DILTIAZEM (Cardizem)

Name:

DILTIAZEM (Cardizem^R)

• prolongs the refractory periods of the AV node and intranodal conduction
• provides temporary control of rapid ventricular rate in atrial fibrillation and atrial flutter, but rarely converts to normal sinus rhythm
• may provide rapid conversion of paroxysmal supraventricular tachycardias to sinus rhythm
• has been used as intracoronary injection to prevent vasospasm during coronary angioplasty
• used post radial artery coronary bypass graphs to prevent spasm

• Bolus:
  • 0.1-0.3mg/kg IV direct over 2 minutes
  • a subsequent dose of 0.35mg/kg may be administered after 15 minutes if the initial response is inadequate
• Infusion:
  • 5-10 mg/h immediately following direct injection
  • may be increased by 5 mg/h to a maximum of 15mg/h to achieve target
• Intracoronary: 
  • 1 mg

IV Infusion: 
dilute 125 mg in 100ml dextrose 5% or sodium chloride 0.9% (1 mg/ml)

• refrigerate unused vial

• hypotension, decreased SVRI
• decreased cardiac output
• arrhythmias
• bradycardia
• AV block
• prolonged QT 
• flushing
• dizziness
• dyspnea
• headache

• contraindicated in patients with hypotension, sick sinus syndrome, second and complete AV block, and in patients with acute myocardial infarction and pulmonary edema
• use cautiously in patients with AV conduction delays or transient sinus pauses

• diltiazem + beta blockers = decreased HR, CI and prolonged PR interval
• diltiazem + digoxin = increased digoxin plasma concentrations
• diltiazem + cyclosporin = increased cyclosporin plasma concentrations
• diltiazem + amiodardone = increased diltiazem plasma concentrations
• diltiazem + cisapride = prolonged QT with Torsades de Pointes

• continuous heart rate and rhythm
• PR interval and QT interval
• blood pressure
• urine output
• central or mixed venous oxygen saturation
• lacate
• breath sounds

• May be administered IV direct or by IV infusion by an approved nurse in CCTC.
• Continuous infusion must be administered via an infusion pump.
• Patient requires placement of an arterial line to monitor BP if intravenous infusion is used.