Generic Tiazac Cd

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 CONSEQUENCES OF PHYSICAL ACTIVITY
Reduces arterial stiffness
Large-artery compliance is increased (decreased stiffness) immediately after an acute exercise bout. Moreover, 4 weeks of moderate aerobic exercise has been shown to increase large-artery compliance in young normotensive, but previously sedentary subjects. On the other hand, sedentary individuals have reduced large-artery compliance, i.e., stiffer vessels, than do endurance-trained counterparts. Aerobic fitness, total cholesterol, and LDL-cholesterol were all found to be significant independent physiological correlates of central arterial stiffness in healthy females varying in age and physical activity status.

Reduces ischemia and injury
Physical activity also appears to exert an acute protective effect in heart muscle. A single 30-minute bout of running by rats on a treadmill conferred a cardioprotective effect on the myocardium that resulted in a limitation of infarct size 24 hours later. Pharmacological inhibition of protein kinase С activation during the exercise period abrogated this protective response. Exercise has also been shown to reduce ischemia/reperfusion injury to the heart of rats by up-regulating tumor necrosis factor (TNF-B), interleukin 1 (IL-1B), and manganese-superoxide dismutase (Mn-SOD), all of which are known to be cardioprotectants. Mn-SOD is an intrinsic radical scavenger, while TNF and IL-1 are inducers of Mn-SOD.

Reduces atherosclerosis
Physically active primates have a lower incidence of atherosclerosis. Although serum total cholesterol was the same (approximately 600 mg/dl) in exercising and non-exercising monkeys on an atherogenic diet, the physically active monkeys, even on this diet, had significantly higher HDL cholesterol and much lower triglyceride and LDL plus VLDL triglyceride levels. Ischemic electrocardiographic changes, angiographic signs of coronary artery narrowing, and sudden death were observed only in physically inactive monkeys, in which post-mortem examination revealed marked coronary atherosclerosis and stenoses. Physical activity was associated with substantially reduced overall atherosclerotic involvement, lesion size, and collagen accumulation. The physically active monkeys also had much larger hearts and wider coronary arteries, further reducing the degree of luminal narrowing. Thus, moderate-intensity physical activity significantly prevents or retards CHD in primates.
*4/282/5*
CARDIO & BLOOD

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