Diltizem SR (Diltiazem 90mg) Tablets

Diltizem general information

What is Diltizem used for?

Cardiovascular disease covers a range of heart and circulation problems, including hypertension (high blood pressure), heart failure, and angina.  Coronary artery disease (CAD) is the most common form of heart disease.  It is the narrowing of blood vessels that supply the heart due to clogged arteries.  Angina is a symptom of CAD, and if it gets worse, CAD can result in a heart attack.  If CAD is not treated, this can lead to heart failure, where the heart muscle becomes weakened and cannot pump efficiently.  Diltizem tablets 90mg are used for long-term treatment of chronic stable angina that has persisted for some time.  They are also used to treat mild to moderate arterial hypertension.

Chronic stable angina

Narrowing of the arteries is also known as atherosclerosis and is caused by a build-up of plaque, which is fatty deposits, mainly cholesterol.  Clogged arteries restrict blood flow to the heart, and the heart muscle becomes starved of oxygen.  However, because the arteries are not blocked entirely, angina does not permanently damage the heart.  Angina pectoris is one of the first signs that your heart is not getting enough oxygen.  Symptoms of angina include chest pain, tightness or heaviness across the chest, and a feeling of discomfort like indigestion.  This condition is known as chronic stable angina, and symptoms can be triggered by any form of exertion or emotional stress.  Chronic stable angina is a warning sign that you are at increased risk of a more serious heart problem such as a heart attack.  Coronary artery spasm is a sudden tightening of the muscles in the artery wall, which temporarily cuts off the blood supply to your heart.  Coronary artery spasm causes angina symptoms but does not last long.  Diltizem tablets 90mg relieve symptoms of chronic stable angina and angina caused by coronary artery spasm, and prevent the condition from getting worse.  Diltizem tablets 90mg are also used to treat exercise-induced chronic and persistent angina.  However, they are not suitable for treating unstable or acute angina, which is when symptoms can develop when you are at rest, and they usually last for longer. 

High blood pressure

Blood pressure is determined by the force of your heart pumping blood around the body, and the resistance of the artery walls to the blood being pumped through the circulation.  Two blood pressure measurements indicate whether your blood pressure is within the normal range.  Systolic pressure measures the force generated by the heart contracting with each heartbeat as it pumps blood out into the arteries.  Diastolic pressure is the resting phase between each heartbeat when the heart muscle relaxes and the heart fills with blood.  When your blood pressure is measured, it is expressed as systolic pressure (the highest measure) over diastolic pressure (the lowest measure). 

If the arteries become narrowed or constricted, this increases their resistance to blood flow, and more force is needed to pump blood around the body.  The extra strength of the blood against artery walls due to narrowing causes systemic hypertension, which is high blood pressure when your body is relaxed and at rest.  High blood pressure puts a strain on the heart by increasing its workload and its need for more oxygen.  The extra force of blood in the circulation can damage blood vessels, especially smaller blood vessels, such as those in the kidneys, leading to kidney damage.  Hypertension also increases the risk of cardiovascular disease, including stroke and heart attack.  There are usually no symptoms of hypertension, so you will only know if you have high blood pressure by having a check. 

Risk factors for high blood pressure include smoking, a high-fat diet, high blood cholesterol, obesity, lack of exercise, too much alcohol; also, some health conditions like kidney disease, diabetes, or a heart condition.  Sometimes, there is no known cause of hypertension.

Arterial hypertension

Arterial hypertension, also known as pulmonary hypertension, is caused by the narrowing of arteries in the lungs.  Narrow pulmonary arteries make it more difficult for the heart to pump blood through the lungs to be oxygenated, and the right side of the heart must work harder.  Pulmonary arterial hypertension differs from systemic hypertension, which is high blood pressure due to narrowing in arteries taking blood away from the heart to the rest of the body.  Unlike systemic hypertension, pulmonary hypertension has symptoms including chest pain, dizziness, shortness of breath, heart palpitations, and oedema (fluid retention), causing swelling of the ankles, legs, and abdomen.

How does Diltizem work?

Diltizem tablets 90mg contain diltiazem, a calcium channel blocker that is used to treat chronic stable angina, and arterial hypertension. 

Calcium is needed for the contraction of smooth muscle in artery walls (vasoconstriction) and the heart muscle (myocardium).  Diltiazem in Diltizem tablets 90mg works by inhibiting calcium ions flowing into smooth muscle cells across specific calcium channels in their cell membranes.  If these calcium channels are blocked, the smooth muscle cells cannot contract as strongly, which allows arteries to relax and widen (vasodilation). 

Widening of the main arteries of the heart, increases the oxygen supply to the heart, which reduces the heart’s workload and demand for oxygen.  As the heart recovers its oxygen supply, the heart rate and systemic blood pressure are also reduced.  Increasing the oxygen supply to the heart means that the heart does not need to work so hard to pump blood, which improves your exercise tolerance.  Now you can exercise without getting so breathless. You will also find that Diltizem tablets 90mg relieve other symptoms of angina like chest pain. 

Widening of the pulmonary arteries helps the heart pump blood through the lungs and reduces the strain put on the heart by having to work harder.  Reduced resistance to blood flow increases the oxygen supply to the rest of the body, which relieves symptoms of pulmonary arterial hypertension.

Diltizem tablets 90mg are formulated for sustained continuous release, and they are effective for 12 hours.

What does Diltizem contain?

Diltizem tablets 90mg contains the active ingredient diltiazem hydrochloride, a calcium channel blocker used to treat chronic stable angina and arterial hypertension. 

What are the side effects of Diltizem?

Most medications have some side effects, but they are not experienced by everyone.  Some side effects are commonly experienced when taking Diltizem tablets 90mg, but others are not so common, and you should discuss any problems or concerns with your primary care physician. 

Common side effects when taking Diltizem include headache, dizziness, gastrointestinal upset with nausea, vomiting and constipation, oedema (swelling of the ankles, feet, face or hands), arrhythmia (palpitations), fatigue, rash.

When should Diltizem not be used?

Have a talk with your primary healthcare physician before taking Diltizem tablets 90mg so that you have a full understanding of what this medicine is for and how to use it.  There are some reasons for not taking a medication; these are called contraindications, and for Diltizem you should consider the following before taking Diltizem:

• Have you ever had an unusual reaction or an allergy when taking Diltizem?
• Are you pregnant or breastfeeding?
• Do you have any problems with your kidneys or your liver?
• Do you have certain types of abnormal heart rhythm like sick sinus syndrome?
• Do you have heart problems including, congestive heart failure, left ventricular failure or myocardial infarction with pulmonary congestion?
• Do you have hypotension (low blood pressure)?

What medications interact with Diltizem?

Some medicines interact with Diltizem tablets 90mg and may affect the way it works, or are affected by Diltizem or increase side effects; you should discuss possible interactions with your primary care physician.  These may include cimetidine for reflux, digoxin for heart failure, the immunosuppressant cyclosporine, the antiepileptic carbamazepine, nitrates for heart conditions, statins for high cholesterol like simvastatin, theophylline for asthma, benzodiazepines like diazepam for anxiety, lithium for mood disorders, the antiarrhythmic amiodarone, corticosteroids like methylprednisolone. 

If other medications may interact with Diltizem, your doctor will discuss these with you. 

How should Diltizem be taken and for how long?

You should take your Diltizem tablets 90mg swallowed whole with a glass of water, twice daily, morning and evening, with or without food.  The dose you take and for how long should be as recommended by your doctor.  If required, your doctor may increase your dose. 

Missed dose of Diltizem

If you miss a dose of Diltizem tablets 90mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Diltizem be stored?

You should store your Diltizem tablets 90mg below 25°C in a cool dry place and away from direct sunlight.