Page 114 - 2026 SMOG

DILTIAZEM (CARDIZEM)
Class/Mechanism of Action
• Calcium Channel Blocker; Antiarrhythmic Agent, Class IV
Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of
vascular smooth muscle and myocardium during depolarization; produces relaxation of
coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen
delivery in patients with vasospastic angina.
˚ Onset of action—IV: 3min; Duration—IV: 1–3hr
Indications
• Labeled Indications
˚ Atrial fibrillation or atrial flutter for acute ventricular rate control, conversion of
supraventricular tachycardia, hypertension, chronic stable angina, vasospastic angina
• Off-Label Indications
˚ Atrial fibrillation or atrial flutter, chronic ventricular rate control, hypertrophic
cardiomyopathy; idiopathic ventricular tachycardia; nonsustained ventricular tachycardia or
ventricular premature beats, symptomatic; Pulmonary arterial hypertension (group 1)
Contraindications
• Sick sinus syndrome (except in patients with a functioning artificial pacemaker); Second- or
third-degree AV block
• Atrial fibrillation or flutter associated with an accessory bypass tract (WPW, short
PR syndrome)
• Severe hypotension; Cardiogenic shock; Hypersensitivity to diltiazem or any formulation
component
• Ventricular tachycardia (with wide-complex tachycardia [QRS ≥0.12 seconds]; must be
determined whether the origin is supraventricular or ventricular)
Adverse Reactions/Precautions
• Cardiovascular: Edema, atrioventricular block, bradycardia, hypotension, dyspnea
• Central nervous system: Headache, dizziness, pain, nervousness, vomiting, weakness, myalgia
• Pregnancy: Use with caution.
• Lactation: Use with caution
(continues)

106 • MEDICATIONS