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Diltiazem
Diltiazem remains an extraordinarily useful calcium blocker and relative of amlodipine. Diltiazem possesses additional properties beyond controlling hypertension. It reduces the force of contraction and slows the heart rate. As a result of these actions the heart uses less oxygen which translates into improvement in both exercise related angina and chest pain occurring at rest or variant angina.
In addition Diltiazem reduces the rate of contractions of the ventricle in atrial fibrillation without actually converting the rhythm to normal. Diltiazem also improves other atrial rhythm disturbances including supraventricular tachycardia or SVT.
The side effect profile of Diltiazem seems quite mild. Adverse reactions tend to be infrequent and include occasional swelling of the legs, minor headache and at times dizziness or subnormal blood pressure. Nausea, vomiting and constipation occur even with placebo therapy.
Diltiazem interacts with other medicines especially those that lower the heart rate. Special cautions are necessary with clonidine and beta blockers such as propranolol. Combining amiodarone and Diltiazem leads to potentially life threatening consequences. Simvastatin - Zocor - blood levels rise dramatically when co-administered with Diltiazem. In these circumstances the maximum dose of simvastatin dose should not exceed 10 mg.
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