Adult Dosing
Atrial Fibrillation or Atrial Flutter/Paroxysmal Supraventricular Tachycardia
- Loading dose: 0.25 mg/kg IV bolus administered over 2 mins, if inadequate response repeat 0.35 mg/kg IV bolus over 2 mins after 15 mins
- May follow with IV infusion of diltiazem at the rate 5-15 mg/hr for 24 hrs, may increase by 5 mg/hr increments up to 15 mg/hr as needed [Max: 15mg/hr, duration: 24 hrs]
Note:
- For IV infusion dilute diltiazem in dextrose (5%) injection, sodium chloride (0.9%) injection or dextrose (5%) and sodium chloride (0.45%) injection
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- As diltiazem prolongs AV nodal conduction and refractoriness, it can result in second- or third-degree AV block in sinus rhythm especially when used with agents known to affect cardiac conduction. Discontinue the drug and provide appropriate supportive measures if high-degree AV block occurs
- Use of diltiazem in patients with normal ventricular function and compromised myocardium, such as severe CHF, acute MI, and hypertrophic cardiomyopathy, have not shown a reduction in cardiac index nor consistent negative effects on contractility. Use cautiously in these patients
- Diltiazem hydrochloride injection causes hypotension, use cautiously in hemodynamically compromised patients and in patients taking other drugs that decrease peripheral resistance, intravascular volume, myocardial contractility or conduction
- Intravenous diltiazem can cause acute hepatic injury with significant elevations in enzymes such as alkaline phosphatase, LDH, SGOT, SGPT
- Ventricular premature beats can occur with diltiazem IV when used for conversion of PSVT to sinus rhythm. It is benign and have no clinical significance
- When employing continuous intravenous infusion, monitor ECG and BP continuously and a defibrillator and emergency equipment should be readily available
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Hemodynamically compromised patients
- Severe CHF
- Acute MI
- Hypertrophic cardiomyopathy
- Impaired ventricular function
Pregnancy Category:C
Breastfeeding: Limited data indicates, small amounts of diltiazem is ingested by the infant and would not be expected to cause any adverse effects in breastfed infants. This data is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 1 Feb 2011). As per manufacturer data diltiazem is excreted in human milk, if use of diltiazem is essential an alternative method of infant feeding should be instituted.
