Page 129 - 2023 SMOG Digital

DILTIAZEM Lactation?(Not Recommended) Trade Name: 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: 3 minutes, Duration 1-3 hours
Indications
Labeled Indications: Atrial fibrillation or atrial flutter for acute ventricular rate control, conversion of
supraventricular tachycardia, hypertension, chronic stable angina, vasospastic angina.
Unlabeled: 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 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 determine
whether 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
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Atrial fibrillation or atrial flutter, rate control: Atrial tachyarrhythmias, rate control:
Note: For rate control in hemodynamically stable Very limited data available: Infants, Children,
patients. Do not use in patients with preexcitation and Adolescents
associated with an accessory pathway, as this can lead IV:
to ventricular arrhythmias. • Initial bolus: 0.25mg/kg over 5 minutes
IV: (maximum dose: 20mg/dose [average adult
• Bolus dose: 0.25mg/kg (actual body weight) over 2 dose]) followed by a continuous IV infusion.
minutes (average dose: 20mg); if rate control is Dose should be individualized based on
insufficient after 15 minutes, a repeat bolus dose of patient response.
0.35mg/kg over 2 minutes may be given (average
dose: 25mg). Patients who respond after 1 or 2 • Continuous infusion (titrated to effect):
bolus doses can be started on a continuous 0.05-0.15mg/kg/hour (Rate control achieved
infusion. ≈10min)
• Continuous infusion following bolus(es): Initial:
5-10mg/hour; infusion rate may be increased in
5mg/hour increments according to ventricular
response, up to a maximum of 15mg/hour.
Supraventricular tachycardia (alternative agent):
Note: For hemodynamically stable patients if vagal
maneuvers and/or adenosine are unsuccessful.
• Bolus dose: 0.25mg/kg (actual body weight) over 2
minutes (average dose: 20mg); if rate control is
insufficient after 15 minutes, a repeat bolus dose of
0.35mg/kg over 2 minutes may be given (average
dose: 25mg). If bolus(es) do not terminate the
arrhythmia, consider alternative therapy.

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