Cardizem

The dosage of Cardizem depends on the condition being treated and the formulation (immediate-release or extended-release). Typical dosages include:

• Immediate-release tablets: 30-120 mg, taken 3-4 times daily.
• Extended-release capsules: 120-360 mg, taken once daily.

The dosage is individualized based on the patient’s condition and response to treatment.

• For off-label uses:
• Pulmonary hypertension: 120-360mg per day.
• Anal fissure: 2% ointment applied topically.

Cardizem is contraindicated in patients with:

• Severe low blood pressure (hypotension).
• Certain heart conditions, such as sick sinus syndrome, and 2nd or 3rd-degree AV block (unless the patient has a pacemaker).
• Heart failure with reduced ejection fraction, may worsen the condition.
• Hypersensitivity to diltiazem or any components of the formulation.

Patients using Cardizem should be advised to:

• Take the medication exactly as prescribed and not stop taking it abruptly, as this may worsen heart conditions.
• Avoid drinking grapefruit juice while taking Cardizem, as it can interfere with the metabolism of the drug and increase its concentration in the blood, leading to potential side effects.
• Monitor blood pressure regularly and report any signs of low blood pressure (such as dizziness or fainting).
• Be aware of the potential for interactions with other medications, particularly those affecting heart rate or blood pressure, including beta-blockers and digoxin.
• Inform their healthcare provider if they experience any new or worsening chest pain, swelling in the legs or feet, or shortness of breath.

• Dizziness or lightheadedness
• Fatigue
• Nausea
• Flushing
• Swelling of the hands or feet (peripheral edema)
• Headache

• Low Blood Pressure (Hypotension): Symptoms include dizziness, fainting, or blurred vision.
• Bradycardia (Slow Heart Rate): This may cause fatigue, shortness of breath, or fainting.
• Heart Failure: Symptoms include swelling in the legs or ankles, shortness of breath, or rapid weight gain.
• Liver Dysfunction: Signs include yellowing of the skin or eyes (jaundice), dark urine, or severe abdominal pain.

Bradycardia and Hypotension: Cardizem can cause a significant drop in heart rate and blood pressure, particularly in patients already on medications like beta-blockers or digoxin. Patients should be monitored regularly for these effects.

Heart Failure Worsening: In patients with heart failure and reduced ejection fraction, Cardizem may worsen symptoms. Its use should be avoided in this population.

Liver Function: Diltiazem can elevate liver enzymes, and liver function should be monitored periodically in patients using this medication long-term.

Cardizem may interact with other medications, including:

• Beta-Blockers: The combination of Cardizem and beta-blockers (e.g., atenolol, metoprolol) can increase the risk of low heart rate (bradycardia) and low blood pressure (hypotension).
• Digoxin: Cardizem can increase digoxin levels, leading to toxicity.
• Grapefruit Juice: Grapefruit juice can inhibit the metabolism of diltiazem, increasing its concentration in the blood and the risk of side effects.
• Statins: Diltiazem can increase the risk of statin-associated muscle damage (rhabdomyolysis), especially with simvastatin and atorvastatin.

Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.

Alternative treatments for hypertension, angina, and heart rhythm disorders include:

• Other Calcium Channel Blockers: Such as amlodipine or nifedipine, which work similarly to diltiazem but may have different side effect profiles.
• Beta-Blockers: Such as metoprolol or propranolol, which reduce heart rate and blood pressure.
• ACE Inhibitors: Such as lisinopril, used to treat high blood pressure and heart failure.
• Angiotensin II Receptor Blockers (ARBs): Such as losartan or valsartan, used to treat high blood pressure.