Generic Cartia

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

ANTIARRHYTHMIC AGENTS
Optimal therapy of cardiac arrhythmias requires documentation, accurate diagnosis, and modification of precipitating causes, and if indicated, proper selection and use of antiarrhythmic drugs. These drugs are classified according to their effects on the action potential of cardiac cells and their presumed mechanism of action.
Class I: Local anesthetics or membrane-stabilizing agents that depress phase 0.
IA (quinidine, procainamide, disopyramide) - Depress phase 0 and prolong the action potential duration.
IB (tocainide, lidocaine, phenytoin, mexiletine) - Depress phase 0 slightly and may shorten the action potential duration. Although arrhythmia is not a labeled indication for phenytoin, it is commonly used in treatment of digitalis-induced arrhythmias.
IС (flecainide, encainide, propafenone) - Marked depression of phase 0. Slight effect on repolarization. Profound slowing of conduction. Encainide was voluntarily withdrawn from the market, but is still available on a limited basis.
Moricizine - Moricizine is a Class I agent that shares some of the characteristics of the Class IA, B, and С agents.
Class II (propranolol, esmolol, acebutolol): Depress phase 4 depolarization.
Class III (bretylium, amiodarone): Produce a prolongation of phase 3 (repolarization).
Class IV (verapamil): Depress phase 4 depolarization and lengthen phases 1 and 2 of repolarization.
Sotalol: Sotalol has both Class II (beta blocking) and III properties; Class III effects are seen at doses > 160 mg.
Digitalis glycosides (digoxin): Digitalis glycosides (digoxin) cause a decrease in maximal diastolic potential and action potential duration and increase the slope of phase 4 depolarization. Adenosine: Adenosine slows conduction time through the AV node and can interrupt the reentry pathways through the AV node.
Serum drug levels: Some antiarrhythmic drugs (e.g., quinidine) can produce toxic effects that can be easily confused with the symptoms for which the drug has been prescribed. Drug serum levels are important in evaluating toxic or sub-therapeutic dosage regimens of most of the antiarrhythmic drugs.
Proarrhythmic effects: Antiarrhythmic agents may cause new or worsened arrhythmias. It is essential that each patient be evaluated electrocardiographically and clinically prior to and during therapy to determine whether the response to the drug supports continued treatment.
CARDIO & BLOOD – CHOLESTEROL

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