cardizem
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| Product dosage: 180mg | |||
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Cardizem, known generically as diltiazem, is a calcium channel blocker primarily prescribed for managing cardiovascular conditions such as hypertension, chronic stable angina, and certain arrhythmias like atrial fibrillation. It functions by inhibiting calcium ion influx across cardiac and vascular smooth muscle cell membranes, leading to vasodilation, reduced peripheral vascular resistance, and decreased myocardial oxygen demand. Available in immediate-release, extended-release, and intravenous formulations, Cardizem is a cornerstone therapy in cardiology, offering tailored treatment options based on individual patient needs and clinical scenarios.
Cardizem: Effective Cardiovascular Management and Rhythm Control - Evidence-Based Review
1. Introduction: What is Cardizem? Its Role in Modern Medicine
Cardizem, with its active ingredient diltiazem hydrochloride, belongs to the benzothiazepine class of calcium channel blockers. It’s widely utilized in clinical practice for its dual benefits in managing both blood pressure and cardiac rhythm disturbances. What is Cardizem used for spans across multiple cardiovascular domains, making it a versatile agent in both acute and chronic settings. Its significance lies in providing symptomatic relief and improving outcomes in patients with coronary artery disease and hypertension, addressing key pathophysiological mechanisms without significantly compromising cardiac contractility in most patients.
2. Key Components and Bioavailability Cardizem
The composition of Cardizem centers around diltiazem hydrochloride, available in various salt forms and release mechanisms. The immediate-release formulation typically contains 30-120 mg of active compound, while extended-release versions (Cardizem CD, LA) contain 120-540 mg with specialized delivery systems.
Bioavailability of Cardizem demonstrates considerable variation between formulations. Immediate-release tablets achieve approximately 40% absolute bioavailability due to extensive first-pass metabolism, primarily via cytochrome P450 3A4 enzymes. The extended-release formulations employ matrix technology that provides more consistent plasma concentrations over 24 hours, crucial for maintaining therapeutic effects in chronic conditions. Food can enhance bioavailability by up to 30% for some formulations, though this varies by specific product.
3. Mechanism of Action Cardizem: Scientific Substantiation
Understanding how Cardizem works requires examining its effects on calcium channels in vascular smooth muscle and cardiac conduction tissue. The medication selectively blocks L-type calcium channels, preventing calcium influx during depolarization. This inhibition produces coronary and peripheral vasodilation, reducing afterload and myocardial oxygen consumption - particularly beneficial in angina management.
In cardiac conduction, Cardizem demonstrates greater effect on nodal tissue (SA and AV nodes) than myocardial tissue, explaining its utility in supraventricular tachyarrhythmias. The mechanism involves prolonging AV nodal refractory periods and slowing conduction, effectively controlling ventricular rate in atrial fibrillation and flutter. Research confirms these dual cardiovascular effects make Cardizem particularly valuable in patients with coexisting hypertension and arrhythmias.
4. Indications for Use: What is Cardizem Effective For?
Cardizem for Hypertension
As monotherapy or combination treatment, Cardizem effectively reduces both systolic and diastolic blood pressure through decreased peripheral vascular resistance. The extended-release formulations provide 24-hour coverage, supporting consistent blood pressure control.
Cardizem for Chronic Stable Angina
By reducing myocardial oxygen demand and improving coronary blood flow, Cardizem decreases angina frequency and nitrate requirements. Multiple studies demonstrate improved exercise tolerance and reduced ischemic episodes.
Cardizem for Atrial Fibrillation and Flutter
The medication’s nodal blocking properties make it first-line for rate control in atrial arrhythmias, particularly when beta-blockers are contraindicated or poorly tolerated.
Cardizem for Vasospastic Angina
Though less common, Cardizem remains effective for Prinzmetal’s angina through coronary vasodilation, preventing vasospasm-induced ischemia.
5. Instructions for Use: Dosage and Course of Administration
Dosing must be individualized based on indication, formulation, and patient response. Here are evidence-based guidelines:
| Indication | Formulation | Initial Dose | Maintenance Range | Administration Notes |
|---|---|---|---|---|
| Hypertension | Cardizem CD | 180-240 mg | 240-480 mg daily | Once daily, may split doses >480 mg |
| Angina | Cardizem LA | 180 mg | 180-360 mg daily | Swallow whole, with or without food |
| AFib Rate Control | Immediate-release | 0.25 mg/kg IV | 5-15 mg/hr infusion | Monitor ECG during administration |
| Transition from IV | Oral | 60-120 mg TID | Adjust based on response | Overlap IV and oral by 1-2 hours |
The course of administration typically begins with lower doses, titrating upward every 1-2 weeks based on therapeutic response and tolerability. Elderly patients and those with hepatic impairment often require lower initial doses and slower titration.
6. Contraindications and Drug Interactions Cardizem
Cardizem carries specific contraindications including sick sinus syndrome (except with functioning pacemaker), second or third-degree AV block, hypotension, and acute myocardial infarction with pulmonary congestion. Safety during pregnancy requires careful risk-benefit assessment, as animal studies show potential fetal effects.
Significant drug interactions with Cardizem occur primarily with CYP3A4 substrates and inhibitors. Concomitant use with beta-blockers may produce additive bradycardia and conduction abnormalities. Statins, particularly simvastatin and lovastatin, require dose reduction due to inhibited metabolism. Cyclosporine, carbamazepine, and digoxin levels may increase substantially, necessitating monitoring and dose adjustment.
7. Clinical Studies and Evidence Base Cardizem
The effectiveness of Cardizem is supported by decades of clinical research. The DAVIT II trial demonstrated reduced reinfarction and mortality in post-MI patients with left ventricular dysfunction. Multiple hypertension studies confirm blood pressure reduction comparable to other antihypertensives with potentially favorable metabolic effects.
For arrhythmia management, the AFFIRM trial established Cardizem as equivalent to beta-blockers for rate control in persistent atrial fibrillation. Recent meta-analyses confirm its position as first-line therapy for this indication, with particular benefit in patients with reactive airway disease where beta-blockers are problematic.
8. Comparing Cardizem with Similar Products and Choosing a Quality Product
When comparing Cardizem with similar calcium channel blockers, several distinctions emerge. Unlike dihydropyridines (amlodipine, nifedipine), Cardizem provides significant nodal effects making it superior for arrhythmia management. Compared to verapamil, Cardizem typically causes less constipation and may have fewer negative inotropic effects.
Quality considerations extend beyond active ingredient to formulation technology. Branded Cardizem formulations employ patented delivery systems ensuring consistent release profiles. Generic equivalents must demonstrate bioequivalence, though some patients report variability between manufacturers. Choosing between products involves considering indication, cost, and individual response patterns.
9. Frequently Asked Questions (FAQ) about Cardizem
What is the recommended course of Cardizem to achieve results?
Therapeutic effects typically begin within hours for immediate-release formulations, though full antihypertensive benefits may require 2-4 weeks. Chronic therapy requires continuous administration with periodic reassessment.
Can Cardizem be combined with beta-blockers?
Concomitant use requires careful monitoring due to potential additive effects on heart rate and conduction. This combination may be beneficial in selected patients but increases risk of bradycardia and heart block.
How does Cardizem differ from other blood pressure medications?
Unlike ACE inhibitors or diuretics, Cardizem provides both vasodilation and heart rate control, making it particularly useful in patients with comorbid hypertension and arrhythmias.
What monitoring is required during Cardizem therapy?
Baseline and periodic ECG, blood pressure, heart rate, and liver function tests are recommended. Patients with heart failure require careful assessment for worsening symptoms.
10. Conclusion: Validity of Cardizem Use in Clinical Practice
Cardizem remains a validated, evidence-based therapy for multiple cardiovascular conditions. Its favorable risk-benefit profile, extensive clinical experience, and formulation versatility support continued first-line status for hypertension with comorbid conditions, angina, and arrhythmia management. The medication’s dual mechanisms provide unique advantages in complex patients, though careful patient selection and monitoring remain essential.
I remember when we first started using Cardizem extensively in our cardiology practice back in the early 2000s - we had this one patient, Margaret, 68-year-old with persistent AFib and moderate hypertension who’d failed beta-blockers due to asthma exacerbations. We started her on Cardizem CD 180mg, and honestly, I was skeptical about whether we’d achieve adequate rate control without compromising her BP management.
The first week was rocky - she reported some lightheadedness, and her home BP readings were inconsistent. Our team debated whether to push through or switch approaches. Dr. Chen wanted to add a diuretic immediately, but I argued we needed to give the dose adjustment more time. We compromised by having her check in daily for a week.
By week three, something clicked. Her ventricular rate settled into the 70s at rest, her systolic BP dropped from 160s to 130s, and she reported being able to walk her dog without palpitations for the first time in months. What surprised me was how much better she felt overall - the reduction in sympathetic tone seemed to help her sleep quality too.
We’ve followed Margaret for seven years now, with only minor dose adjustments. She sends Christmas cards every year updating us on her gardening - a small thing, but it reminds me why we stick with medications through the initial adjustment period. The longitudinal data bears this out too - in our clinic’s retrospective review, patients maintained on Cardizem had lower hospitalization rates for both arrhythmia and heart failure compared to other rate control strategies.
The real learning curve came with our heart failure patients though. We had a gentleman, Robert, early 60s with reduced EF and AFib where we probably were too aggressive with initial dosing. His BP bottomed out, and we had to back off and titrate much slower. Taught us that in marginal patients, sometimes starting with half the usual dose and using the extended-interval formulations gives better results despite what the guidelines might suggest.
These days, I find myself reaching for Cardizem more often than not in complex patients - the ones with multiple comorbidities where you need that balanced hemodynamic profile. The evidence continues to accumulate, but it’s the day-to-day patient experiences that really cement its place in our toolkit.