Diltiazem



General

Pronunciation

(dil TYE a zem)

Brand Names: U.S.

  • Cardizem
  • Cardizem CD
  • Cardizem LA
  • Cartia XT
  • Dilacor XR [DSC]
  • Dilt-CD [DSC]
  • Dilt-XR
  • DilTIAZem CD
  • Diltzac [DSC]
  • Matzim LA
  • Taztia XT
  • Tiazac

Indications

Use: Labeled Indications

Oral: Management of hypertension (monotherapy or in combination with other antihypertensives); management of chronic stable angina or angina from coronary artery spasm.

Guideline recommendations:

Hypertension: The 2014 guideline for the management of high blood pressure in adults (JNC 8) recommends initiation of pharmacologic treatment to lower blood pressure for the following patients (JNC8 [James 2013]):

• Patients ≥60 years of age, with systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg. Goal of therapy is SBP <150 mm Hg and DBP <90 mm Hg.

• Patients <60 years of age, with SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 years of age with diabetes, with SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 years of age with chronic kidney disease (CKD), with SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

Chronic kidney disease (CKD) and hypertension: Regardless of race or diabetes status, the use of an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB) as initial therapy is recommended to improve kidney outcomes. In the general nonblack population (without CKD) including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker, ACEI, or ARB. In the general black population (without CKD) including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic or a calcium channel blocker instead of an ACEI or ARB.

Coronary artery disease (CAD) and hypertension: The American Heart Association, American College of Cardiology and American Society of Hypertension (AHA/ACC/ASH) 2015 scientific statement for the treatment of hypertension in patients with coronary artery disease (CAD) recommends that a non-dihydropyridine CCB (verapamil, diltiazem) may be used as a substitute for a beta blocker in patients who have an intolerance or contraindication to beta blockers with ongoing ischemia, hypertension and chronic stable angina, or if angina or hypertension continues to be uncontrolled while receiving standard therapies (eg, beta blocker). However, a non-dihydropyridine CCB (eg, verapamil, diltiazem) should be avoided in patients with LV dysfunction or heart failure (with reduced ejection fraction). A BP target of <140/90 mm Hg is reasonable for the secondary prevention of cardiovascular events. A lower target BP (<130/80 mm Hg) may be appropriate in some individuals with CAD, previous MI, stroke or transient ischemic attack, or CAD risk equivalents (AHA/ACC/ASH [Rosendorff 2015]).

Injection: Control of rapid ventricular rate in patients with atrial fibrillation or atrial flutter; conversion of paroxysmal supraventricular tachycardia (PSVT)

Guideline recommendations: ACC/AHA/HRS supraventricular tachycardia (SVT) guidelines recommends IV diltiazem as a therapeutic option for the acute treatment (ie, conversion) of a variety of SVTs (AVNRT, AVRT, and focal AT) in hemodynamically stable patients. Diltiazem is not appropriate for patients with suspected systolic heart failure or pre-excitation on ECG (ACC/AHA/HRS [Page 2015]).

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