Cardizem SR
Generic Name
Diltiazem Hydrochloride Extended-Release
Manufacturer
Takeda Pharmaceuticals (original)
Country
USA
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| cardizem sr 90 mg tablet | ৳ 6.05 | ৳ 60.50 |
| cardizem sr 120 mg tablet | ৳ 8.05 | ৳ 80.50 |
Description
Overview of the medicine
Diltiazem is a calcium channel blocker used to treat high blood pressure, angina (chest pain), and certain heart rhythm disorders. The SR (sustained-release) formulation allows for once-daily dosing, providing continuous therapeutic effect.
Uses & Indications
Dosage
Adults
Initial dose: 180-240 mg once daily. May be titrated up to 360-480 mg once daily based on patient response.
Elderly
Start at the lower end of the dosing range and titrate cautiously due to potential for increased sensitivity.
Renal_impairment
Use with caution. No specific dosage adjustments usually needed, but monitor patients carefully for adverse effects.
How to Take
Take orally once daily, preferably before meals. Swallow the capsule whole; do not crush, chew, or divide.
Mechanism of Action
Diltiazem inhibits the influx of extracellular calcium ions across the myocardial and vascular smooth muscle cell membranes. This leads to relaxation of vascular smooth muscle, resulting in vasodilation, reduced peripheral vascular resistance, and decreased blood pressure. It also reduces myocardial oxygen demand and slows AV nodal conduction.
Pharmacokinetics
Onset
Varies with formulation. For SR, antihypertensive effect may be seen within 2 weeks, peak plasma concentration after 10-14 hours.
Excretion
Primarily excreted in urine (about 60-65%) and feces (about 35%).
Half life
3.5 to 9 hours for extended-release formulations.
Absorption
Well absorbed from the GI tract (about 90%), but undergoes extensive first-pass metabolism resulting in 35-40% bioavailability for immediate release. SR formulation has prolonged absorption.
Metabolism
Extensively metabolized in the liver, primarily by CYP3A4, to several active and inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to diltiazem
- Sick sinus syndrome (unless a functional pacemaker is present)
- Second- or third-degree AV block (unless a functional pacemaker is present)
- Severe hypotension (systolic blood pressure less than 90 mmHg)
- Acute myocardial infarction with pulmonary congestion
Drug Interactions
Digoxin
Increased digoxin plasma concentrations, leading to increased risk of toxicity.
Amiodarone
Potentiates diltiazem's effects on heart rate and AV conduction.
Statins (e.g., simvastatin, lovastatin)
Increased statin levels, leading to increased risk of myopathy/rhabdomyolysis.
Beta-blockers (e.g., propranolol, metoprolol)
Increased risk of bradycardia, AV block, and heart failure.
CYP3A4 Inducers (e.g., rifampin, carbamazepine, phenobarbital)
May decrease diltiazem plasma levels.
CYP3A4 Inhibitors (e.g., ketoconazole, erythromycin, protease inhibitors)
May increase diltiazem plasma levels.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Protect from moisture and light. Keep out of reach of children.
Overdose
Symptoms of overdose include severe bradycardia, hypotension, heart block, and asystole. Management involves supportive measures, gastric lavage, activated charcoal, intravenous fluids, atropine, calcium gluconate, and vasopressors as needed.
Pregnancy & Lactation
Pregnancy Category C. Should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Diltiazem is excreted in breast milk; therefore, caution should be exercised when administered to a nursing mother. Consult your doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2-3 years, as per manufacturer's specification. Check packaging for exact date.
Availability
Pharmacies, Hospitals
Approval Status
FDA Approved
Patent Status
Expired
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of diltiazem for its approved indications, demonstrating its effectiveness in managing hypertension, angina, and certain arrhythmias.
Lab Monitoring
- Blood pressure monitoring
- Heart rate monitoring
- Electrocardiogram (ECG) periodically
- Liver function tests (LFTs) periodically
- Kidney function tests periodically
Doctor Notes
- Monitor patients for signs of bradycardia, AV block, and hypotension, especially when initiating therapy or increasing dosage.
- Use with caution in patients with impaired hepatic or renal function, and in elderly patients, often requiring lower initial doses and careful titration.
- Concomitant use with beta-blockers, digoxin, or amiodarone requires close monitoring due to additive effects on heart rate and AV conduction.
Patient Guidelines
- Take this medication regularly as prescribed by your doctor, even if you feel well.
- Do not stop taking this medication abruptly without consulting your doctor, as it may worsen your condition.
- Swallow the capsule whole; do not crush, chew, or divide it.
- Report any unusual symptoms or side effects to your doctor immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Cardizem SR may cause dizziness or lightheadedness, especially at the beginning of treatment or when the dosage is adjusted. Exercise caution when driving or operating machinery until you know how this medication affects you.
Lifestyle Advice
- Adopt a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity as advised by your doctor.
- Avoid smoking and limit alcohol consumption.
- Manage stress effectively.
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