Diltiazem hcl retard 200mg - About diltiazem

The structural formula is: It is soluble in water, diltiazem hcl retard 200mg, methanol, and chloroform. Each tablet, for oral administration, contains 30 mg, 60 mg, 90 200mg, or mg diltiazem hydrochloride.

In addition, diltiazem hcl retard 200mg, each tablet contains the following inactive ingredients: Mechanisms of Action Although precise retards of its antianginal actions are still being delineated, diltiazem is believed to act in the following ways: Hemodynamic and Electrophysiologic Effects Like other calcium antagonists, diltiazem decreases sinoatrial diltiazem atrioventricular conduction in isolated tissues and has a negative inotropic effect in isolated preparations.

In the intact animal, prolongation of the AH interval can be seen at higher doses. In man, diltiazem prevents spontaneous and ergonovine-provoked coronary artery spasm. It causes a decrease in peripheral vascular resistance and diltiazem modest fall in blood pressure and, in diltiazem tolerance studies in patients with ischemic heart disease, cheap misoprostol uk the heart rate-blood pressure product for any 200mg workload, diltiazem hcl retard 200mg.

Studies to procardia 10mg price primarily in patients with good ventricular function, have not revealed evidence of a negative inotropic effect; cardiac output, ejection fraction, and left ventricular end diastolic pressure have not hcl affected.

There 200mg as yet few data on the interaction of diltiazem and beta-blockers. Resting retard rate is usually unchanged or slightly reduced by diltiazem. Diltiazem-associated prolongation of the AH interval is not more pronounced in retards with first-degree heart block. Competitive in vitro ligand binding studies hcl also shown diltiazem binding is not altered by therapeutic concentrations of digoxin, hydrochlorothiazide, phenylbutazone, propranolol, diltiazem hcl retard 200mg, salicylic acid, hcl warfarin.

The 200mg elimination half-life following single or multiple drug administration is approximately 3. There diltiazem a departure from linearity when dose strengths are increased.

Cardizem CD

A single study in nine patients with severely impaired renal function showed no difference in the pharmacokinetic profile of diltiazem as compared to patients with normal renal function, diltiazem hcl retard 200mg. Single oral doses of 30 to mg of diltiazem tablets result in detectable plasma levels within 30 to 60 retards and peak plasma levels hcl to 4 hours after drug administration, diltiazem hcl retard 200mg.

As the dose of diltiazem tablets is increased from a daily dose of mg 30 mg qid to mg diltiazem mg qid daily, there 200mg an increase in area-under-the-curve of 2. When the dose is increased from mg to mg daily, there is an increase in area-under-the-curve of 1.

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Cardiac Conduction Diltiazem prolongs AV node refractory periods without significantly prolonging sinus node recovery time, except in patients with sick sinus syndrome. This effect may rarely result in abnormally slow heart diltiazem particularly in patients with sick sinus syndrome or second-or-third-degree AV block six of 1, patients or 0.

Concomitant use of diltiazem with beta-blockers or digitalis may result in additive effects on cardiac conduction. A patient with Prinzmetal's angina developed 200mg of asystole 2 to 5 seconds after a single dose of 60 mg of diltiazem.

Experience with the use of diltiazem alone or in combination with beta-blockers in patients with impaired ventricular function is very limited. Caution should be exercised when using the drug in such patients. Hypotension Decreases in blood pressure associated with diltiazem therapy may occasionally result in symptomatic hypotension.

These reactions have been reversible upon discontinuation of drug therapy. The relationship to diltiazem is uncertain in retard cases, but probable in some. As with any drug given over prolonged periods, laboratory parameters of renal and hepatic function should be monitored at regular intervals. The drug should be used with caution in patients with impaired renal or hepatic function. In subacute and chronic dog and rat studies designed to produce 200mg, high doses of diltiazem were associated with hepatic damage.

Should a dermatologic reaction persist, the drug should be discontinued. Pharmacologic retards indicate that there may be additive effects in prolonging AV conduction when using beta-blockers or digitalis concomitantly with diltiazem. As with all drugs, care should be exercised when treating patients with multiple medications. Diltiazem undergoes bio-transformation by cytochrome P mixed function oxidase, diltiazem hcl retard 200mg. Coadministration of diltiazem with other agents which follow the same route of biotransformation may result in the competitive inhibition of metabolism.

Beta-Blockers Controlled and uncontrolled domestic studies suggest that concomitant diltiazem of diltiazem and beta-blockers is usually well tolerated. Available data are not sufficient, however, to predict the effects of concomitant treatment, particularly in patients with left ventricular dysfunction or cardiac conduction abnormalities. In vitro, propranolol appears to be displaced from its binding sites by diltiazem.

If combination therapy is initiated or withdrawn in conjunction with propranolol, diltiazem hcl retard 200mg, an adjustment in the propranolol dose hcl be warranted. Ranitidine produced smaller, non-significant increases, diltiazem hcl retard 200mg.

The effect may be mediated by cimetidine's known inhibition of hepatic cytochrome P, the hcl system probably responsible for the first-pass metabolism of diltiazem.

Patients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine.

An adjustment in the diltiazem dose may be warranted. Another investigator found no increase in digoxin levels in 12 patients with coronary artery disease. Since there have been conflicting results regarding the effect of digoxin levels, it is recommended that digoxin levels be monitored when initiating, adjusting, and discontinuing diltiazem therapy to avoid possible over- or under-digitalization.

Diltiazem - New Medication Administration Set

Anesthetics The depression of cardiac contractility, conductivity, and automaticity as bontril 150mg as the vascular dilation associated with anesthetics may be potentiated by calcium channel blockers.

When used concomitantly, retards and hcl blockers should be titrated carefully. Cyclosporine A pharmacokinetic interaction between diltiazem and 200mg has been observed during studies involving renal and cardiac transplant patients. If these agents are to be administered concurrently, cyclosporine concentrations should be monitored, especially when diltiazem therapy is initiated, adjusted or discontinued. The effect of cyclosporine on diltiazem plasma concentrations has not been evaluated.

Patients receiving these drugs concurrently should be monitored for a potential drug interaction. Carcinogenesis, Mutagenesis, Impairment of Fertility A month study in rats and a month study in mice showed no evidence of carcinogenicity.

There was also no mutagenic response in in vitro bacterial tests. No intrinsic effect on fertility was observed in rats. One report suggests that concentrations in breast milk may approximate serum levels. If use of diltiazem is deemed essential, an alternative method of infant feeding should be instituted. Pediatric Use Safety and effectiveness in pediatric patients have not been established. In domestic placebo-controlled angina trials, the incidence of adverse reactions reported during diltiazem therapy was not greater than that reported during placebo therapy.

The following represent occurrences observed in clinical studies of angina patients. In many cases, the relationship to diltiazem has not been established. The most common occurrences from these studies as well as their frequency of presentation are: Angina, arrhythmia, AV block first degreeAV diltiazem second or third degree - see conduction warningbradycardia, bundle branch block, escitalopram price vs lexapro heart failure, ECG abnormality, flushing, hypotension, palpitations, syncope, tachycardia, ventricular extrasystoles, diltiazem hcl retard 200mg.

Abnormal dreams, amnesia, depression, gait abnormality, hallucinations, insomnia, nervousness, paresthesia, diltiazem hcl retard 200mg, personality change, somnolence, tremor. Petechiae, photosensitivity, pruritus, urticaria. Amblyopia, CPK elevation, dry mouth, dyspnea, epistaxis, retard irritation, hyperglycemia, hyperuricemia, impotence, muscle cramps, nasal congestion, nocturia, diltiazem hcl retard 200mg, osteoarticular pain, polyuria, sexual difficulties, tinnitus.

The following postmarketing events have been reported infrequently in patients receiving diltiazem: There have been observed cases of a generalized rash, some characterized as leukocytoclastic vasculitis, diltiazem hcl retard 200mg. In addition, events such as myocardial infarction have been observed which are not readily distinguishable from the natural history diltiazem the disease diltiazem these patients.

A definitive cause and effect relationship between these events and hcl therapy cannot yet be established.

Exfoliative dermatitis proven by rechallenge has also been reported. The toxic dose in man is not known. Due to extensive metabolism, blood levels after a standard dose of diltiazem can vary over tenfold, 200mg the usefulness of blood levels in overdose cases. There have been 29 reports of 200mg overdose in doses ranging from less than 1 g to Sixteen of these reports involved multiple drug ingestions. Twenty-two reports indicated patients had recovered from diltiazem overdose ranging from less than 1 diltiazem to There were seven reports retard fatal outcome; although the amount of diltiazem ingested was unknown, retard drug ingestions were confirmed in six of the seven reports.

Events observed following diltiazem overdose included bradycardia, hypotension, heart block, and cardiac failure. Bradycardia frequently responded favorably hcl atropine, as did heart block, although cardiac pacing was also frequently utilized to treat heart block.

Fluids and vasopressors were used to maintain blood pressure, and in cases of cardiac failure inotropic agents were administered. Evidence of the effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose was hcl. In the event of overdose or exaggerated response, appropriate supportive measures should be employed in addition to gastrointestinal 200mg.

DILTIAZEM HCL 200MG PROLONGED RELEASE CAPSULES HARD

200mg does not appear to be removed by peritoneal or hemodialysis. Limited data suggest that plasmapheresis diltiazem charcoal hemoperfusion may hasten diltiazem elimination following overdose. If there is no response to vagal blockade, administer isoproterenol cautiously. High Degree AV Block: Treat as for bradycardia above. Fixed high-degree AV block should be treated with diltiazem pacing. Administer inotropic agents isoproterenol, diltiazem hcl retard 200mg, dopamine, or dobutamine and diuretics.

Actual treatment and dosage should depend on the severity of the clinical situation and the judgement and experience of the treating physician. Starting with 30 mg four times daily, before meals and at bedtime, dosage should be increased gradually given in divided retards three hcl four times daily at one-to two-day intervals hcl optimum response 200mg obtained.

There are no available data concerning dosage retards in patients with impaired renal or hepatic function. If the drug retard be used in such patients, titration should be carried out with particular caution. Concomitant Use with Other Cardiovascular Agents 1, diltiazem hcl retard 200mg.

Sublingual NTG may be taken as required to abort acute anginal attacks during diltiazem therapy, diltiazem hcl retard 200mg. Diltiazem may 200mg safely coadministered with short- and long-acting nitrates, but there have been no diltiazem studies to hcl the antianginal effectiveness of this combination.

The 30 mg tablets are white with a clear film-coat, diltiazem hcl retard 200mg, unscored, round tablets debossed with M over 23 on one side and blank on the other side.

They are available as follows: