Mono Tildiem Lp (Diltiazem Hydrochloride)

• Diltiazem is used in cardiovascular conditions that involve elevated blood pressure or myocardial oxygen demand.
• Hypertension: lowers systemic blood pressure by reducing peripheral vascular resistance.
• Stable angina pectoris: alleviates chest pain by improving coronary blood flow.
• Chronic stable angina: decreases frequency of anginal episodes during daily activities.
• Atrial fibrillation rate control: slows ventricular response by reducing atrioventricular nodal conduction.

• Diltiazem is a non‑dihydropyridine calcium channel blocker that selectively inhibits L‑type calcium channels in cardiac myocytes and vascular smooth muscle. This inhibition reduces intracellular calcium influx, leading to decreased myocardial contractility, slowed sinoatrial and atrioventricular nodal conduction, and vasodilation of peripheral arteries, collectively lowering heart rate, blood pressure, and myocardial oxygen consumption.

Common Side Effects

• Headache: mild to moderate pain often occurring early in therapy.
• Flushing: transient warmth and redness of the skin.
• Peripheral edema: swelling of the lower extremities due to fluid accumulation.
• Dizziness: sensation of light‑headedness, especially when standing.
• Nausea: mild gastrointestinal upset.
• Fatigue: reduced energy levels.

Serious or Rare Side Effects

• Severe bradycardia: markedly slow heart rate requiring medical attention.
• Heart block: impaired electrical conduction through the atrioventricular node.
• Hypotension: dangerously low blood pressure with risk of syncope.
• Hepatic dysfunction: abnormal liver enzyme elevations.
• Allergic reactions: rash, itching, or anaphylaxis.
• Atrioventricular conduction disturbances: worsening of existing conduction defects.

• Before initiating therapy, consider the following precautions.
• Blood pressure monitoring: regularly assess to avoid excessive hypotension.
• Cardiac function assessment: evaluate for existing conduction abnormalities or heart failure.
• Hepatic impairment: adjust use in patients with liver disease.
• Avoid abrupt discontinuation: taper dose to prevent rebound hypertension.
• Concomitant beta‑blocker use: monitor for additive negative chronotropic effects.
• Store below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Diltiazem may interact with several medicines; review patient medication lists carefully.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase diltiazem levels.
• Beta‑blockers: combined effect can cause severe bradycardia or heart block.
• Digoxin: elevated digoxin concentrations and risk of toxicity.
• Antihypertensive combinations (e.g., ACE inhibitors, ARBs): may precipitate profound hypotension.
• Certain antiarrhythmics (e.g., amiodarone): heightened risk of conduction disturbances.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce therapeutic effect.
• Diuretics: electrolyte shifts can augment hypotensive response.
• NSAIDs: may blunt antihypertensive efficacy.
• Alcohol: additive central nervous system depression leading to dizziness.
• Grapefruit juice: can increase plasma concentrations of diltiazem.