Description overdue on 08.06.2012

Calcium channel blocker slow . The main ingredient is derived benzothiazepine. The drug has antiarrhythmic, antianginal and antihypertensive effects . Diltiazem reduces intracellular calcium in the smooth muscle of blood vessels in cardiac myocytes. The drug exerts a negative inotropic effect reduces heart rate, improves kidney, cerebral and coronary blood flow . Diltiazem causes dilation of small and large arteries, relaxation of smooth muscles of coronary vessels. Antianginal effect is to improve myocardial blood supply, lowering blood pressure, systemic vascular resistance, increase in diastolic relaxation time of the left ventricle, reducing the tone of the myocardium.   Antianginal effect suppression provided by calcium transport in the cardiac tissue, that causes an increase in the refractory time, the effective period of deceleration atrioventricular conduction . The drug has no effect on intraventricular conduction, normal atrial action potential. However, the speed and the speed of depolarization decrease with decreasing amplitude contractions of the atria. Perhaps shortening effective, anterograde refractory period of bypass, additional bundles of. For parenteral administration Diltiazem causes a rapid transition supraventricular paroxysmal tachycardia to sinus rhythm, temporarily stops the rapid ventricular rate at which developed atrial fibrillation and flutter. Antihypertensive effect of a decrease in systemic vascular resistance is provided, dilation of resistive vessels. The correlation of blood pressure reduction is performed in accordance with the baseline. Diltiazem reduces blood pressure in both horizontal and vertical positions. Rarely in patients receiving the drug observed reflex tachycardia , Postural hypotension. When you load Diltiazem slightly reduces the maximum rate of heart rate. Long-term treatment is not observed increased activity of the renin-angiotensin-aldosterone system, does not develop giperkateholaminemii. The medicament reduces peripheral and renal effects of angiotensin-2. In CHD, hypertension drug reduces platelet aggregation It has a positive effect on diastolic myocardial relaxation. On the smooth muscles of the gastrointestinal drug affects minimal. Tolerance does not develop even on long-term therapy. In patients with hypertension Diltiazem causes regression LVH Not affect the blood lipid profile. Diltiazem is available in tablet form, in the form of capsules.

Indications:

Diltiazem is prescribed after myocardial infarction, with diabetic retinopathy , Hypertension, Prinzmetal angina , Angina pectoris, for the prevention of coronary spasm during surgery (coronary artery bypass grafting, koronaroingiografiya). Intravenous drug is administered at supraventricular tachycardia , Paroxysmal tachycardia, atrial flutter, cupping paroxysmal atrial Arrhythmia , Hypertension in the pulmonary circulation.

Contraindications:

Diltiazem does not apply to atrioventricular block, severe course of hypertension, intolerance to the main substances in atrial fibrillation, atrial flutter, Lown-Ganong syndrome-Levine, WPW syndrome , SA-blockade breastfeeding. In renal failure, ventricular tachycardia with the expansion of the complex QRS, myocardial infarction with left ventricular failure, moderate arterial hypotension, cardiogenic shock, in CHF bradycardia , Severe aortic stenosis, atrioventricular block first degree, children and the elderly Diltiazem is prescribed with caution.

Side effect:

Nervous system: extrapyramidal disorders Parkinsonism, stiffness in the arms, legs, shuffling gait, mask-like face, depression, transient loss of vision, tremor, paresthesia, difficulty swallowing, fatigue, fatigue, fainting, headaches, anxiety, drowsiness, dizziness. Cardiovascular system:   asystole, bradycardia, arrhythmia, angina, ventricular fibrillation, ventricular flutter, tachycardia, development of heart failure, marked drop in blood pressure, atrioventricular block. Digestive system:   gingival hyperplasia, swelling, soreness and bleeding gums, increased levels of liver enzymes, diarrhea, constipation , Nausea, dry mouth, vomiting, giperkreatinemiya . Perhaps the development of Stevens-Johnson syndrome, erythema multiforme exudative, stridor, cough, shortness of breath, pulmonary edema, swelling of legs and feet, agranulocytosis, weight gain, galactorrhea.

Overdose:

Manifested asystole, cardiogenic shock , Heart failure, violation of atrioventricular conduction, drop in blood pressure, severe bradycardia. Requires gastric lavage, call artificial vomiting, appointment enterosorbents. With the development of bradycardia injected isoprenaline, atropine, heart failure diuretics dobutamine, dopamine, when the pressure is prescribed vasopressors, in severe bradycardia use pacemakers . Peritoneal dialysis and hemodialysis does not bring relief.

Mode of application:

As an anti-anginal and antihypertensive Diltiazem administered 3-4 times a day to 30 mg Dosage correction performed individually .  Elderly people, patients with liver disease, renal drug is administered twice a day to 30 mg .  Prolonged therapy form begins with 2 doses per day at 60-120 mg or 180-240 mg for once in 2 weeks following the correction of the dose per day is not more than 360 mg .  When long-term therapy with positive dynamics of every 3 months reduce dosage .  Tablets are advised to take before meals, drink water, do not chew, swallow whole .  If emergency treatment is administered intravenously Diltiazem .  For relief of supraventricular tachycardia shown intravenous 0, 25 mg / kg for two minutes under the control of heart rate, blood pressure .  In the absence of positive dynamics of re-injection is carried out after 15 minutes at 0, 35mg / kg .  The combination of 160 mg propranolol and 120 mg of diltiazem allows you to restore sinus rhythm .  The effect is recorded in half an hour .  For the prevention of supraventricular tachycardia shows the assignment of 240-360 mg per day .  Atrial flutter, constant flickering form Diltiazem administered in combination with a cardiac glycoside at a dose of 240 mg per day .  Hypertension in the pulmonary circulation: up to 720 mg per day .

Special instructions:

Older patients with bradycardia dosing of the drug is made with extreme caution. Prolonged intravenous infusion of diltiazem require regular monitoring of liver function, kidney function, pulse, blood pressure, dynamics ECG . Not recommended infusion at a rate of more than 15 mg per hour and lasting more than a day. The drug contributes to lengthening of PQ interval on the ECG. Upon completion of therapy is recommended a gradual reduction in dosage. In the case of the need for surgical treatment is mandatory warn anesthesiologist on the use of the drug with an indication of the dose. In the elderly Diltiazem increases the half-life. Patients with left ventricular failure   the risk of complications from the heart of the system is increased by 40%. The drug has no effect on mortality in pathologies of the cardiovascular system.

Drug Interactions:

Combination with quinidine, beta-blockers, cardiac glycosides , Antiarrhythmics considered potentially dangerous, causes a decrease in myocardial contractility with the formation of heart failure, atrioventricular conduction slowing, excessive bradycardia. Diltiazem may increase the bioavailability of the drug Propanolol. Quinidine, procainamide contribute to lengthening of the QT interval on an electrocardiogram. Thiazide diuretics, inhalation anesthesia and drugs that reduce blood pressure contribute to the strengthening of the hypotensive effect of the drug. Diazepam, phenobarbital and rifampicin   reduce the concentration of diltiazem in the blood, and cimetidine - increases. In some cases, both appointed   nitrates That does not cause adverse drug interactions. Diltiazem increases theophylline carbamazepine , Cyclosporine, digoxin, valproic acid, quinidine levels. With respect to general anesthetics there is a growing cardiodepressive impact. The preparations of lithium increase the neurotoxic effect of the drug (manifested by tinnitus, ataxia, nausea, diarrhea, vomiting). A solution of furosemide pharmaceutically compatible with Diltiazem drug solutions. Estrogens glucocorticosteroids Indomethacin, sympathomimetic drugs reduce the severity of the hypotensive effect.