Diltiazem: Difference between revisions
| (One intermediate revision by the same user not shown) | |||
| Line 6: | Line 6: | ||
*Routes of Administration: IV, PO | *Routes of Administration: IV, PO | ||
*Common Trade Names: Cardizem | *Common Trade Names: Cardizem | ||
==Adult Dosing== | ==Adult Dosing== | ||
===[[Atrial fibrillation with rapid ventricular response]] (if hemodynamically stable)=== | |||
*Loading dose = 0.25 mg/kg (max=20 mg) IV bolus over 2 minutes | *Loading dose = 0.25 mg/kg (max=20 mg) IV bolus over 2 minutes | ||
**Can consider breaking down into 10 mg boluses in older patients to decrease risk of adverse reactions | **Can consider breaking down into 10 mg boluses in older patients to decrease risk of adverse reactions | ||
| Line 17: | Line 14: | ||
**If effective: Start infusion at 5-15 mg/hr | **If effective: Start infusion at 5-15 mg/hr | ||
***Consider 30mg IR PO or home dose to avoid need for a drip | ***Consider 30mg IR PO or home dose to avoid need for a drip | ||
===[[Supraventricular tachycardia]] (if hemodynamically stable)=== | |||
*Same as for atrial fibrillation with rapid ventricular response (see above) | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
| Line 23: | Line 23: | ||
==Special Populations== | ==Special Populations== | ||
===[[Drug pregnancy categories|Pregnancy Rating]]=== | |||
* Pregnancy Rating: C | * Pregnancy Rating: C | ||
===Lactation risk=== | |||
* Lactation: Does appear to diffuse into breast milk, but doses are typically not harmful to infants | * Lactation: Does appear to diffuse into breast milk, but doses are typically not harmful to infants | ||
* Hepatic Dosing: Not studied, use caution | ===Renal Dosing=== | ||
*Adult: Not studied, use caution | |||
*Pediatric: Not studied, use caution | |||
===Hepatic Dosing=== | |||
*Adult: Not studied, use caution | |||
*Pediatric: Not studied, use caution | |||
==Contraindications== | ==Contraindications== | ||
*Allergy to drug/class | *[[Allergy]] to drug/class | ||
*Infants <1yo | *Infants <1yo | ||
*Wide-complex tachycardia due to bypass tract (e.g. WPW) | *[[Wide-complex tachycardia]] due to bypass tract (e.g. WPW) | ||
*Symptomatic severe hypotension | *Symptomatic severe hypotension | ||
*Sick sinus syndrome/2nd or 3rd degree heart block if no pacemaker | *[[Sick sinus syndrome]]/2nd or 3rd degree heart block if no pacemaker | ||
*PO: acute MI and pulmonary congestion | *PO: acute [[MI]] and pulmonary congestion | ||
*Ventricular tachycardia | *[[Ventricular tachycardia]] | ||
*Caution if: | *Caution if: | ||
**Hypertrophic cardiomyopathy | **Hypertrophic cardiomyopathy | ||
| Line 73: | Line 82: | ||
*Class IV - Inhibits Ca influx | *Class IV - Inhibits Ca influx | ||
**Slows AV nodal conduction | **Slows AV nodal conduction | ||
==Comments== | |||
==See Also== | ==See Also== | ||
| Line 78: | Line 89: | ||
*[[Calcium Channel Blocker Toxicity]] | *[[Calcium Channel Blocker Toxicity]] | ||
*[[Atrial Fibrillation with RVR]] | *[[Atrial Fibrillation with RVR]] | ||
==References== | |||
<references/> | |||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 16:45, 7 September 2022
Administration
- Type: Calcium channel blocker
- Dosage Forms
- IV: 25 mg/5 mL and 50 mg/10 mL bottles
- Oral: 30 mg, 60 mg, 90 mg
- Routes of Administration: IV, PO
- Common Trade Names: Cardizem
Adult Dosing
Atrial fibrillation with rapid ventricular response (if hemodynamically stable)
- Loading dose = 0.25 mg/kg (max=20 mg) IV bolus over 2 minutes
- Can consider breaking down into 10 mg boluses in older patients to decrease risk of adverse reactions
- If ineffective after 15 minutes: 0.35mg/kg (max=25mg) over 2 minutes
- If effective: Start infusion at 5-15 mg/hr
- Consider 30mg IR PO or home dose to avoid need for a drip
Supraventricular tachycardia (if hemodynamically stable)
- Same as for atrial fibrillation with rapid ventricular response (see above)
Pediatric Dosing
- Contraindicated in pediatric patients <1yo
- See critical care quick reference for drug doses by weight
Special Populations
Pregnancy Rating
- Pregnancy Rating: C
Lactation risk
- Lactation: Does appear to diffuse into breast milk, but doses are typically not harmful to infants
Renal Dosing
- Adult: Not studied, use caution
- Pediatric: Not studied, use caution
Hepatic Dosing
- Adult: Not studied, use caution
- Pediatric: 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
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