Bidizem 60 Bidiphar drug prevents and treats long -term angina (3 blisters x 10 tablets)

ATC code: C05AE03

Pharmacological and mechanism of action:

diltiazem reduces calcium passing through calcium channels into smooth muscle and heart muscle cells selectively. This reduces the in intracellular calcium concentration as a protein active agent. This activity of the diltiazem leads to the expansion of coronary arteries, causing an increase in oxygen supply to the heart muscle. It reduces heart activity by adjusting the heart rate and reducing blood vessel resistance, thus reducing oxygen demand.

When the diltiazem is used alone or in common with the beta blocker, the mitigating myocardial spasm is reported in patients with conservation function.

Dynamic pharmacokinetics

absorption: Diltiazem is absorbed quickly and almost completely through the digestive tract after drinking, but first metabolized through strong liver.

Distribution: Bioions are reported about 40% despite the significant difference in plasma concentrations in individuals.

About 80% of diltiazem associated with plasma proteins.

Metabolism: Diltiazem fast metabolism in the liver, one of the metabolites, Diltiazem Desacetyl has been reported with 25 - 50% of the activity of the original drug.

Elimination: The sale time is reported for about 3-5 hours.

About 2-4% of the dose is excreted in urine in a constant form and the rest is discharged in the form of metabolites in bile and urine.

Notify the physician with unwanted effects when using the drug.

Caution when using

Patients with rare genetic problems are galactose intolerance, Lapp lactase deficiency, or absorbent glucose-galactose should not take this drug.

It is necessary to closely observe patients with reduced left ventricular function, slow heart rate (severe risk) of prolonged PR interval, or atrial atrial block detected on electrocardiograms (more serious risk and rarely blocking).

Before the whole body anesthesia, anesthetic must be notified of the continuous diltiazem treatment. The decline in heart contraction, transmission and automatic, as well as vascular expansion related to anesthesia can be enhanced by calcium channel blockers.

Increased plasma diltiazem concentration may be observed in the elderly and patients with renal impairment or liver failure. Contraindications and caution should be carefully observed and closely monitored, especially heart rate, which should be conducted at the beginning of treatment.

Calcium channel blockers, such as diltiazem, may be related to mood changes, including depression.

Like other calcium antagonists, diltiazem has the effect of inhibiting bowel motility. Therefore, it is advisable to use diltiazem carefully in patients at risk of developing intestinal obstruction.

The effect of the drug on the ability to drive and operate machinery

Common reactions such as dizziness, discomfort can images the ability to drive and use machinery. However, no research has been conducted.

Do not drive or operate the machine when encountering the above symptoms.

Using drugs for women during pregnancy and lactation

There is very little data from the use of diltiazem in pregnant patients. Diltiazem has been shown to have reproductive toxicity in animals (rats, rats, rabbits). Therefore Diltiazem is not recommended during pregnancy, as well as in women who are likely to not use effective contraception.

diltiazem is excreted in low concentrations. You should avoid breastfeeding while taking this medication. If using diltiazem is considered necessary, should use another method of feeding instead of breastfeeding.

Drug interaction

Contraindicated simultaneously:

Dantrolen (transmission): The deadly vibration is often observed in animals when used simultaneously Verapamil intravenously and dantrolen. Therefore, there is a potential danger when combining a calcium antagonist with dantrolen.

Contraindications to simultaneously with Ivabradin due to increased effect on the heart rate of diltiazem.

Precautions when used simultaneously:

Lithium: The risk of increasing lithium nerve toxicity.

Nitrate derivatives: increase the effect of lowering blood pressure and lightheadedness (vasodilation effect): In all patients treated with calcium antagonistic drugs, the prescription of nitrate derivatives should only be performed at an increasing dose.

Theophylllin: Increases the concentration of theophyllin in the blood.

Alpha receptor antagonists: simultaneously treated with alpha receptor resistance agents that can produce or worsen hypotension. The combination of diltiazem with Alpha receptor antagonist should only be considered under strict blood pressure monitoring.

Amiodaron, Digoxin: Increases the risk of slow heart rate: Caution should be careful when they are combined with diltiazem, especially in the elderly and when using high doses. In general with other calcium antagonists, diltiazem can cause an increase in plasma digoxin levels.

Beta blockers: The likelihood of arrhythmia (clear bradycardia, slow sinus rhythm), atrial, atrial and heart failure disorders (synonymous effects). Such a combination is only used under clinical monitoring and tight ECG, especially at the beginning of treatment.

The blood concentration of beta blockers with low bioavailability (eg propranolol) may be increased and observed a slight increase in the concentration of cardiac glycosides.

Other anti -arrhythmic drugs: Because the diltiazem has anti -arrhythmia properties, single -handedly simultaneously with other anti -arrhythmic drugs are not recommended (the risk of increased cardiovascular side effects). This combination should only be used under clinical monitoring and ECG.

Carbamazepin: Increased blood carbamazepine levels: recommend carbamazepin in plasma carbamazepine concentration and should be adjusted if necessary.

Rifampicin: The risk of decreased plasma diltiazem after starting treatment with rifampicin: Patients should be carefully monitored when starting or stopping Rifampicin treatment.

H2 receptor antagonists (cimetidin, ranitidine): Increased plasma diltiazem concentration. Patients who are being treated with diltiazem should be carefully monitored when starting or stopping treating H2 antagonistic drugs. Dendiazem daily dose adjustment may be necessary.

ciclosporin: Increases blood ciclosporin levels: recommends reducing dosage ciclosporin, monitoring kidney function, determining ciclosporin levels in the blood and adjusting willow when combined and after stopping.

General information

Due to the potential of side effects, it is necessary to adjust the dose carefully in patients using diltiazem simultaneously with other drugs that affect heart contraction and/or conduction.

diltiazem is metabolized by CYP3A4. A moderate increase (less than 2 times) plasma diltiazem concentration in case of use simultaneously with a stronger CYP3A4 inhibitor has been recorded. Diltiazem is also a CYP3A4 isomer inhibitor. Simultaneously used with other CYP3A4 substrates can lead to an increase in plasma concentrations of two combined medications. Simultaneous use of diltiazem with a CYP3A4 induction can lead to a decrease in plasma diltiazem concentration.

Benzodiazepin (Midazolam, Triazolam): Diltiazem significantly increases the plasma concentrations of Midazolam and Triazolam and prolongs their waste selling time. Special care should be performed when prescribing benzodiazepin medications shortened by CYP3A4 in patients using Diltiazem.

corticosteroid (methylprednisolon): inhibit the metabolism of methylprednisolon (CYP3A4) and inhibit P-Glycoprotein:

Patients should be monitored at the beginning of methylprednisolon treatment. Methylprednisolone adjustment is necessary.

Statin: diltiazem is a CYP3A4 inhibitor and has been shown to significantly increase the AUC of some statins. The risk of muscle and muscle diseases is still caused by metabolic statins because CYP3A4 can be increased when used simultaneously with diltiazem. When possible, a non -metabolic statin is used through CYP3A4 should be used with diltiazem, if not closely monitored the signs and symptoms of statin poisoning.

diltiazem increases the plasma concentration of imipramin and is capable of three -ring antidepressants.

Medications that increase liver microsom activity (such as phenobarbital, phenytoin) leads to a decrease in plasma diltiazem levels.

Diltiazem has been safely used in combination with diuretics. Recommendations regularly monitoring patients for use.

Diltiazem hydrochlorid treatment is continued without problems during anesthesia, but anesthetic doctors should be told that the patient is being used for calcium antagonists.

Ability to channel blockers can occasionally reduce glucose tolerance.

Cavalry of the drug: There is no information about the cavalry of the drug.