Generic Dilacor Cr

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

QUESTIONS ABOUT DRUGS USED TO LOWER CHOLESTEROL

Are Statins Effective at Preventing Death?
There is so much emphasis on cholesterol, and trying to lower it, that the big picture has been lost. Cholesterol is over rated, and it isn't the huge risk factor for heart disease that the drug companies would like us to believe. It is excessive inflammation and oxidized cholesterol that cause harm to our heart and result in death. The ultimate goal is to lower the incidence of death from heart disease, not to lower a particular number. What is the point of having a low cholesterol level when the drags you take to achieve this make you sick, and having low cholesterol puts you at risk of other diseases that can kill you or make your life miserable?
In order for a cholesterol lowering drug to be approved for sale by the FDA, a drug company must only prove that it lowers cholesterol levels; not necessarily that it reduces death from heart disease. Several long term studies have shown in patients taking statins, death rates from heart attacks do go down, but overall mortality stays the same for both groups. So the people who took statins died just as often as those who didn't, but from other causes. Statins reduce death from heart disease, but they usually don't reduce overall mortality.

If some Lipitor is good, more should be better?
A study published in the New England Journal of Medicine, called the TNT study analyzed 10 001 patients with established coronary heart disease (CHD) and an LDL "bad" cholesterol level less than 3.3mmol/ L. The purpose of the study was to find out if getting LDL cholesterol below currently recommended levels offers any benefits to patients with coronary heart disease. The study aimed to lower LDL cholesterol levels below 2.6mmol/L.
The participants were divided into two groups; one group was given l0 mg of atorvastatin (Lipitor), and the other received 80mg per day. The patients were followed for 4.9 years. Patients who took 80mg Lipitor got their LDL cholesterol down to an average of 2.0mmol/L, and those who took l0 mg had a mean LDL of 2.6mmol/L. The incidence of liver problems (raised liver enzymes) was six times higher in the group given 80mg of Lipitor. The total deaths due to cardiovascular causes were 126 in the 80mg group, and 155 in the l0 mg group. However, the total deaths due to other causes were 158 in the 80mg group, and 127 in the l0 mg group.
This means that more people died in the group taking a bigger dose of Lipitor! Clearly, if deaths due to coronary heart disease went down, but total deaths didn't, some other cause of death had to increase. Cancer accounted for more than half the deaths from non-cardiovascular causes in both groups of participants. However, the conclusion of this study did not mention that; it states that "intensive lipid-lowering therapy with 80mg atorvastatin (Lipitor) per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with l0 mg atorvastatin per day ". This study was funded by Pfizer (the drag company that makes Lipitor), and conducted by Pfizer sponsored scientists. There was no control group in this study; no group was given a placebo. The authors of the study stated that it would be unethical to have a placebo group, as it would deny people of the benefits of Lipitor!

*26/53/5*
CHOLESTEROL

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