Diltiazem SR
Generic Name
Diltiazem Hydrochloride Sustained Release 90 mg Tablet
Manufacturer
Various Generic Manufacturers
Country
Global
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Price Details
Current market pricing information
Variant | Unit Price | Strip Price |
---|---|---|
diltizem sr 90 mg tablet | ৳ 5.63 | ৳ 56.30 |
Description
Overview of the medicine
Diltiazem SR 90 mg is an extended-release tablet containing Diltiazem Hydrochloride. It is used to manage hypertension, chronic stable angina, and to control ventricular rate in atrial fibrillation or flutter.
Uses & Indications
Dosage
Adults
Initial dose typically 120-240 mg once daily. For 90 mg, it may be an initial low dose or for titration, usually once daily. Doses may be increased gradually based on clinical response, up to a maximum of 360 mg/day.
Elderly
Start with a lower dose (e.g., 90 mg once daily) and titrate slowly due to increased sensitivity and potential for reduced hepatic/renal function.
Renal_impairment
Use with caution. While dose adjustment is generally not required, monitor for adverse effects. Severe impairment may necessitate lower doses.
How to Take
Swallow whole, do not crush, chew, or divide the tablet. Can be taken with or without food, usually once daily at approximately the same time each day.
Mechanism of Action
Diltiazem blocks the influx of calcium ions into myocardial and vascular smooth muscle cells. This action leads to coronary and peripheral vasodilation, reduction in peripheral vascular resistance, and a decrease in heart rate and myocardial contractility.
Pharmacokinetics
Onset
Onset of action for SR formulations is typically within 2-3 hours; peak plasma concentrations reached in 6-11 hours.
Excretion
Approximately 60-65% of an oral dose is excreted in the urine (as metabolites) and 35% in the feces.
Half life
Plasma elimination half-life is approximately 3.5 to 9 hours (can be up to 10-14 hours at steady state for SR formulations).
Absorption
Well absorbed orally, but undergoes extensive first-pass metabolism. Sustained-release formulations provide prolonged absorption. Bioavailability 40-65%.
Metabolism
Extensively metabolized in the liver, primarily by CYP3A4, to several active and inactive metabolites.
Side Effects
Contraindications
- 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 < 90 mmHg)
- Acute myocardial infarction with pulmonary congestion
- Hypersensitivity to diltiazem
Drug Interactions
Digoxin
Can increase serum digoxin levels, leading to toxicity. Monitor digoxin levels.
Amiodarone
Increased risk of bradycardia, AV block, and decreased cardiac output.
Beta-blockers
May potentiate bradycardia, AV block, and hypotension. Close monitoring is required.
Grapefruit Juice
May increase diltiazem plasma concentrations.
Statins (e.g., Simvastatin, Lovastatin)
Increases plasma concentration of statins due to CYP3A4 inhibition, increasing risk of myopathy/rhabdomyolysis. Consider lower statin dose or alternative statin.
Storage
Store at controlled room temperature (20-25°C), protected from moisture and light. Keep out of reach of children. Do not freeze.
Overdose
Overdose symptoms may include severe hypotension, bradycardia, AV block, and cardiac arrest. Management is supportive, involving IV fluids, atropine for bradycardia, vasopressors for hypotension, and possibly cardiac pacing. Activated charcoal may be considered if ingested recently.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Diltiazem is excreted in breast milk; caution is advised during breastfeeding, and a physician should be consulted.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months from manufacturing date, depending on manufacturer.
Availability
Available in retail pharmacies and hospitals
Approval Status
Approved by major regulatory authorities
Patent Status
Off-patent (generic available)
WHO Essential Medicine
YesClinical Trials
Diltiazem has been extensively evaluated in numerous clinical trials establishing its efficacy and safety for hypertension, angina, and certain arrhythmias. Ongoing post-marketing surveillance continues to monitor real-world outcomes.
Lab Monitoring
- Blood pressure (regularly)
- Heart rate (regularly)
- ECG (especially at initiation or dose titration, and in patients with cardiac conduction abnormalities)
- Liver function tests (periodically, if clinically indicated)
Doctor Notes
- Emphasize the importance of not crushing or chewing SR tablets due to altered pharmacokinetics and potential for adverse events.
- Closely monitor patients with pre-existing cardiac conduction disturbances or left ventricular dysfunction.
- Advise caution when co-administering with other medications that affect heart rate or AV conduction (e.g., beta-blockers, digoxin).
- Educate patients on symptoms of hypotension or bradycardia and when to seek medical attention.
Patient Guidelines
- Take this medicine exactly as prescribed by your doctor. Do not change the dose or stop taking it without consulting your doctor.
- Swallow the tablet whole; do not crush, chew, or divide it.
- Report any unusual or persistent side effects, such as swelling, dizziness, or slow heartbeat, to your doctor.
- Regularly monitor your blood pressure and heart rate as advised by your healthcare provider.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next scheduled dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
This medicine may cause dizziness or lightheadedness, especially when starting the medication or increasing the dose. Avoid driving or operating heavy machinery until you know how Diltiazem affects you.
Lifestyle Advice
- Maintain 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.
- Practice stress-reduction techniques such as meditation or yoga.
Alternative Medicines in Bangladesh
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Global Brand Names
International brand names for this medicine
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