Transcript Which Diltiazem ? - Health Quality & Safety

Which Diltiazem?
June 2006
There are 4 different formulations of
diltiazem and 9 different products
Plain
SR
CD
LA
Plain Tablets – Dilzem®
•Release diltiazem
immediately
30mg tablet
•Usually administered THREE
or FOUR times daily (only lasts
~ 8 hrs)
•Must NOT be substituted for
slow release preparations
60mg tablet
Sustained Release Capsules –
Dilzem SR®
• Gelatin capsule filled with
coated beads
SR 90mg capsule
• SR = sustained release but
not for 24 hours!
• Release diltiazem slowly
over 12 to 16 hours
• Usually administered TWICE
daily
SR 120mg capsule
Controlled Delivery Capsules –
Cardizem CD®
CD 120mg capsule
• Gelatin capsule filled with
coated beads of differing
thickness
• Release diltiazem slowly
over 24
hours
CD 180mg capsule
• Usually administered ONCE
daily
CD 240mg capsule
Long Acting Tablets – Dilzem LA®
LA 180mg tablet
• Inner core of diltiazem
surrounded by a porous
membrane
• Release diltiazem slowly over
24 hours
LA 240mg tablet
• Usually administered ONCE
daily
Diltiazem Release Characteristics
Preparation
Peak concentration Duration of action
Plain 30mg, 60mg 2-4 hours
tablets
(Dilzem)
~ 8 hours
SR 90mg, 120mg
(Dilzem SR)
~ 12 to 16 hours
2-8 hours
CD 120mg, 180mg, 10-14 hours
240mg (Cardizem (based on
CD)
CD 360mg dose)
~ 24 hours
LA 180mg, 240mg
(Dilzem LA)
~ 24 hours
2-8 hours
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
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