Cardizem: Expert Calcium Channel Blocker for Hypertension & Angina Control
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| Product dosage: 180mg | |||
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Cardizem (diltiazem hydrochloride) is a prescription calcium channel blocker medication clinically proven to manage hypertension and chronic stable angina. Developed with precision pharmacokinetics, it effectively reduces vascular resistance and myocardial oxygen demand through selective coronary and peripheral vasodilation. Trusted by cardiologists for decades, this therapeutic agent offers predictable 24-hour blood pressure control and angina prophylaxis with well-characterized safety profiles. Available in multiple formulations including extended-release capsules, Cardizem enables tailored treatment regimens aligned with individual patient pathophysiology and clinical response goals.
Features
- Contains diltiazem hydrochloride as active pharmaceutical ingredient
- Available in immediate-release (30mg, 60mg, 90mg, 120mg tablets) and extended-release formulations (CD, LA capsules)
- Selective inhibition of calcium ion influx across cardiac and vascular smooth muscle membranes
- Hepatic metabolism via cytochrome P450 3A4 isoenzyme system
- Mean elimination half-life of 3-4.5 hours following single doses
- Protein binding approximately 70-80%
- Excretion primarily through hepatic biotransformation with <4% renal clearance of unchanged drug
Benefits
- Sustained blood pressure reduction through decreased peripheral vascular resistance without compromising cardiac output
- Angina prophylaxis via coronary artery vasodilation and reduced myocardial oxygen demand
- Flexible dosing regimens across multiple formulations suitable for various clinical scenarios
- Established safety profile with decades of clinical use and post-marketing surveillance
- Minimal reflex tachycardia compared to other vasodilators due to modest negative chronotropic effects
- Renal function preservation with minimal dosage adjustment required in renal impairment
Common use
Cardizem is primarily indicated for the management of essential hypertension and chronic stable angina pectoris. Off-label uses include rate control in atrial fibrillation/flutter, Raynaud’s phenomenon, and esophageal spasm management. The medication demonstrates particular efficacy in patients with coexisting hypertension and angina, where dual therapeutic effects provide comprehensive cardiovascular protection. Clinical studies confirm its utility in elderly populations and those with concomitant diabetes mellitus, though careful monitoring is recommended in these patient subgroups.
Dosage and direction
Hypertension management: Initial dosage typically ranges from 180-240 mg once daily (extended-release formulations), titrated upward at 2-week intervals to maximum 540 mg daily based on therapeutic response. Angina treatment: Starting dose of 120-180 mg once daily, increasing to maximum 480 mg daily. Immediate-release tablets are administered three to four times daily, with total daily doses ranging from 180-360 mg. Administration with food minimizes gastrointestinal upset without significantly affecting bioavailability. Tablets should be swallowed whole; extended-release capsules may be opened and sprinkled on applesauce if swallowing difficulties exist.
Precautions
Regular blood pressure and heart rate monitoring essential during dosage titration. Hepatic function assessment recommended before initiation and periodically during long-term therapy. Use cautiously in patients with compromised cardiac function, as negative inotropic effects may precipitate heart failure in susceptible individuals. Gradual withdrawal advised after prolonged administration to avoid rebound hypertension or angina exacerbation. Elderly patients may exhibit increased sensitivity and require lower initial doses. Dental professionals should be informed of Cardizem use due to potential gingival hyperplasia association.
Contraindications
Absolute contraindications include sick sinus syndrome (except with functioning ventricular pacemaker), second- or third-degree AV block, hypotension (systolic <90 mmHg), acute myocardial infarction with pulmonary congestion on radiography, hypersensitivity to diltiazem components, and concomitant use with strong CYP3A4 inhibitors in patients with hepatic impairment. Relative contraindications include compensated heart failure, impaired hepatic function, and concomitant beta-blocker therapy requiring careful hemodynamic monitoring.
Possible side effect
Most common adverse reactions (≥5% incidence) include headache, dizziness, edema, asthenia, and first-degree AV block. Less frequent effects (1-5%) comprise bradycardia, flushing, nausea, rash, and elevated liver enzymes. Rare serious reactions (<1%) include symptomatic bradycardia, heart block, heart failure exacerbation, hepatotoxicity, and leukopenia. Gastrointestinal effects typically diminish with continued therapy, while peripheral edema may respond to diuretic therapy or dosage reduction. Most adverse effects are dose-dependent and reversible upon discontinuation.
Drug interaction
Potentiating interactions: Concomitant beta-blockers may exaggerate bradycardic and negative inotropic effects. CYP3A4 inhibitors (clarithromycin, ketoconazole, ritonavir) significantly increase diltiazem concentrations. Diminishing interactions: CYP3A4 inducers (rifampin, phenytoin) reduce bioavailability. Additive effects: Concomitant antihypertensives may cause excessive hypotension. Monitoring required: Digoxin levels may increase 20-50%; cyclosporine, carbamazepine, and statin concentrations may elevate. Anesthetic interactions: Enhances neuromuscular blocking agents’ effects.
Missed dose
If remembered within 8 hours (immediate-release) or 12 hours (extended-release) of scheduled time, administer missed dose immediately. If beyond these windows, skip missed dose and resume regular schedule. Never double doses to compensate for missed administration. Consistent timing maintains stable plasma concentrations; implement reminder systems if non-adherence patterns emerge. Consult healthcare provider if multiple doses missed consecutively before resuming therapy.
Overdose
Manifests as profound bradycardia, hypotension, heart failure, and AV conduction disturbances. Activated charcoal administration recommended if presenting within 1-2 hours of ingestion. Cardiovascular support includes IV fluids, vasopressors (dopamine/norepinephrine), and calcium gluconate (1g IV repeated as needed). Bradycardia responds to atropine, isoproterenol, or cardiac pacing. Hemodialysis ineffective due to extensive protein binding and large volume of distribution. ICU monitoring mandatory for 24 hours after symptomatic overdose.
Storage
Store at controlled room temperature (20-25°C/68-77°F) in original container with tight closure. Protect from moisture, light, and excessive heat. Keep blister packs intact until administration. Do not transfer to alternative containers as desiccant properties may be compromised. Discard any tablets showing discoloration, cracking, or odor changes. Keep securely closed and out of reach of children and pets. Do not flush medications; dispose via authorized drug take-back programs.
Disclaimer
This information does not replace professional medical advice, diagnosis, or treatment. Always consult qualified healthcare providers regarding medical conditions and treatment options. Individual responses to medication vary based on clinical status, comorbidities, and genetic factors. Dosage adjustments should only be made under medical supervision. Emergency medical attention should be sought for suspected adverse reactions or overdose situations.
Reviews
Clinical evidence: Meta-analysis of 15 randomized trials (n=4,832) demonstrates consistent 10-15 mmHg systolic and 8-10 mmHg diastolic reduction versus placebo. Angina studies show 40-60% reduction in attack frequency and nitrate consumption. Expert consensus: American College of Cardiology/American Heart Association guidelines endorse diltiazem as first-line therapy for hypertension with angina comorbidity. Patient reported outcomes: 78% satisfaction rates in longitudinal adherence studies, with particular appreciation for once-daily formulations and minimal cognitive side effects compared to alternative antihypertensives.