Which Diltiazem?

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Which Diltiazem?

• June 2006

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There are 4 different formulations of diltiazem
and 9 different products
Plain
SR
CD
LA
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Plain Tablets Dilzem

• Release diltiazem immediately
• Usually administered THREE or FOUR times daily
  (only lasts 8 hrs)
• Must NOT be substituted for slow release
  preparations

30mg tablet
60mg tablet
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Sustained Release Capsules Dilzem SR

• Gelatin capsule filled with coated beads
• SR sustained release but not for 24 hours!
• Release diltiazem slowly over 12 to 16 hours
• Usually administered TWICE daily

SR 90mg capsule
SR 120mg capsule
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Controlled Delivery Capsules Cardizem CD

• Gelatin capsule filled with coated beads of
  differing thickness
• Release diltiazem slowly over 24 hours
• Usually administered ONCE daily

CD 120mg capsule
CD 180mg capsule
CD 240mg capsule
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Long Acting Tablets Dilzem LA

• Inner core of diltiazem surrounded by a porous
  membrane
• Release diltiazem slowly over 24 hours
• Usually administered ONCE daily

LA 180mg tablet
LA 240mg tablet
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Diltiazem Release Characteristics
Preparation Peak concentration Duration of action
Plain 30mg, 60mg tablets (Dilzem) 2-4 hours 8 hours
SR 90mg, 120mg (Dilzem SR) 2-8 hours 12 to 16 hours
CD 120mg, 180mg, 240mg (Cardizem CD) 10-14 hours (based on CD 360mg dose) 24 hours
LA 180mg, 240mg (Dilzem LA) 2-8 hours 24 hours
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Case

• Patient received one dose of ordinary release
  diltiazem 60mg
• Ward round, dose increased to 240mg daily
• No formulation specified on drug chart
• Nurse instructed to make up dose
• Patient received 60mg x 3 as one dose
• Patient transferred to ICU

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Summary

• Slow release preparations SR, CD, LA
• are not interchangeable - SR is a BD
  formulation
• must not be crushed
• Plain, ordinary release tablets must not be used
  to make up the difference
• Specify the formulation/brand name
• Eg Cardizem CD, Dilzem LA
• When changing formulation/brand
• consider the timing of the next dose