Diltiazem

Diltiazem belongs to calcium channel blockers at the muscle level, causing vasodilation, which is why they are used in medicine to treat hypertension, angina, and some heart rhythm disorders. Diltiazem is categorized as a class 3 antianginal drug and class 4 antiarrhythmic, causing minimal changes in the sympathetic nervous system.

Diltiazem selectively limits calcium entry through the slow calcium channels of vascular smooth muscle and myocardial muscle fibers in a voltage-dependent manner. Through this mechanism, diltiazem reduces the intracellular calcium concentration in the contractile protein. Diltiazem is considered the reference substance for class III calcium channel blockers.

This high blood pressure treatment medication is a calcium channel blocker that is used to treat hypertension (high blood pressure) or angina (chest pain). Diltiazem is used to treat certain heart rhythm disorders, such as atrial fibrillation or atrial flutter, or dangerously fast heartbeat (tachycardia).

Always use this blood pressure medicine exactly as your doctor has told you. If in doubt, consult your doctor or pharmacist again.

The diltiazem pill is administered orally. Your doctor will tell you how many tablets to take each day.

The recommended dose is:

Adults

Angina pectoris: the starting dose is 1 tablet every 12 hours. Your doctor will gradually increase your dose until you get the optimal response. The maximum dose is 4 tablets every 12 hours (480 mg/day).

High blood pressure: the initial dose is 1 tablet every 12 or 8 hours. Your doctor will gradually increase your dose until you get the optimal response. The maximum dose is 4 tablets every 12 hours (480 mg/day).

Elderly patients, patients with renal or hepatic impairment

Initial dose adjustment should be done with caution.

All dosage modifications and dosage control will be performed under medical supervision.

Like all medicines, this medicine can cause side effects, although not everybody suffers them. Adverse effects of diltiazem vary in intensity from one patient to another and should be especially taken into account at the beginning of treatment or when changing medications. The following section details the known diltiazem side effects and their frequency.

Very common (may affect more than 1 in 10 patients):

• edema in the lower limbs.

Common (may affect up to 1 in 10 patients):

• headache, dizziness,
• atrioventricular block (a type of arrhythmia), palpitations, slow heart rate (bradycardia),
• redness,
• constipation, difficult digestion (dyspepsia), stomach pain, nausea,
• rashes,
• swelling of the joints,
• tiredness (asthenia), fatigue, discomfort.

Uncommon (may affect up to 1 in 100 patients):

• nervousness, difficulty falling asleep (insomnia),
• drop in blood pressure when joining quickly associated or not with dizziness (orthostatic hypotension),
• vomiting, diarrhea,
• increased levels of liver enzymes in the blood.

Rare (may affect up to 1 in 1,000 patients):

• dry mouth,
• skin irritation and itching (hives).

Frequency not known (cannot be estimated from the available data):

• reduction in the number of platelets (thrombocytopenia),
• decreased appetite, high blood sugar levels (hyperglycemia),
• mood swings including depression, confusion, hallucinations, personality and sleep disturbances,
• movement disturbances (extrapyramidal syndrome), memory loss (amnesia), abnormal tingling sensation, numbness or burning (paresthesia), tendency to fall asleep (drowsiness), temporary loss of consciousness (syncope), tremor, sudden and involuntary shaking of a muscle or group of muscles.
• lazy eye (partial loss of vision in one or both eyes), eye irritation,
• ringing in the ear (tinnitus)
• interruption or alteration of the electrical signal in the heart (sinoatrial block, sinus arrest), the difficulty of the heart to pump blood (congestive heart failure), rapid heartbeat (tachycardia), abnormal heart contractions (ventricular extrasystoles), irregular heartbeat (arrhythmia), pain or tightness in the chest (angina pectoris),
• inflammation of the blood vessels (vasculitis),
• difficulty breathing (dyspnea), nosebleeds (epistaxis), nasal congestion,
• inflammation of the gums (gingival hyperplasia)
• hepatitis (an inflammatory disease affecting the liver), liver disease (granulomatous liver disease),
• sensitivity to light (photosensitivity), inflammation of the throat, lips and airways (angioneurotic edema), erythema multiforme (severe skin disease associated with red spots, blisters), including rare cases of Stevens-Johnson Syndrome (severe vesicular reactions of the skin and mucous membranes), toxic epidermal necrolysis (desquamative skin disease), sweating, exfoliative dermatitis (redness, itching, hair loss) and acute generalized exanthematous pustular dermatitis (sudden rash accompanied by fever with the formation of Pustules or lesions on the surface of the skin characterized by being small, inflamed, pus-filled and blister-like), small red spots on the skin (petechiae), itching (pruritus).
• joint pain, muscle pain,
• need to urinate at night (nocturia), increased number of times you need to urinate (polyuria),
• increase in the volume of the breasts in men (gynecomastia), alterations in sexual function,
• trouble walking,
• elevation of the creatine phosphokinase enzyme (CPK) in blood tests, weight gain.

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