Diltiazem Stella 60mg Treatment and prevent angina (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Diltiazem hydrochlorid
Ingredient Angina

Ingredient

Composition information	Content
Diltiazem hydrochlorid	60mg

Uses

Indications

Diltiazem 60 drugs are indicated for treatment and prophylaxis.

Pharmacokic

diltiazem is a calcium channel blocker under the derivative of benzothiazepin. The drug restricts the intrusion of calcium slow channels into the cell and thus reduces the release of calcium from the reserve in the mesh. This leads to a reduction in the number of calcium available in cells, reducing the consumption of oxygen of the heart muscle.

The drug increases exertion and improves all the indicators of ischemia in patients with angina.

Diltiazem relaxes coronary artery large and small and reduces the spasm of atrophic lenses (prinzmetals) and responds to catecholamine but has little effect on peripheral blood vessels. Therefore, there is no ability to reflect tachycardia. The mitigation of heart rate along with an increase in cardiac supply helps improve myocardial perfusion and makes the ventricle work less.

In animal studies, diltiazem protects myocardial resistance against the effects of ischemia and reduces damage due to excessive calcium to myocardial cells during reproduction.

pharmacokinetics

absorption: Diltiazem is absorbed almost completely through the gastrointestinal tract after drinking but being metabolized through the liver for the first time, leading to about 40%bioavailability. The peak concentration of plasma is achieved after about 3-8 hours of taking 1 dose of the drug, depending on the form of preparation.

Distribution: about 80% of diltiazem binds to plasma proteins. The drug is secreted into breast milk.

Metabolism: The drug is metabolized in the liver, mainly by Cytochrom P450 Isoenzyme CYP3A4; One of the metabolites, DesacethyLliltiltiazem, has an activity of 25-50% compared to Diltiazem.

Diltiazem waste time is about 3-8 hours, depending on the form of preparation.

Elimination: About 2-4% of the dose is excreted into urine in the form of constant and the rest is excreted into the bile and urine in the form of metabolites.

diltiazem and its metabolites are less likely to be separated.

Before taking Diltiazem Stella 60mg Treatment and prevent angina (3 blisters x 10 tablets)

How to use

Diltiazem 60mg is used by oral. Take medicine with a glass of water before meals, intact tablets, do not chew, break, crush.

Dosage

Adults:

The usual dose is a 60 mg 3 times/day. However, the patient's response may change and the need for dosage may vary significantly between patients. If necessary, the dose can be increased to 360 mg/day. Higher doses of up to 480 mg/day have been beneficial in some patients, especially in unstable angina. There is no evidence of reducing effectiveness in these high doses.

Elderly and patients with liver or kidney function:

The recommended starting dose is a tablet of 60 mg x 2 times/day. Should measure the heart rate regularly for these patients and should not increase the dose if the heart rate drops to less than 50 beats/minute.

Children:

Safety and efficiency in children have not been set up. Therefore, it is not recommended to use Diltiazem for children.

Note:

The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose?

Symptoms

Most patients who take diltiazem overdose will lead to hypotension after about 8 hours of medication. Slow heartbeat and atrial hobby from degree 1 to degree 3, can lead to cardiac arrest.

Diltiazem waste time after overdose is about 5.5-10.2 hours.

Treatment

If the patient comes early: need to wash the stomach and drink activated carbon to reduce the ability to absorb Diltiazem.

In case of hypotension can transmit calcium gluconate and dopamine, dobutamin or isoprenalin. In case the patient has a bradycardia and a high -level atrial atrial block may use atropine, isoprenalin. If failure may have to put the pacemaker.

What to do when forgetting a dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Side Effects

When using Diltiazem 60mg, you may experience unwanted effects (ADR).

Very common (ADR ≥ 1/10)

Body: peripheral edema.

Common (1/100 ≤ ADR Neurological: headache, dizziness. tolerance.

Mental: Stress, insomnia 1/1000)

Digestive: dry mouth.

skin: urticaria. Thu). Ban, diverse roses (including Stevens - Johnson syndrome and toxic skin necrosis syndrome), sweating, flaking dermatitis, acute overseas pustules syndrome, sometimes skin flaky skin has or no fever.

In a few cases, some liver enzymes can be seen (SGOT, SGPT, Gamma GT, LDH) and alkaline phosphatase with symptoms similar to acute hepatitis.

Therefore, it is necessary to monitor the parameters of the liver regularly. Especially when using high doses and/or a history of heart disease, slow rhythm, conduction disorders (atrial or atrial sinus block), hypotension, chest drum and heart failure may occur. Doctors need to monitor regularly, handle depending on the symptoms (see overdose and handle).

Warnings

Before using 60mg Diltiazem, you need to read the instructions carefully and refer to the information below.

Contraindicated

Diltiazem 60mg contraindicated drug in the following cases:

Hypersensitivity to diltiazem or any ingredients of the drug.

Sinus activity disorders.

Atrial atrial block level 2 and level 3.

left ventricular failure accompanied by pulmonary congestion.

Slow heart rate below 50 beats/minute.

breastfeeding women.

Simultaneously used with infusion dantrolen.

Combined with Ivabradin.

Patients with severe blood pressure (systolic blood pressure below 90mmHg).

Patients with acute myocardial infarction and pulmonary congestion on lung X-ray.

Precautions when used

Need to closely monitor patients with decline in left ventricular function, slow heart rate (serious risk) or atrial atrial block of degree 1 or prolonged PR interval detected on electrocardiograms (serious risks and rarely completely blocking).

Increased plasma diltiazem levels can be seen in elderly and patients with renal or liver. Be careful to adhere to the contraindications, caution and closely monitoring, especially the heart rate when starting treatment.

In case of general anesthesia, anesthetic must be notified to the diltiazem. The reduction of contractions, transmission and automatic heart and blood vessels due to anesthetic can be increased by calcium channel blockers.

Diltiazem treatment may be related to temperament changes, including depression.

It is important to recognize the relevant symptoms early, especially in patients. In such a case, it is advisable to consider stopping the drug.

diltiazem has the effect of inhibiting bowel motility. Therefore, caution should be used for patients at risk of intestinal progression.

Need to monitor carefully for patients with potential or clear diabetes due to the ability to increase blood glucose.

The ability to drive and operate machinery

affect the ability to drive and operate machinery: Based on the harmful reaction report of the drug such as dizziness, sleeping chicken (common), can change the ability to drive and operate machinery. However, no research has been conducted.

Pregnancy and lactation

Pregnancy:

There are very little data from the use of diltiazem for pregnant women. Diltiazem has been shown to have reproductive toxicity in some animals (rats, rats, rabbits). Therefore, Diltiazem is not recommended for pregnant women, as well as in women who are likely to be pregnant without using effective contraception.

Breastfeeding period:

diltiazem is excreted through breast milk and does not know the effect that can occur with breastfed babies, so do not breastfeed during medication.

Drug interaction

anti -arrhyths: Diltiazem has anti -arrhythmia properties, so it should not be used in combination with other anti -arrhythmic drugs because they increase the adverse effects on the heart due to coordination.

When used in combination with diltiazem with carbamazepin, ciclosporin and theophylin, diltiazem increases the concentration of these drugs in the blood. Therefore, the dose should be adjusted during coordination and after the coordination.

H2 receptor antagonistic drugs: When using cimetidine or ranitidine simultaneously with diltiazem, these drugs increase the concentration of diltiazem in plasma.

Anti -epileptic drugs: Diltiazem can increase the toxicity of carbamazepin.

Diltiazem can be used safely with beta blockers, diuretics, enzyme inhibitors and other hypertension drugs; But when using these drugs, patients need to be monitored regularly.

Alpha blockers: When concurrent alpha receptor blockers with diltiazem (eg Prazosin) need to closely monitor arterial blood pressure, because combining these two drugs can cause co -effects to reduce blood pressure of the patient.

dantrolen (infusion): The atrial fibrillation is often observed in animals when using intravenous tract simultaneously Verapamil and Dantrolen. Therefore, it can be dangerous when using simultaneously antagonists and dantrolen.

Ivabradin: Contrain to be contraindicated with Ivabradin due to the effect of reducing the combined heart rate of diltiazem with Ivabradin.

Amiodaron, Digoxin: Increasing the risk of slow heart rate; Be careful when combined with diltiazem, especially in adults and when using high doses.

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

Phenytoin: When used simultaneously with phenytoin, diltiazem may increase the level of phenytoin in plasma.

Acetylsalicylate: Because of the increased risk of bleeding due to the potential plus effect on platelet aggregation, be careful when using simultaneously acetylsalicylate with diltiazem.

X -ray contrast: Cardiovascular effects (such as hypotension) can increase in patients treated with diltiazem when intravenous injection quickly an ionized X -ray contrast. Especially cautious in patients with simultaneous use of diltiazem and X -ray contrast.

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

Lithi: The risk of increasing lithium toxicity.

diltiazem is metabolized by CYP3A4. There is a moderate increase (

Patients using grapefruit juice should be monitored the increase of the unwanted effects of the diltiazem. Grapefruit juice should be avoided if there is suspicion of interaction. Diltiazem is also a CYP3A4 inhibitor.

Concentrated with other CYP3A4 substrates can lead to an increase in plasma concentrations of combined medication. Simultaneous use of diltiazem with a CYP3A4 induction can lead to a decrease in plasma diltiazem concentration.

Statin: Diltiazem is a CYP3A4 inhibitor and significantly increases the AUC of some statins.

The risk of muscle disease and muscle pattern increases due to simultaneous use of diltiazem with statin transformed by CYP3A4 (eg Atorvastatin, Fluvastatin, and Simvastatin). Statin dose adjustment may be necessary. When possible, the recommendation of statin is not metabolized by CYP3A4 (for example pravastatin) with diltiazem.

benzodiazepin (Midazolam, Triazolam): Diltiazem significantly increases the concentration of Midazolam and Triazolam in plasma and prolongs the sale time. Special care should be taken care of patients who use diltiazem when prescribing benzodiazepin short metabolized effects by CYP3A4.

corticosteroid (methylprednisolon): diltiazem may increase methylprednisolon levels (through CYP3A4 inhibition and can inhibit P-Glycoprotein). Patients should be monitored at the beginning of treatment with methylprednisolon. Methylprednisolone adjustment is necessary.

Anesthesia: Calcium channel blockers are capable of increasing the inhibition of myocardial contraction, transmission, automatic properties as well as vasodilation of anesthetic drugs. The careful dose should be adjusted for anesthesia and calcium channel blockers when used simultaneously.

Bospiron: When used simultaneously, diltiazem can increase the effect and increase the toxicity of the bullire. Adjusting the next dose may be necessary during simultaneous use with diltiazem, and should be based on clinical assessment.

Clonidin: Slow sinus rhythms leading to hospitalization and pacemaker have been reported related to the use of clonidin simultaneously with diltiazem. Monitor heart rate in patients with simultaneous use of diltiazem and clonidin.

quinidine: Diltiazem significantly increases AUC (0 → ∞), the time to sell and reduce the oral clearance of quinidine is 51%, 36%and 33%. Monitor the unwanted effects of quinidine and adjust the dose accordingly.

Storage

Leave a cool place, avoid light, temperature below 30⁰C.

To be out of reach of children.

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