Names and pronunciation
(dil-tye′a-zem) Cardizem, Cardizem CD, Cardizem LA, Cartia XT, Dilt-XR, Matzim LA, Taztia XT, Tiadylt ER, Tiazac
PDF page 395
Loading InternPractice…
Drug reference
(dil-tye′a-zem) Cardizem, Cardizem CD, Cardizem LA, Cartia XT, Dilt-XR, Matzim LA, Taztia XT, Tiadylt ER, Tiazac
PDF page 395
Func. class.: Calcium channel blocker, antiarrhythmic class IV, antihypertensive Func. class.: Antiemetic, antihista- mine, anticholinergic
PDF pages 395, 398
Chem. class.: Benzothiazepine Chem. class.: H1-receptor antagonist, ethanolamine derivative
PDF pages 395, 398
ACTION: Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node con- duction times, dilates peripheral arteries
PDF page 395
USES: PO angina pectoris due to coro- nary artery spasm, hypertension, improve- ment in exercise tolerance (chronic stable angina), IV atrial fibrillation, flutter, parox- ysmal supraventricular tachycardia USES: Motion sickness, nausea, vomit- ing, vertigo
PDF pages 395, 398
Do not confuse: dimenhydrinate/diphenhydramine
PDF page 398
CONTRAINDICATIONS: Sick sinus syndrome, AV heart block, hypoten- sion <90 mm Hg systolic, acute MI, pul- monary congestion, cardiogenic shock Precautions: Pregnancy, breastfeeding, children, geriatric patients, HF, aortic steno- sis, bradycardia, GERD, hepatic disease, hiatal hernia, ventricular dysfunction CONTRAINDICATIONS: Hyper- sensitivity, infants, neonates, tartrazine dye hypersensitivity Precautions: Pregnancy, breastfeeding, children, geriatric patients, cardiac dys- rhythmias, asthma, prostatic hypertro- phy, bladder-neck obstruction, closed- angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction
PDF pages 396, 398
SIDE EFFECTS CNS: Tremor, paresthesia CV: Dysrhythmia, edema, HF, bradycardia, hypotension, palpitations GI: Nausea, vomiting, diarrhea, constipation GU: Nocturia, polyuria, sexual dysfunc- tion, dysuria INTEG: Rash, flushing, photosensitivity, burning, pruritus, Stevens-Johnson syn- drome, sweating RESP: Rhinitis, dyspnea, pharyngitis, cough EENT: Blurred vision, epistaxis, tinnitus ENDO: Hyperglycemia, gynecomastia HEMA: Anemia, leukopenia, thrombocytopenia MS: Stiffness, muscle cramps MISC: Gingival hyperplasia
PDF pages 396, 397
INTERACTIONS Increase: effect, toxicity—theophylline, lithium Increase: effects of beta-blockers, digoxin, lithium, carBAMazepine, cycloSPORINE, anesthetics, HMG-CoA reductase inhibitors, benzodiazepines, methylPREDNISolone; monitor for increased action of each product Increase: AV node slowing—cimetidine, ranitidine; monitor closely Decrease: antihypertensive effect— NSAIDs, phenobarbital, phenytoin Drug/Food Increase: dilTIAZem effect—grapefruit juice; avoid use
PDF page 397
TREATMENT OF OVERDOSE: Atropine for AV block, vasopressor for hypotension (dye-men-hye′dri-nate) Dramamine, Driminate, GoodSense Motion Sickness, Gravol TripTone, Wal-Dram
PDF pages 397, 398
DOSAGE AND ROUTES Prinzmetal’s or variant angina, chronic stable angina • Adult: PO 30 mg qid, increasing dose gradually to 180-360 mg/day in divided doses or EXTENDED RELEASE (LA, CD, XT, XR products) 180-360 mg, max 480- 540 mg/day, depending on brand Atrial fibrillation/flutter, paroxysmal supraventricular tachycardia • Adult: IV BOLUS 0.25 mg/kg over 2 min initially, then 0.35 mg/kg may be given after 15 min; if no response, may give CONTINUOUS INFUSION 5-15 mg/hr for up to 24 hr Hypertension • Adult: PO 30 mg tid, increase to max 480 mg/day; EXTENDED RELEASE 120-240 mg daily, max 540 mg/day; SUSTAINED RELEASE 60 mg bid, max 360 mg/day Rapid ventricular rate secondary to dysrhythmias (unlabeled) • Adolescent/child/infant >7 mo: IV BO- LUS 0.25 mg/kg over 5 min, then CON- TINUOUS IV INFUSION 0.11 mg/kg/hr Exercise tolerance in chronic stable angina (Cardizem LA) Adult PO extended release 180 mg daily, increase q7-14days, max 360 mg DOSAGE AND ROUTES • Adult: PO 50-100 mg q4hr; max 400 mg/24 hr; IM/IV 50 mg q4hr as needed (Canada only) • Child 6-12 yr: PO 25-50 mg q6-8hr prn, max 150 mg/day • Child 2-5 yr: PO 12.5-25 mg q6-8hr, max 75 mg/day
PDF pages 396, 398
Available forms: Tablets 30, 60, 90, 120 mg; extended-release tablets 120, 180, 240, 300, 360, 420 mg; extended- release capsules 60, 90, 120, 180, 240, 300, 360, 420 mg; injection 5 mg/mL (5, 10 mL); powder for injection 100 mg
PDF page 396
Administer: PO route • Not all products are interchangeable • CCBs should be used cautiously in those prone to excessive hypotension with acute cerebral interactions, hemor- rhage, edema, severely raised intracra- nial pressure or cerebrovascular insuffi- ciency, or with outflow obstruction of the left ventricle (aortic stenosis) • Store at room temperature • Cardizem LA extended-release tablet 24 hr: give daily, either AM or PM, without regard to meals • Tiazac, Tiztia XT: give daily without regard to meals • Conventional regular-release tablet: give before meals, at bedtime • Cardizem CD or equivalent (Cartia XT): generic extended-release capsule 24 hr: give daily, without regard to meals • May crush, sprinkle regular tablet on applesauce for administration Direct IV route • IV undiluted over 2 min Continuous IV INFUSION route • Diluted 125 mg/100 mL, 250 mg/250 mL of D5W, 0.9% NaCl, D5/0.45% NaCl, give 10 mg/hr, may increase by 5 mg/hr to 15 mg/hr, continue infusion up to 24 hr max Y-site compatibilities: Albumin, amika- cin, amphotericin B, aztreonam, bumetanide, ceFAZolin, cefotaxime, cefo- TEtan, cefOXitin, cefTAZidime, cefTRIAX- one, cefuroxime, cimetidine, ciprofloxa- cin, clindamycin, digoxin, DOBUTamine, DOPamine, doxycycline, EPINEPHrine, erythromycin, esmolol, fentaNYL, flucon- azole, gentamicin, hetastarch, HYDRO- morphone, imipenem-cilastatin, labet- alol, lidocaine, LORazepam, meperidine, metoclopramide, metroNIDAZOLE, mid- azolam, milrinone, morphine, multivita- mins, niCARdipine, nitroglycerin, norepi- nephrine, oxacillin, penicillin G potassium, pentamidine, piperacillin, potassium chloride, potassium phos- phates, ranitidine, sodium nitroprusside, theophylline, ticarcillin, ticarcillin/clavu- lanate, tobramycin, trimethoprim-sulfa- methoxazole, vancomycin, vecuronium
PDF page 396
Assess: • HF: dyspnea, weight gain, edema, jug- ular venous distention, rales; monitor I&O ratios daily, weight • Angina: location, duration, alleviating factors, activity when pain starts • Dysrhythmias: cardiac status: B/P, pulse, respiration, ECG and intervals PR, QRS, QT; if systolic B/P <90 mm Hg or HR <50 BPM, hold dose, notify prescriber; monitor B/P, ECG continuously if using IV; report bradycardia, have emergency equipment nearby • Monitor if refills are being purchased • Monitor digoxin levels if taking both products, digoxin toxicity is more common • Potassium baseline and periodically; LFTs, renal studies • Stevens-Johnson syndrome: assess for rash, fever, fatigue, mouth blistering; D discontinue product immediately if severe • Beers: avoid extended-release capsule in older adults; promotes fluid retention, exacerbates heart failure • Pregnancy/breastfeeding: identify whether pregnancy is planned or suspected or if breastfeeding; no well-controlled stud- ies; use only if benefit outweighs fetal risk; discontinue breastfeeding or product, ex- creted in breast milk
PDF page 397
Evaluate: • Therapeutic response: decreased angi- nal pain, decreased B/P, increased exercise tolerance
PDF page 397
CLINICAL CONSIDERATIONS
PDF page 397
Patient and caregiver information: • How to take pulse, B/P before taking prod- uct; that a record or graph should be kept • To avoid hazardous activities until stabi- lized on product, dizziness is no longer a problem • To limit caffeine consumption; to avoid grapefruit juice • To discuss OTC, Rx, herbals, supple- ments with provider • About the importance of complying with all areas of medical regimen: diet, exercise, stress reduction, product therapy • To report dizziness, SOB, palpitations, rash, nausea, headache, swelling of face, hands • Not to discontinue abruptly • To use sunscreen, protective clothing to prevent photosensitivity • To rise or change positions slowly, orthostatic hypotension may occur • Angina: To discuss other therapy, includ- ing nitrates, beta-blockers and when to take • To use good oral hygiene and teeth cleaning, gingival hyperplasia occurs • Pregnancy: to avoid pregnancy and breastfeeding
PDF page 397
PHARMACOKINETICS Onset 30-60 min; peak 2-3 hr immediate release, 10-14 hr extended release, 11-18 hr sustained release; half-life 3½-9 hr; metabolized by liver; excreted in urine (96% as metabolites)
PDF page 397
• Adolescent/child/infant >7 mo: IV BO- LUS 0.25 mg/kg over 5 min, then CON- TINUOUS IV INFUSION 0.11 mg/kg/hr Exercise tolerance in chronic stable angina (Cardizem LA) Adult PO extended release 180 mg daily, increase q7-14days, max 360 mg DOSAGE AND ROUTES
PDF pages 396, 398