statins (e.g., Simvastatin, Lovastatin)
Diltiazem is a moderate inhibitor of CYP3A4, which can increase statin levels and risk of myopathy/rhabdomyolysis.
Beta-blockers (e.g., Propranolol, Atenolol)
Increased risk of bradycardia, AV block, and decreased myocardial contractility. Close monitoring is required.
CYP3A4 Inducers (e.g., Carbamazepine, Rifampin, Phenytoin)
May decrease diltiazem plasma concentrations, reducing its efficacy. Dose adjustment may be necessary.
CYP3A4 Inhibitors (e.g., Ketoconazole, Ritonavir, Erythromycin)
May increase diltiazem plasma concentrations, enhancing its effects. Dose adjustment may be necessary.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe bradycardia, profound hypotension, high-degree AV block, and cardiac failure. Management involves gastric lavage, activated charcoal, supportive measures, atropine for bradycardia, IV fluids and vasopressors for hypotension, and intravenous calcium gluconate.
Pregnancy & Lactation
Pregnancy Category C. Diltiazem should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is excreted into breast milk. Nursing mothers should consider discontinuing the drug or discontinuing breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
36 months from the date of manufacture.
Availability
Pharmacies, Hospitals
Approval Status
Approved by major regulatory authorities worldwide
Patent Status
Generic available, original patent expired
WHO Essential Medicine
YesClinical Trials
Diltiazem has been extensively studied in numerous clinical trials establishing its efficacy and safety for the treatment of hypertension, angina, and supraventricular tachyarrhythmias. These trials demonstrate its ability to reduce blood pressure, decrease anginal episodes, and control ventricular rate.
Lab Monitoring
- Regular blood pressure monitoring
- Heart rate monitoring (ECG if clinically indicated)
- Liver function tests (periodically, especially in patients with hepatic impairment)
- Kidney function tests (periodically, especially in patients with renal impairment)
Doctor Notes
- Monitor vital signs (BP, HR) closely, especially during initiation and dose titration.
- Exercise caution when co-administering with beta-blockers, digoxin, or amiodarone due to increased risk of bradycardia and AV block.
- Adjust dose in patients with significant hepatic or renal impairment.
- Advise patients to avoid grapefruit juice.
Patient Guidelines
- Take Angimil-80 exactly as prescribed by your doctor. Do not stop taking it suddenly without consulting your doctor.
- Avoid consuming grapefruit or grapefruit juice while on this medication.
- Report any severe dizziness, persistent swelling of ankles/feet, shortness of breath, or very slow heart rate to your doctor immediately.
- Measure your blood pressure regularly at home if advised by your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Angimil-80 may cause dizziness or lightheadedness, especially when initiating treatment or increasing the dose. Patients should be cautious when driving or operating machinery until they know how the drug affects them.
Lifestyle Advice
- Maintain a healthy diet, low in sodium and saturated fats, to support blood pressure management.
- Engage in regular physical activity as recommended by your doctor.
- Limit alcohol consumption and avoid smoking.
- Practice stress management techniques such as meditation or yoga.
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