Diltiazem: Difference between revisions
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==Indications== | ==Indications== | ||
*Conversion of PSVT to NSR | *Conversion of [[PSVT]] to NSR | ||
*Slow RVR in a-fib/flutter | *Slow RVR in [[a-fib]]/[[Atrial flutter|flutter]] | ||
==Adult Dosing== | ==Adult Dosing== | ||
Revision as of 21:53, 5 March 2021
Administration
- Type: Calcium channel blocker
- Dosage Forms:
- Routes of Administration: IV, PO
- Common Trade Names: Cardizem
Indications
Adult Dosing
- Loading dose = 0.25mg/kg (max=20mg) IV bolus over 2min
- If ineffective after 15min: 0.35mg/kg (max=25mg) over 2min
- If effective: Start infusion at 5-15mg/hr
Pediatric Dosing
- Contraindicated in pediatric patients <1yo
- See critical care quick reference for drug doses by weight
Special Populations
- Pregnancy Rating: C
- Lactation:
- Renal Dosing: Not studied, use caution
- Hepatic Dosing: Not studied, use caution
Contraindications
- Allergy to drug/class
- Infants <1yo
- Wide-complex tachycardia due to bypass tract (e.g. WPW)
- Symptomatic severe hypotension
- Sick sinus syndrome/2nd or 3rd degree heart block if no pacemaker
- PO: acute MI and pulmonary congestion
- Ventricular tachycardia
- Caution if:
- Hypertrophic cardiomyopathy
- LV dysfunction
- Concomitant beta-blockade
- Hepatic/renal impairment
- Heart failure
Adverse Reactions
Serious
- Bradycardia, AV block, BBB
- Hypotension
- CHF
- SJS/TEN
Common
- Peripheral edema
- Elevated LFTs
- Headache
- Dizziness
- Nausea/vomiting, diarrhea, contipation
- Flushing, vasodilation
- Gingival hyperplagia
- Myalgia
- Bronchitis, sinus congestion, dypsnea
- Hemolytic anemia, thrombocytopenia
- Extrapyramidal symptoms
Pharmacology
- Onset of action = 2-3min (IV)
- Duration of action = 1-3hr (IV)
- Half life: 3-5h
- Metabolism: Hepatic
- Excretion: Urine/feces
Mechanism of Action
- Class IV - Inhibits Ca influx
- Slows AV nodal conduction