Diltiazem: reviews, instructions for use, price and description of the preparation

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Diltiazem belongs to the group of slow calcium channel blockers. It has a beneficial effect on the operation of blood vessels, expanding them and lowering peripheral resistance, normalizes blood pressure and circulation. About the price and analogues of the drug Diltiazem, his instructions, testimony to the application and reviews about him, we will tell in this detailed article.

Features of the drug

• Medication affects the speed of perception and reaction, including physical, for example, when working at height, with mechanisms, as well as when you are driving a vehicle.
• A sharp discontinuation of Diltiazem administration can provoke a "cancellation" syndrome, which will accompany the manifestations of hypertension, tachycardia. It is possible and aggravation of angina pectoris.
• From taking alcohol during the period of use Diltiazem should be discarded.
• In the presence of left ventricular heart failure may increase the risk of heart complications by 40%.

Composition of

The content of the tablet of the basic substance is 30, 60, 90, 180 mg. In the preparation diltiazem is presented as a hydrochloride.

Dosage form

Tablet form of diltiazem form of release, including prolonged action. Produced in the same way in capsules.

The average cost is 180 rubles. In some pharmacies of the CIS countries, Diltiazem ointment can also be found.

Pharmacological action Diltiazem

Antiarrhythmic, antihypertensive, antianginal.

Farmakodinamika

• Obtain the main substance of the drug from benzodiazepines. It is able to improve blood flow through expansion of arterioles and arteries, lowering of vascular resistance, relaxation of blood vessels.
• The heart rate decreases and the blood flow accelerates, including cerebral, coronary and renal.
• Anti-anginal effect can be traced to the improvement of the state of the heart muscle, lowering the tone of the myocardium and blood pressure, improving its blood supply, as well as relieving tension from the left ventricle.
• The atrioventricular conduction is slowing and the effective period is increasing, as calcium transport is suppressed in the heart tissues.

• Because of the decrease in vascular resistance, hypotensive effect is observed.
• Medication can affect both diastolic and systolic pressure. At the time of loading with prolonged therapy, a decrease in the maximum heart rate is noticeably.
• With arterial hypertension or ischemic heart disease, the drug improves diastolic relaxation in the myocardium and reduces platelet aggregation.
• Addiction to the drug does not occur even after prolonged therapy, and in the presence of hypertrophy of the left ventricle can help overcome the disease and return the heart muscle to a healthy state.

It is known that the duration of exposure to the drug is up to 14 hours, and the most pronounced effect can be traced after 2 weeks of therapy.

Pharmacokinetics of

• Absorption in the gastrointestinal tract reaches 70-90%, however, because of the passage through the liver, bioavailability is about 40%.The maximum concentration in the blood depends on the reception of the funds of one form or another. So, when treating with tablets, the Cmax level is reached after 2-4 hours, the capsules after 4-4.3 hours. Diltiazem retard( with a two-phase release) and prolonged maximum concentrations reached after 7 and 6-14 hours, respectively.
• With proteins, the connection is up to 80%, if there is an intravenous injection, then the first effect occurs after 3 minutes. When ingested diltiazem tablet form, the effect is noticeable after 60 minutes, and capsules - after 3-4 hours. The duration of the effect of tablets and capsules also differs, amounting to 8 and up to 24 hours( respectively).
• Metabolism occurs in the liver, after which the drug is concentrated in the bile. With a constant intake of plasma in the blood, two major metabolites are formed: desmethodilthiazem and deacetylldithioasem. The latter type of metabolite is capable of cumulation and has the property of a coronary vasodilator.
• Up to 30% of metabolites are excreted by the kidneys, the major part of them is excreted through the digestive tract. Unchanged in the urine can detect up to 4% of the drug. The medicine also has the ability to penetrate into breast milk.

Indications

1. Prophylaxis of attacks of different degrees of angina pectoris;
2. arterial hypertension;
3. diabetic retinopathy;
4. during surgery to prevent coronary spasm;
5. after myocardial infarction;
6. as a preventive therapy against the onset of attacks of ventricular arrhythmias( extrasystole, atrial flutter or flicker, paroxysmal tachycardia).

The use of diltiazem for children, as well as during pregnancy or feeding is prohibited. For women who are taking treatment for this drug, it is necessary to exclude the possibility of becoming pregnant.

The instructions for the use of diltiazem tablets will be further considered.

Instructions for use

Ingestion before the start of the meal.

• The individual dosage varies, it can reach up to 300 mg of the drug. Diltiazem is divided into several doses during the day.
• The retarded form of the drug can be taken once in a dosage not exceeding 500 mg.
• In the presence of violations in the liver and kidneys, the initial dose of the drug should not be more than 30 mg twice a day. The same restriction applies to older people.
• Intravenously, Diltiazem is used only when emergency care is needed. In such cases, the drug is allowed to apply for several days, but all dosages are strictly individual.
• During the period of therapy, control over BP and heart rhythm is required. In the presence of a "small" circle of treatment, hypertension is prescribed per day up to 720 mg of the drug, with supraventricular tachycardia up to 360 mg, with flutter or atrial fibrillation. Diltiazem 240 mg is combined with cardiac glycosides.

Contraindications

Contraindications to diltiazem intake are:

• Atrial fibrillation,
• arterial hypotension,
• aortic aortic stenosis in severe form,
• AV blockade,
• severe hypertension,
• cardiogenic shock,
• hypersensitivity,
• severe bradycardia,
• heart failure of various types.

Side effects of

• Allergic reaction: itching, Stephen-Johnson syndrome, a rash, sometimes the emergence of multimorphic exudative erythema.
• Nervous system: fatigue, pathological fear, depression, dizziness, parkinsonism, increased photosensitivity, weakness, headache. Paresthesia is observed only at high doses.
• Skin: redness, sweating, flushing of the face.
• HF and cardiac system: tachycardia, eosinophilia, hypotension transient, AV blockade up to asystole, decrease in minute volume of cardiac muscle, syncope, dyspnea, arrhythmia, sinoauric blockade, increased heart rate. With prolonged therapy with large doses of Diltiazem, bradycardia, angina pectoris may occur.
• GASTROINTESTINAL: hypercreatininaemia, increased appetite, impaired liver function, dyspeptic phenomena( nausea, stool change, etc.).Dyspeptic symptoms are noted in elderly patients.
• Genitourinary system: deterioration of potency in rare cases, but more often peripheral edema.
• Other: hyperglycemia;increased LDH, transaminase and alkaline phosphatase activity;impaired vision. If diltiazem was used in high dosage, it is likely the development of pulmonary edema, galactorrhea, thrombocytopenia, weight gain.

Overdose

There are such manifestations as hypotension, heart failure, bradycardia, intracardiac blockade. Therapy is standard, including, in addition to washing, also the reception of activated carbon, as well as hemoperfusion and plasmapheresis with it. As an antidote, intravenous calcium is used.

If the symptomatology is severe and does not disappear after the measures taken, resort to symptomatic therapy. For such cases, you need to use diuretics, isoproterenol, dobutamine or dopamine, atropine. If the atrioventricular blockade has reached high degrees, the question of the need for electrocardiostimulation is posed.

Special instructions

• With care choose the dose of the drug in the presence of the patient AV-blockade or bradycardia, because Diltiazem can reduce the conductance of the myocardium.
• Much attention is also paid to combination therapy, since with some medicines the drug can be used dangerously without medical supervision. This category includes, for example, beta-blockers.
• Patients with kidney or liver problems( especially with regard to insufficiency) should be under continuous medical supervision, and at the initial stage, only small doses of the drug should be used at all. Be sure to monitor the level in the blood of creatinine and urea in the urine. These substances should not exceed the level of 90 mg.
• Throughout the treatment period, the same is observed for the level of blood pressure, because Diltiazem sometimes provokes secondary hypertension. Observation, as a rule, is removed after the end of the initial period, when the appropriate therapeutic doses are already selected. Particular attention is paid to elderly patients, since in this case the exact dosage is very important.
• Before any intervention, it is necessary to notify the doctor that this medication is being treated. Stop it should be taken with copious skin rashes, which were transformed into dermatitis exfoliative or polymorphic erythema.

Next, let's talk about the reviews of patients and cardiologists about diltiazem.

Reviews

The main dissatisfaction of patients about taking a drug that includes diltiazem hydrochloride, is the side effects. Most often they suffer from weakness, headaches, nausea.

Specialists claim that all these manifestations can be stopped with the help of symptomatic therapy with other medications.

Analogues

Diltiazem has the following analogues:

• Diacordin,
• Diltiazem Lannacher,
• Altiazem,
• Dilren,
• Blocalcin,
• Tiakem,
• Zilden,
• Cortiazem,
• Diltiazem hydrochloride,
• Cardil,
• Diltzem.