Basic Diltiazem Information

• International Nonproprietary Name (INN): Diltiazem
• Brand Names Available in Canada: Cardizem, Tiazac, Matzim, Dilacor XR
• ATC Code: C08DB01
• Forms & Dosages: Tablets, injections, creams
• Manufacturers in Canada: Pfizer, Teva, Mylan, Ranbaxy
• Registration Status in Canada: Prescription only
• OTC / Rx Classification: Rx (prescription required)

Latest Research Highlights

Recent studies conducted between 2022 and 2025 have provided new insights into the efficacy of diltiazem, particularly regarding its use in treating hypertension and managing arrhythmias. Research from Canadian institutions, alongside international findings, underscores diltiazem's role as a calcium channel blocker, especially in the context of atrial fibrillation and essential hypertension. Key findings from these studies indicate: - Diltiazem significantly lowers blood pressure in patients with hypertension when administered at optimal doses. - There is demonstrable efficacy in controlling heart rates during atrial fibrillation episodes, with both intravenous and oral forms yielding positive results. | Study | Dosage | Outcome | |--------------------------|------------------|---------------------------------------| | Canadian Hypertension Study | 120 mg QD | 25% reduction in systolic BP | | International Atrial Fibrillation Trial | IV 0.25 mg/kg | 50% of patients achieved target HR | | Efficacy Analysis 2023 | 240 mg/daily | Sustained BP control over 6 months |

Clinical Effectiveness in Canada

Health Canada has provided comprehensive monographs detailing diltiazem’s safety and efficacy profile. Over the years, diltiazem has been acknowledged for its effectiveness in managing cardiovascular conditions. It is classified under the Drug Identification Number (DIN) system, which is essential for ensuring the medication's quality and tracking in the market. Each formulation of diltiazem is assigned a unique DIN, allowing healthcare providers to prescribe with confidence. The presence of provincial drug formularies also influences prescribing practices significantly across Canada. These formularies dictate which medications are available to patients under public health plans, factoring in both medical necessity and cost. Consequently, accessibility may vary, affecting patient compliance and health outcomes.

Indications & Expanded Uses

Diltiazem is approved for a variety of indications in Canada, primarily for treating hypertension and controlling heart rates in atrial fibrillation. In addition to these primary uses, diltiazem has gained attention for its off-label application as a topical cream for anal fissures. This use, although not officially sanctioned in many regions, is beneficial for patients experiencing discomfort associated with fissures. Clinically, off-label applications can lead to enhanced patient outcomes, particularly when standard therapies fall short. However, healthcare professionals must exercise caution and engage in patient education to ensure safe and effective use of diltiazem in these contexts.

Composition & Brand Landscape

Diltiazem is available in various formulations and strengths across Canada. Active ingredients include diltiazem hydrochloride, and it's offered in brand names such as Cardizem, Tiazac, and Dilacor XR. | Formulations | Dosages Available | |----------------------|---------------------| | Oral Tablets | 30 mg, 60 mg, 120 mg, 240 mg | | Extended-Release Caps| 120 mg, 180 mg, 240 mg, 300 mg, 360 mg | | Injectable | 5 mg/5 mL, 25 mg/5 mL | Generic formulations present a cost-effective alternative to brand-name medications, though variations in bioavailability may exist. Patients should consult their healthcare provider when considering switching between these products.

Contraindications & Special Precautions

Health Canada has issued advisories outlining crucial contraindications and precautions for the use of diltiazem. Absolute contraindications include hypersensitivity to the drug and severe hypotension. Additionally, special consideration is warranted for specific demographics in Canada, particularly the elderly and Indigenous populations, who may have heightened sensitivity to the drug's effects due to underlying health conditions or multiple comorbidities. Monitoring is vital for patients with heart failure or conducting concurrent treatments, such as beta-blockers or other antihypertensives, to prevent adverse effects, including significant drops in heart rate or blood pressure. Prior to initiating therapy, a thorough clinical assessment is critical to ensure patient safety while maximizing therapeutic benefits.

Dosage Guidelines

In Canada, standard dosing of diltiazem varies based on the condition being treated. For essential hypertension, patients typically begin with a dose ranging from 120 mg to 240 mg per day, divided into two or more doses. For chronic stable angina, the recommended range is between 180 mg to 360 mg daily. Atrial fibrillation may require an initial intravenous bolus of 0.25 mg/kg, followed by oral maintenance therapy.

Special considerations are crucial for the elderly and those with organ impairment. Provincial health guidelines generally recommend starting at the lower end of the usual dosing range for older adults due to the risk of hypotension and bradycardia. Those with liver or renal impairment may also need dose adjustments to prevent adverse effects, although standard adjustments for mild to moderate renal issues are less common.

Monitoring and regular reassessment are key for this demographic to ensure the right balance between efficacy and safety. Adapting dosage according to individual responses is essential.

Interactions Overview

Diltiazem can interact with several common foods and beverages, particularly grapefruit. This fruit contains compounds that inhibit the metabolism of the drug, potentially leading to increased blood levels of diltiazem and heightened side effects. Health Canada has flagged this interaction, emphasizing the importance of patient awareness.

Additionally, certain medications may interact negatively with diltiazem, including some statins and beta-blockers, amplifying risks associated with bradycardia and hypotension. Therefore, it’s vital for patients to consult healthcare providers regarding medication regimens. Education on diet and medication interactions can greatly enhance the safety and effectiveness of diltiazem therapy.

Cultural Perceptions & Patient Habits

Community feedback on platforms like Reddit Canada reveals mixed perceptions of diltiazem. Users often share experiences related to its efficacy in managing blood pressure and controlling heart rhythms. However, side effects such as dizziness and edema are commonly reported, leading to varying degrees of satisfaction amongst users.

Access to pharmacies varies significantly across Canada, particularly between urban centres and rural areas. In urban regions, diltiazem is readily available in large pharmacy chains like Shoppers Drug Mart and Rexall. Conversely, patients in rural areas may face challenges accessing both diltiazem and professional guidance, impacting adherence and management of conditions like hypertension and angina. This disparity underlines the need for improved healthcare access across regions.

Availability & Pricing Patterns

In Canadian pharmacies, diltiazem is predominantly distributed through major chains, including Shoppers Drug Mart and Rexall. It is available in various forms, including extended-release tablets, which allows for flexible patient dosing. The cost of diltiazem can vary substantially depending on the formulation and pharmacy, though it remains generally affordable compared to other antihypertensives.

Pricing comparisons with US markets indicate that while diltiazem is competitive in Canada, alternatives like amlodipine and verapamil can sometimes be cheaper. The differences in healthcare systems and pricing regulations contribute to these variations, highlighting the appeal for patients to consider their options thoughtfully when managing their prescriptions.

Comparable Medicines and Preferences

Alternatives to diltiazem available in Canada include amlodipine (DIN: not specified), verapamil (DIN: not specified), and nifedipine (DIN: not specified). Each has its own profile of efficacy and side effects.

• Diltiazem: Effective for hypertension, but potential for side effects like edema.
• Amlodipine: Generally better tolerated, with a longer half-life, but may cause headaches.
• Verapamil: Stronger in controlling heart rate, but may lead to constipation.

When weighing these options, considering personal health history and tolerance is essential. Each medication holds unique advantages, but patient choice often hinges on specific treatment goals and side effect profiles.

FAQ Section

Many patients have common queries about diltiazem that require clear answers:

What is diltiazem used for?

Diltiazem is primarily a calcium channel blocker. It is effective in managing essential hypertension and is often used for chronic stable angina and atrial fibrillation. Additionally, topical forms of diltiazem, such as creams and ointments, are indicated for anal fissures, providing relief by increasing blood flow to the affected area.

Can diltiazem cause severe side effects?

Like any medication, diltiazem can cause side effects. Mild side effects may include dizziness, fatigue, and peripheral edema, while severe reactions, although rare, could involve bradycardia or profound hypotension. Monitoring by a healthcare professional is advisable, particularly for elderly patients or those with underlying conditions.

How to apply diltiazem ointment for anal fissures?

For diltiazem 2% cream, apply a small amount to the anal margin twice daily. Ensure the area is clean before application. This regimen typically continues for 4 to 8 weeks, with a reassessment after that period to evaluate healing and adjust treatment as necessary.

Guidelines for Proper Use

In Canada, pharmacists offer essential advice regarding the integration of diltiazem into treatment regimens:

• Start with the lowest effective dose, particularly in elderly patients or those with liver impairment.
• Monitor blood pressure and heart rate to prevent adverse effects, especially during initial treatments.
• For patients using diltiazem for angina or hypertension, lifestyle adjustments such as diet and exercise should be encouraged to enhance efficacy.

Provincial health authorities suggest following these tips:

1. Consult a healthcare professional before combining diltiazem with other medications, especially beta-blockers or other antihypertensives.
2. Maintain regular follow-up appointments to monitor the effectiveness of diltiazem and make necessary adjustments.

City Delivery Times

City	Region	Delivery Time
Toronto	Ontario	5–7 days
Vancouver	British Columbia	5–7 days
Calgary	Alberta	5–7 days
Montreal	Quebec	5–7 days
Ottawa	Ontario	5–7 days
Halifax	Nova Scotia	5–9 days
Winnipeg	Manitoba	5–9 days
Victoria	British Columbia	5–9 days
Quebec City	Quebec	5–9 days
Regina	Saskatchewan	5–9 days
Saskatoon	Saskatchewan	5–9 days
St. John's	Newfoundland	5–9 days