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Conversion from immediate-release to extended-release diltiazem in angina pectoris
P E Pool1, U Thadani, A B Miller
1North County Cardiology Research Laboratory, Encinitas, California.
Clinical Cardiology
|September 1, 1994
Summary
Converting patients with chronic stable angina from immediate-release to extended-release diltiazem is effective. Direct conversion to the same or next higher dose of extended-release diltiazem reduces angina and nitroglycerin use.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic stable angina requires effective long-term management.
- Immediate-release diltiazem is a common treatment.
- Transitioning to extended-release formulations can improve adherence and efficacy.
Purpose of the Study:
- To evaluate the effectiveness of converting patients from immediate-release to extended-release diltiazem.
- To determine optimal conversion strategies for diltiazem formulations.
Main Methods:
- A multicenter, open-label, single crossover study involving 195 patients.
- Patients were converted from immediate-release to extended-release diltiazem (mg-for-mg or to the next higher dose).
- Evaluated weekly angina episodes, nitroglycerin use, exercise testing, and ambulatory electrocardiographic monitoring.
Main Results:
- Statistically significant decrease in angina frequency and nitroglycerin consumption with extended-release diltiazem.
- Insignificant increase in exercise tolerance and significantly lower end-exercise blood pressure and heart rate.
- Total ischemic duration and episodes were insignificantly lower with extended-release formulation.
Conclusions:
- Direct conversion to the same or next higher dose of extended-release diltiazem is a reasonable strategy for managing symptomatic coronary artery disease.
- This conversion effectively reduces angina symptoms and medication use.
- Adverse reactions were comparable between formulations.