Diltiazem

General characteristics. Structure:

Active ingredient: 60 mg of diltiazem of a hydrochloride.

Excipients: lactose, starch corn, microcrystallic cellulose, calcium phosphate double-base, Natrium benzoicum, magnesium stearate, povidone, gelatin, gidroksipropilmetiltsellyuloza, talc, colloid silicon dioxide.

Medicine which possesses anti-anginal, antiarrhytmic and hypotensive action.

Pharmacological properties:

Pharmacodynamics. Diltiazem is an antagonist of calcium of a benzotiazepinovy row, possesses anti-anginal, antiarrhytmic and hypotensive action. The mechanism of effect of drug is based on oppression of receipt of calcium ions in cells of a cardiac muscle and peripheral vessels due to blocking of slow calcium channels.

Diltiazem reduces contractility of a myocardium and reduces its oxygen requirement, causes delay of atrioventricular conductivity, reduces heart rate, causes expansion of coronary arteries, increases a coronary blood stream.

Diltiazem reduces a tone of smooth muscles of peripheral arteries and the general peripheric resistance that results in hypotensive effect.

Pharmacokinetics. The tablets Diltiazem are well soaked up (80 - 90%). Bioavailability of drug makes 40 - 50%. The maximum concentration is registered in blood on average in 3 hours after reception of tablets. Drug is almost completely metabolized in a liver, removed, mainly with bile (65%) and, to a lesser extent, through kidneys (35%).

Indications to use:

- arterial hypertension
- prevention and treatment of attacks of stenocardia (including Printsmetal's stenocardias).

Route of administration and doses:

Pill should be taken before food, to swallow entirely, without chewing, washing down with a small amount of liquid.

Treatment there begin with 30 mg of diltiazem 3-4 times a day. If necessary the daily dose can be increased to 240 mg. The maximum daily dose makes 360 mg.

Features of use:

To carry out monitoring of arterial pressure, number of cordial reductions and an ECG in an initiation of treatment at selection of a dose or in case of need co-administration of other drugs influencing function of heart or arterial pressure.

Drug withdrawal needs to be carried out gradually.

With care to apply the patient with a tendency to bradycardia, with tendency to arterial hypotension, at disturbance of intra ventricular conductivity, abnormal liver functions and/or kidneys, to people of advanced age.

During administration of drug it is necessary to abstain from alcohol intake.

Efficiency and safety of diltiazem at children is not established.

Side effects:

Diltiazem is usually well transferred.


The headache, dizziness, fatigue and weakness, frustration of a dream, hypostases of the lower extremities are in rare instances possible.


From digestive tract: nausea, vomiting, dryness in a mouth, a meteorism, a lock, heartburn, perhaps tranzitorny increase in hepatic transaminases.


Allergic reactions in the form of an itch, skin rashes, a dieback are possible.


Extremely seldom when using high doses bradycardia, arterial hypotension, symptoms of heart failure, disturbance of atrioventricular conductivity meet.

Interaction with other medicines:

It is not recommended to apply without consultation with the doctor diltiazem with other medicines.

Co-administration of diltiazem and drugs with cardiodepressive effect and/or AV-inhibitors of conductivity (the means blocking beta adrenoceptors, cardiac glycosides, local anesthetics) can lead to development of bradycardia, disturbance of atrioventricular conductivity, emergence by a symptom of heart failure.

Cimetidinum suppresses metabolism of diltiazem in a liver, slows down its elimination, increasing duration of its action.

The concomitant use of diltiazem with carbamazepine, cyclosporine and quinidine can lead to strengthening of toxicity of the last in connection with overwhelming effect of diltiazem on system P 450 cytochrome and, therefore, their dose at appointment has to be reduced.

Simultaneous use of diltiazem and Disopyramidum can induce a hypopotassemia.

Contraindications:

- sick sinus syndrome;

- sinus bradycardia;

- a sinuatrial and atrioventricular block of Iiili Iiistepeni (without electrocardiostimulator), Wolf-Parkinson-Whyte's syndrome and a syndrome of Launa-Ganonga-Levina with paroxysms of blinking or an atrial flutter (except for patients with the implanted pacemaker);

- cardiogenic shock;

- arterial hypotension (systolic pressure is lower than 90 mm Hg),

- acute myocardial infarction;

- radiological the confirmed pulmonary hypertensia;

- pregnancy and lactation;

- the expressed abnormal liver functions and kidneys;

- the expressed aortal stenosis;

- sistolichestolichesky dysfunction of a left ventricle.

Overdose:

At overdose by drug diltiazem the following symptoms are possible: arterial hypotension, bradycardia or tachycardia, AV conductivity disturbances.

At emergence of symptoms of overdose it is necessary to wash out a stomach, to give absorbent carbon, to lay the patient and to see urgently a doctor.

Storage conditions:

List B. In the place protected from moisture and light at a temperature not above +25 °C.
To store in the place, unavailable to children. Period of validity of 5 years.

Issue conditions:

According to the recipe

Packaging:

On 30 or 50 tablets in banks polymeric. On 10 tablets in a blister strip packaging. Bank or 3 or 5 blister strip packagings together with a leaf insert in secondary packaging (pack).