Generic Cartia Er

DILTIAZEM HCI
Tablets: 30, 60, 90 and 120 mg (Rx) Various, Cardizem (Marion Merrell Dow)
Capsules, sustained-release: 60, 90, 120, Various, Cardizem SR (Marion Merrell Dow)
180, 240, 300 and 360 mg (Rx) Cardizem CD (Marion Merrell Dow),
Dilacor XR (Rhone-Poulenc Rorer), Tiazac (Forest)
Injections: 25 mg (5 mg/50 mL),
50 mg (5 mg/mL) (Rx) Cardizem (Marion Merrell Dow)

Oral-
Tablets: Start with 30 mg 4 times/day before meals and at bedtime; gradually increase dosage to 180 to 360 mg (given in divided doses 3 or 4 times/day) at 1-to 2-day intervals until optimum response is obtained.
Sustained release:
Cardizem SR -Start with 60 to 120 mg twice daily. Adjust dosage when maximum antihypertensive effect is achieved (usually by 14 days chronic therapy). Optimum dosage range is 240 to 360 mg/day, but some patients may respond to lower doses.
Cardizem CD -
Hypertension: 180 to 240 mg once daily; some patients may respond to lower doses. Maximum antihypertensive effect is usually achieved by 14 days chronic therapy; therefore, adjust dosage accordingly. Usual range is 240 to 360 mg once daily; experience with doses > 360 mg is limited.
Angina: Start with 120 or 180 mg once daily. Some patients may respond to higher doses of up to 480 mg once daily. When necessary, titration may be carried out over a 7- to 14-day period.
Cardizem CD may be opened and administered, but do not crush.
Dilacor XR -
Hypertension: 180 to 240 mg once daily; adjust dose as needed. Individual patients, particularly those > 60 years of age, may respond to a lower dose of 120 mg. Usual range is 180 to 480 mg once daily. Although current clinical experience with the 540 mg dose is limited, the dose may be increased to 540 mg with little or no increased risk of adverse reactions. Do not exceed 540 mg once daily. Angina: Adjust dosage to each patient's needs, starting with a dose of 120 mg once daily, which may be titrated to doses of up to 480 mg once daily, when necessary, titration may be carried out over a 7- to 14-day period.
Hypertensive or anginal patients treated with other formulations of diltiazem can safely be switched to Dilacor XR at the nearest equivalent total daily dose. However, subsequent titration to higher or lower doses may be necessary and should be initiated as clinically indicated.
Administration in the morning on an empty stomach is recommended.
Parenteral -
Direct IV single injections (bolus): The initial dose is 0.25 mg/kg as a bolus administered over 2 minutes (20 mg is a reasonable dose for the average patient). If response is inadequate, a second dose may be administered after 15 minutes. The second bolus dose should be 0.35 mg/kg administered over 2 minutes (25 mg is a reasonable dose for the average patient). Individualize subsequent IV bolus doses. Dose patients with low body weights on a mg/kg basis. Some patients may respond to an initial dose of 0.15 mg/kg, although duration of action may be shorter.
Continuous IV infusion: For continued reduction of the heart rate (up to 24 hours) in patients with atrial fibrillation or atrial flutter, an IV infusion may be administered. Immediately following bolus administration of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) and reduction of heart rate, begin an IV infusion. The recommended initial infusion rate is 10 mg/hr. Some patients may maintain response to an initial rate of 5 mg/hr. The infusion rate may be increased in 5 mg/hr increments up to 15 mg/hr as needed, if further reduction in heart rate is required. The infusion may be maintained for up to 24 hours. Therefore, infusion duration > 24 hours and infusion rates > 15 mg/hr arc not recommended.
Concomitant therapy: Concomitant therapy with p-blockers or digitalis is usually well tolerated, but the effects of co-administration cannot be predicted, especially in patients with left ventricular dysfunction or cardiac conduction abnormalities. Use caution in titrating dosages for impaired renal or hepatic function patients, since dosage requirements are not available.
CARDIO & BLOOD – CHOLESTEROL

CARDIOVASCULAR DRUGS
Antianginals
The chest pain known as angina occurs when there is an insufficient supply of blood, and consequently of oxygen, to the heart. Antianginal drugs cause a sudden drop in blood pressure and cause an increased amount of oxygen to enter certain parts of the heart. They are used to relieve or prevent angina. Nitroglycerin is the most frequently prescribed antianginal. Calcium channel blockers (Isoptin, Calan) are often used to treat angina, but may also be used to lower blood pressure.

Antiarrhythmics
If the heart does not beat rhythmically or smoothly (a condition called arrhythmia), its rate of contraction must be regulated. Antiarrhythmic drugs, including Norpace, Pronestyl, and quinidine sulfate, prevent or alleviate cardiac arrhythmias. Dilantin (phenytoin), most frequently used as an anticonvulsant in the treatment of epilepsy, can act as an antiarrhythmic agent when it is injected intravenously.

Anticoagulants
Drugs that prevent blood clotting are called anticoagulants, or blood thinners. Anticoagulants fall into two categories.
The first category contains only one drug, heparin. Heparin must be given by injection; it is generally restricted to hospitalized patients.
The second category includes oral anticoagulants, principally derivatives of the drug warfarin. Warfarin may be used in the treatment of conditions such as stroke, heart disease, or abnormal blood clotting. It is also used to prevent the movement of a clot, which could cause serious problems. Use of warfarin after a heart attack is controversial. Some physicians believe that anticoagulants are not helpful beyond the first month or two following a heart attack.
Persons taking warfarin must avoid many other drugs (including aspirin), because interaction with the anticoagulant could cause internal bleeding. Patients taking warfarin should check with their pharmacist or physician before using any other medications, including over-the-counter products. They must have their blood checked frequently.

Antihypertensives
Briefly, high blood pressure, or hypertension, is a condition in which the pressure of the blood against the walls of the blood vessels is higher than what is considered normal. High blood pressure is controllable. Keeping it under control can help prevent other diseases, such as coronary heart disease. Drugs that counteract or reduce high blood pressure can effectively prolong a hypertensive patient's life.
Several different drug actions produce an antihypertensive effect. Some drugs block nerve impulses that cause arteries to constrict; others slow the heart's rate and force of contraction; others reduce the amount of a certain hormone in the blood that causes blood pressure to rise. The mainstay of antihypertensive therapy is often a diuretic, a drug that reduces body fluids. Examples of antihypertensive drugs include Catapres, Dyazide, Hytrin, Inderal, Lopressor, Minipress, Tenex, and Tenormin.

Antihyperlipidemics
Antihyperlipidemics are drugs used to reduce the cholesterol and triglycerides (fats) in the blood that form plaques on the walls of the arteries. This plaque formation can play a major role in the development of coronary heart disease by narrowing blood vessels and restricting the amount of oxygen-rich blood that reaches the heart. Anti-hyperlipidemic drugs are generally prescribed only after dietary therapy (usually for a minimum of six months) and lifestyle changes have failed to lower blood cholesterol to a desirable level. Even when lipid-lowering drugs are prescribed, dietary therapy must be continued. Examples of antihyperlipidemics include Questran, Mevacor, and Lopid.

Beta Blockers
Beta-blocking drugs block the response to nerve stimulation in order to increase blood flow, slow heart rate, and reduce blood pressure.
They are used in the treatment of angina (chest pain), hypertension (high blood pressure), and arrhythmias (irregular heartbeats). Propranolol (Inderal), Timolol (Blocadren), and Metoprolol (Lopressor) are examples of beta blockers.

Calcium Channel Blockers
Calcium-channel-blocking agents affect muscle contraction and nerve impulses in the heart. They dilate (expand) the coronary arteries and inhibit spasms, thus allowing greater amounts of oxygen to reach the heart. This, in turn, reduces angina (chest pain) and hypertension (high blood pressure). The slowing of nerve transmission helps to relieve arrhythmias (irregular heartbeats). Adalat, Calan, Cardizem, Isoptin, and Procardia are examples of calcium channel blockers.

Digitalis
Drugs derived from digitalis (Digoxin and Lanoxin) affect the heart rate but are not strictly antiarrhythmics. Digitalis slows the rate of the heart but increases the force of contraction. Thus, digitalis acts as both a heart depressant and a stimulant and may be used to regulate erratic heart rhythm or to increase heart output in heart failure.

Diuretics
Diuretic drugs, such as Bumex, Dyazide, Enduron, hydrochlorothiazide, HydroDIURIL, Lasix, and Lozol, promote the loss of water and salt from the body. They also lower blood pressure by causing blood vessels to expand. Because many antihypertensive drugs cause the body to retain sodium and water, they are often used concurrently with diuretics. Most diuretics act directly on the kidneys, but there are different types of diuretics, each with different actions. Thus, therapy for high blood pressure can be individualized for each patient's specific needs.
Thiazide diuretics are the most popular water pills available today. They are generally well tolerated and can be taken once or twice a day. Thiazide diuretics are effective all day, whereas some diuretics have a shorter duration of action. Patients do not develop a tolerance for the antihypertensive effects of these drugs, so the drugs can be taken for long periods.
A major drawback to Thiazide diuretics, however, is that they often deplete potassium. This depletion can be compensated for with a potassium supplement, such as K-Lor or Slow-K. Potassium-rich foods and liquids, such as bananas, apricots, and orange juice, can also be used to correct the potassium deficiency. Salt substitutes are also sources of potassium. Your doctor will direct you as to which source of potassium, if any, is appropriate for you.
Loop diuretics, such as Lasix or Bumex, act more vigorously than thiazide diuretics. They promote more water loss but also deplete more potassium.
To remove excess water from the body but retain its store of potassium, manufacturers developed potassium-sparing diuretics. Potassium-sparing diuretics are effective in the treatment of potassium loss, heart failure, and hypertension. Potassium-sparing diuretics have been combined with thiazide diuretics in medications such as Dyazide. Such combinations enhance the antihypertensive effect and reduce the loss of potassium. They are among the most commonly used antihypertensive agents.

Vasodilators
Vasodilating drugs cause the blood vessels to widen. They are used to treat stroke and diseases characterized by poor circulation.
CARDIO & BLOOD

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