Brand name: Dilzem

Generic name: Diltiazem

Indications: Angina pectoris including Prinzmetal’s angina, hypertension,
supraventricular tachyarrythmias and rapid ventricular rates in atrial flutter of
fibrillation.
Drug Classification: Calcium antagonist
Mechanism of action: Block calcium entrance into cardiac and vascular smooth muscle
cells by blocking the L-type voltage sensitive calcium channel which is
abundant in cardiac and smooth muscle. In smooth muscle, calcium binds to
calmodulin resulting in activating myosin light chain kinase, an enzyme that
phosphorylates the myosin light chain. This phosphorylation is essential for
muscle contraction, thus by decreasing calcium levels in the vascular smooth
muscle these agents lessen contraction.
In the heart, calcium binding to troponin removes the inhibitory effect of
troponin on the actin-myosin interaction thus allowing contraction. Thus,
blockade of the slow calcium channel by these agents can result in negative
inotropic effect.
Dosage: Angina pectoris, 90-360 mg daily in divided dosage. Hypertension, 180-360
mg/24 hr in divided doses.
Special Precaution: Impaired renal or hepatic function; heart failure
Pregnancy Risk Category: C
Adverse Reactions:
CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache,
nervousness, psychiatric disturbances, weakness
EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus
Resp: cough, dyspnea
CV: Arrythmias, CHF, peripheral edema, bradycardia, chest pain, hypotension,
palpitations, syncope, tachycardia
GI: abnormal function liver studies, anorexia, constipation, diarrhea, dry mouth,
dysgeusia, dyspepsia, nausea, vomiting
GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency
Derm: dermatitis, erythema multiforme, flushing, increased sweating,
photosensitivity, pruritus/ urticaria, rash
Endo: gynecomastia, hyperglycemia
Hemat: anemia, leucopenia, thrombocytopenia
(continuation Dilzem)
Metab: weight gain
MS: joint stiffness, muscle cramps
Neuro: paresthesia, tremor
Misc: Stevens- Johnson syndrome, gingival hyperplasia
Contraindications: sick sinus syndromes; 2nd or 3rd degree AV block; hypotension,
pregnancy acute MI
Form: Tablet- 30mg, 60mg, 90 mg, 120 mg
Nursing Responsibilities:
 Monitor BP & pulse before therapy, during titration, and periodically during
therapy. Monitor ECG periodically during prolonged therapy.
 Monitor intake & output ratios and daily weight.
 Angina: Assess location, duration, intensity, & precipitating factors of patient’s
anginal pain.
 Arrythmias: Monitor ECG continuously during administration. Monitor BP and
pulse before and frequently during administration.
 Monitor serum potassium and renal hepatic functions periodically.