Cardizem 30: Managing Angina, Hypertension, and Arrhythmias

Cardizem 30 (Diltiazem Hydrochloride) is a prescription medication used for the prophylaxis and treatment of chronic stable (classical) and vasospastic angina pectoris. It can also be used alone or in combination with other agents for the management of hypertension (high blood pressure). Additionally, Cardizem is effective in treating conditions such as myocardial infarction (heart attack), coronary artery spasm, certain arrhythmias, Raynaud's phenomenon, oesophageal motility disorder, and migraine.

For sustained-release formulations of Cardizem, the primary indications are the prophylaxis and treatment of angina pectoris (classical and vasospastic) and the management of essential hypertension. It's also used for the prophylaxis of some selected supraventricular tachyarrhythmias. 

How Cardizem Works (Pharmacology)

Cardizem contains Diltiazem Hydrochloride, which is a calcium channel antagonist. It primarily works by inhibiting the influx of calcium ions into vascular smooth muscle and cardiac muscle cells. This action leads to several beneficial effects: 

• Antianginal Action: Diltiazem directly dilates coronary arteries and arterioles, increasing oxygen supply to myocardial (heart muscle) tissues. Furthermore, it dilates peripheral vasculature, which reduces systemic pressure (cardiac "afterload"), thereby lessening the stress on the heart and reducing its oxygen requirements. 
• Antiarrhythmic Action: By inhibiting calcium ion influx in cardiac tissues, Diltiazem slows electrophysiological activity through the sino-atrial (S-A) and atrioventricular (A-V) nodes. This helps to regulate heart rhythm without affecting accessory bypass conduction or altering normal atrial action potential or intraventricular conduction. 
• Antihypertensive Action: Diltiazem reduces peripheral vascular resistance due to its vasodilatory effects, leading to a decrease in blood pressure. 

More than 90% of an oral dose is rapidly absorbed, with peak plasma concentrations typically reached within 30-60 minutes. It is highly protein-bound, metabolized in the liver, and primarily excreted (60%) through bile. 

Key Indications & Benefits

• Chronic Stable (Classical) Angina Pectoris: Prevents and treats chest pain due to exertion. 
• Vasospastic Angina Pectoris: Addresses chest pain caused by coronary artery spasms. 
• Hypertension: Manages high blood pressure, alone or in combination. 
• Myocardial Infarction: Used in the context of heart attacks. 
• Coronary Artery Spasm: Relieves spasms in heart arteries. 
• Arrhythmias: Effective for certain irregular heart rhythms, particularly supraventricular tachyarrhythmias (with sustained release formulation). 
• Raynaud's Phenomenon: Helps manage symptoms of this circulatory condition. 
• Oesophageal Motility Disorder: Addresses issues with food movement through the esophagus. 
• Migraine: Used for migraine prophylaxis. 

Always consult a registered physician for medication use.

Dosage & Administration

The dosage of Cardizem should be individualized based on patient response. 

Film-Coated Formulation (Cardizem 30mg likely refers to this):

• Usual Dose: The usual dose of Diltiazem Hydrochloride film-coated tablet is 60 mg thrice daily. 
• Titration: Patient response may vary. Dosage may be started as 30 mg four times daily and increased at 1 to 2-day intervals until the optimum response is achieved. If necessary, the divided dose may be increased to 180-300 mg/day. Higher doses up to 480 mg/day have been used with benefit in some patients, especially in unstable angina. 
• Elderly and Patients with Impaired Hepatic or Renal Function: The recommended starting dose is 60 mg twice daily. The heart rate should be measured regularly, and the dose should not be increased if the heart rate falls below 50 beats per minute. 

Sustained Release Formulation:

• Mild to Moderate Hypertension: Initially 90 mg or 120 mg twice daily (elderly once daily); up to 360 mg daily may be required (elderly up to 240 mg daily). 
• Angina: Initially 90 mg or 120 mg twice daily; up to 360 mg daily may be required (elderly up to 240 mg daily). 

Always consult a registered physician for medication use.

Important Considerations & Warnings

It is crucial to discuss your full medical history with your doctor before taking Cardizem. 

Contraindications: Diltiazem Hydrochloride sustained release tablet is contraindicated in patients with: 

• Known hypersensitivity to the drug. 
• Sick sinus syndrome. 
• Second or third-degree AV block (unless a functional ventricular pacemaker is present). 
• Severe hypotension. 
• Acute myocardial infarction with radiographically documented pulmonary congestion. 
• Overt heart failure. 

Side Effects: Commonly reported side effects include: 

• Bradycardia (slow heart rate) 
• Sino-atrial block
• Atrioventricular block
• Hypotension
• Malaise (general discomfort) 
• Headache
• Hot flushes
• Gastrointestinal disturbances
• Edema (swelling) 
• Hepatitis (liver inflammation) 
• Depression

Interactions:

• Nitrates: Concomitant prophylactic therapy with short- or long-acting nitrates may be administered safely during diltiazem therapy. 
• Other Cardiac Medications: Use caution and careful dosage titration when diltiazem is administered concomitantly with other drugs that can affect cardiac contractility and/or conduction, such as other beta-blockers, certain calcium antagonists (e.g., verapamil), or antiarrhythmic agents (e.g., disopyramide). Combined use can lead to severe hypotension, bradycardia, and cardiac failure, particularly in patients with impaired ventricular function or conduction abnormalities. 
• Digoxin: Diltiazem can increase digoxin levels. 
• Cyclosporine: Diltiazem can increase cyclosporine levels. 
• Beta-blockers: Concomitant use with beta-blockers can increase the risk of bradycardia, AV block, and heart failure. 

Pregnancy & Lactation:

• Pregnancy: There are no adequate and controlled studies with diltiazem in pregnant women. The drug should be used during pregnancy only when the potential benefits justify the possible risk to the fetus.
• Lactation: Diltiazem is distributed into breast milk. Women receiving the drug should not breastfeed their infants. An alternative method of infant feeding should be used if diltiazem therapy is considered necessary in nursing women. 

Storage Conditions

Keep below 30°C temperature, away from light and moisture. Keep out of the reach of children.