Diltiazem

General Toxicity Notes
Headache, edema, flushing, dizziness.
Excreted Unchanged %
<5
Half-Life (Normalesrd) Hours
3-4.4/No change
Plasma Protein Binding %
75-81
Volume Of Distribution L/Kg
2.1-4.5
Dose For Normal Renal Function
180-240 mg q24h
Second Dose
Second Dose: 180-480 mg q24h
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
100% [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: None, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: None, [A]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50,titrate, [D]
References
Buckley MM, Grant SM, Goa KL, McTavish D, Sorkin EM. Diltiazem. A reappraisal of its pharmacological properties and therapeutic use. Drugs. 1990; 39: 757-806. [PMID: 2191851] / Patel R, Lipper B, Schwartzbard A, Nelson C, O&#146; Connor MA, Frishman W. Toxic effects of diltiazem in a patient with chronic renal failure. J Clin Pharmacol. 1994; 34: 273-4. [PMID: 8021338] / Pozet N, Brazier JL, A&#239; ssa AH, Khenfer D, Faucon G, Apoil E, et al. Pharmacokinetics of diltiazem in severe renal failure. Eur J Clin Pharmacol. 1983; 24: 635-8. [PMID: 6873142] / Storstein L, Larsen A, Midtb&#248; K, Saevareid L. Pharmacokinetics of calcium blockers in patients with renal insufficiency and in geriatric patients. Acta Med Scand Suppl. 1984; 681: 25-30. [PMID: 6587753]
Toxicity Notes
Acute renal dysfunction; may exacerbate hyperkalemia. May increase digoxin and cyclosporine levels. For IV, initial dose 0.25 mg/kg over 2 min. Second dose 0.35 mg/kg over 2 min. May follow with IV infusion of 5mg/hr increasing in 5 mg/hr increments to maximum 15 mg/hr for 24 hr.