Diltiazem
It is a less potent vasodilator than nifedipine and has a modest direct negative chronotropic, inotropic and dromotropic action. It produces modest fall in BP with no change in heart rate. Large doses decrease total peripheral resistance markedly and may elicit reflex cardiac effects. It is a potent coronary dilator.Angina pectoris due to coronary artery spasm. Chronic stable angina.
Initially 30 mg, 2-4 times daily before meals & at bed time. Increase gradually to max. 240 mg in 3-4 divided doses daily.
Not recommended for children, pre-existing sinus, A-V nodal or myocardial disease. Heart block greater than Ist degree. Bradycardia. Pregnancy.
Gradual withdrawal only. Breast feeding. Hypotension. Diabetes. Monitor heart rate regularly. Paediatrics: Not recommended. Pregnancy: May affect the foetus. Lactation: Present in breast milk, may affect in lactation. Elderly: Reduced dose may be necessary.
Headache, nausea, dizziness, ankle oedema, bradycardia, rash.
Elevates serum digoxin, cyclosporine and theophylline levels. Potentiates action of propranolol. H-2 receptor blockers increase plasma concentration of Diltiazem.
