Generic Name:

Diltiazem

Trade Name:

Cardizem

Actions:

Calcium Channel Blocker
Class IV antiarrythmic

Indications:

Atrial Fibrillation and Flutter
Paroxysmal Supraventricular Tachycardia

Administration Guidelines:

For continuous infusion:

Usual Dose and Route: Load: 0.25 mg/kg (approx. 15 to 20mg; maximum dose 25mg) direct IV Bolus over 2 minutes.
For inadequate response an additional 0.35mg/kg IV over 2min (app. 25 to 30mg) may be given 15 minutes after initial dose.

Maintenance: Start immediately after loading dose:
IV infusion: 10mg/hr (5mg/hr if hemodynamically unstable). Titrate by 2.5mg/hr every 0.5 to 2 hours to achieve desired heart rate; recommended maximum 30mg/hr.

Standard Concentration:

125mg (25ml) in 100ml IV fluid; final concentration is 1:1 (1mg/ml) ; in D5W or NS.

MICROINFUSION: 100 mg/50 ml (2mg/ml)

EW Standards

125mg (25ml) in 100ml IV fluid; final concentration is 1:1 (1mg/ml) ; in D5W or NS.

Special Considerations:

-Continuous monitoring of EKG and frequent measurement of blood pressure
-Defibrillator and code cart readily available

Contraindications:

-Sick sinus syndrome (except with ventricular pacemaker)
-2 nd or 3 rd degree AV block (except with ventricular pacemaker)
-Severe hypotension/Cardiogenic shock
-Atrial fibrillation/flutter with accessory bypass tract (WPW)
-Ventricular tachycardia
-IV Diltiazem and IV beta blockers should not be administered together or in close proximity (within a few hours).

Precautions:

Prolonged infusions (>72hours) are not recommended and should be used cautiously.

Adverse effects:

Hypotension
Asystole
Bradycardia
AV Block
Exacerbation of heart failure
Vasodilation (flushing)
Arrythmia (junctional rhythm or isorhytmic disassociation)