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Diltiazem. A reappraisal of its pharmacological properties and therapeutic use
M M Buckley1, S M Grant, K L Goa
1ADIS Drug Information Services, Auckland, New Zealand.
Insights
Diltiazem, a calcium antagonist, effectively treats angina, hypertension, and arrhythmias with a good safety profile. It also shows cardioprotective benefits, reducing cardiac events in myocardial infarction patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Diltiazem is a calcium antagonist used for cardiovascular conditions.
- Its efficacy and safety profile are well-established in treating angina and hypertension.
- It also demonstrates utility in managing supraventricular arrhythmias.
Purpose of the Study:
- To review the therapeutic applications and effects of diltiazem.
- To evaluate its role in various ischemic heart diseases and arrhythmias.
- To assess its cardioprotective potential and adverse effect profile.
Main Methods:
- Literature review of clinical studies and pharmacological data on diltiazem.
- Analysis of diltiazem's efficacy in treating stable, variant, and unstable angina pectoris.
- Evaluation of its impact on systemic hypertension, supraventricular tachycardia, and atrial fibrillation/flutter.
Main Results:
- Diltiazem is effective for angina, hypertension, and supraventricular arrhythmias with a favorable safety profile.
- Rare adverse effects include atrioventricular block, potentially increased with beta-blockers.
- Intracoronary diltiazem shows cardioprotective effects; long-term use reduces cardiac events post-myocardial infarction.
Conclusions:
- Diltiazem is a well-tolerated, effective first-line or alternative treatment for ischemic heart disease, hypertension, and arrhythmias.
- It possesses potential cardioprotective properties, limiting ischemia-induced myocardial damage.
- Its broad therapeutic applications and favorable profile support its continued use in cardiovascular medicine.
Abstract:
Diltiazem is a calcium antagonist effective in the treatment of stable, variant and unstable angina pectoris and mild to moderate systemic hypertension, with a generally favourable adverse effect profile. It is also effective in terminating supraventricular tachycardia and in controlling the ventricular response to atrial fibrillation/flutter. Atrioventricular block, the risk of which may be exacerbated by concomitant beta-adrenoceptor antagonist therapy, occurs rarely as an adverse effect of diltiazem treatment. Diltiazem appears to exert complex cardioprotective effects which have been of benefit after intracoronary administration to patients undergoing coronary angiography and bypass procedures. In addition, long term diltiazem treatment has produced a significant reduction in subsequent cardiac events in patients with non-Q wave myocardial infarction. Thus, diltiazem is an effective and well-tolerated first-line or alternative treatment of patients with ischaemic heart disease, systemic hypertension, and supraventricular arrhythmias, with possible potential in limiting ischaemia-induced myocardial damage.