Diltiazem
Diltiazem Hydrochloride
También conocido como: Cardizem CD · Cardizem LA · Dilacor XR · Cartia XT · Tiazac · Diltia XT · Taztia XT · Dilt-CD · Hypercard · Adizem · Angitil · Dilcardia · Dilzem · Slozem · Tildiem · Viazem · Zemret · CRD-401 · diltiazemi hydrochloridum · latiazem hydrochloride · MK-793 · Diltiazem hydrochloride
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Dosis por especie
🌎 NA — North America🌍 EU — Europe
Perros
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Decreasing ventricular rate in dogs with atrial fibrillation | Initially, 0.5 mg/kg PO q8h, if response not adequate can increase to 1 mg/kg PO q8h and finally, to 1.5 mg/kg PO q8h. | PO | q8h | — | 🌎 NA |
| Acute treatment of supraventricular tachycardia | 0.05 mg/kg IV administered over 1-2 minutes. May repeat this dose up to two times, with 5 minutes between doses. Some cardiologists use a dose of 0.25 mg/kg administered over 5 minutes. | IV | As directed | — | 🌎 NA |
| Chronic treatment of supraventricular tachycardia | Initially, 1 mg/kg PO q8h and titrated upward to a maximum of 4 mg/kg PO q8h. | PO | q8h | — | 🌎 NA |
| Acute treatment of atrial tachycardia | 0.05-0.15 mg/kg slowly IV, repeat every 5 minutes to effect or until a total dose of 0.1-0.3 mg/kg; OR give 0.5 mg/kg PO followed by 0.25 mg/kg PO every hour until conversion or a total oral dose of 1.5-2 mg/kg has been given. | IV/PO | As directed | — | 🌎 NA |
| Chronic treatment of atrial tachycardia | May give an initial dose of 0.5 mg/kg PO q8h up to 2 mg/kg. | PO | q8h | — | 🌎 NA |
| Emergency treatment of supraventricular tachyarrhythmias | Initially, 0.25 mg/kg IV bolus given over 2 minutes; subsequent 0.25 mg/kg boluses may be repeated at 15 minute intervals until conversion occurs or to a maximum (total) dose of 0.75 mg/kg. | IV | q15min | — | 🌎 NA |
| Adjunctive treatment of pulmonary hypertension | 1-2 mg/kg PO three times daily. | PO | TID | — | 🌎 NA |
| Emergency management of hypertension (when nitroprusside unavailable) | 0.5 mg/kg PO q6h | PO | q6h | — | 🌎 NA |
| Supraventricular tachyarrhythmias / Atrial fibrillation | 0.05-0.25 mg/kg | IV | single dose over 1-2 min | — | 🌍 EU |
| Supraventricular tachyarrhythmias / Atrial fibrillation | 0.5-2.0 mg/kg | PO | q8h | — | 🌍 EU |
| Supraventricular tachyarrhythmias / Atrial fibrillation | up to 3.0 mg/kg | PO | q12h | — | 🌍 EU |
| Supraventricular tachyarrhythmias / Atrial fibrillation | 10 mg/kg | PO | q24h | — | 🌍 EU |
| Refractory supraventricular tachyarrhythmias | up to 4 mg/kg | PO | q8h | — | 🌍 EU |
- Decreasing ventricular rate in dogs with atrial fibrillation: Digoxin most commonly used first. In general, do not use with beta blocker.
- Chronic treatment of supraventricular tachycardia: Doses from 2-4 mg/kg q8h should probably not be given to dogs that have moderate to severe myocardial failure or with significant cardiac compromise.
- Emergency management of hypertension (when nitroprusside unavailable): If blood pressure not controlled, may add a betablocker (e.g., atenolol).
- Supraventricular tachyarrhythmias / Atrial fibrillation: Lower doses are preferred in the presence of heart failure.
- Supraventricular tachyarrhythmias / Atrial fibrillation: For modified-release (-MR) products.
- Supraventricular tachyarrhythmias / Atrial fibrillation: For sustained/extended release (-SR) preparations (little evidence established).
- Supraventricular tachyarrhythmias / Atrial fibrillation: For long-acting preparations; little experience with such formulations in animals.
Gatos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Treatment of hypertrophic cardiomyopathy (Option A) | 7.5 mg (total dose) PO q8-12h; Long-acting forms: Cardizem CD Capsules: 10 mg/kg once daily. Dilacor XR Capsules: 15-30 mg total dose q12-24h. | PO | q8-24h | — | 🌎 NA |
| Treatment of hypertrophic cardiomyopathy (Option B) | 1.75-2.5 mg/kg PO q8h or sustained release (Dilacor) dosed at 30 mg (total dose) PO q12h | PO | q8-12h | — | 🌎 NA |
| Treatment of hypertrophic cardiomyopathy (Option C) | 7.5-15 mg (total dose) per cat PO q8h. Alternatively, the sustainedrelease products Cardizem CD at 45 mg (total dose) PO q24h or Dilacor XR at 30 mg (total dose; 1/2 of one of the 60 mg tablets found within the capsule) PO q12h can be used. | PO | q8-24h | — | 🌎 NA |
| Treatment of hypertrophic cardiomyopathy (Option D) | If using standard release formulations: 1-2.5 mg/kg PO q8h; if using sustained release formations: 30-60 mg (total dose per cat) q24h. | PO | q8-24h | — | 🌎 NA |
| Treatment of hypertrophic cardiomyopathy (Option E) | Dilacor XR 30 mg/cat PO q24h. | PO | q24h | — | 🌎 NA |
| Emergency treatment of supraventricular tachyarrhythmias | Initially, 0.25 mg/kg IV bolus given over 2 minutes; subsequent 0.25 mg/kg boluses may be repeated at 15 minute intervals until conversion occurs or to a maximum (total) dose of 0.75 mg/kg. | IV | q15min | — | 🌎 NA |
| Acute management of supraventricular tachyarrhythmias | 0.125-0.35 mg/kg IV | IV | As directed | — | 🌎 NA |
| Chronic management of supraventricular tachyarrhythmias | 7.5 mg (per cat) PO q8h | PO | q8h | — | 🌎 NA |
| Emergency management of hypertension (when nitroprusside unavailable) | 0.5 mg/kg PO q6h | PO | q6h | — | 🌎 NA |
| Supraventricular tachyarrhythmias / Hypertrophic cardiomyopathy | 0.05-0.25 mg/kg | IV | single dose over 1-2 min | — | 🌍 EU |
| Supraventricular tachyarrhythmias / Hypertrophic cardiomyopathy | 0.5-2.5 mg/kg | PO | q8h | — | 🌍 EU |
- Treatment of hypertrophic cardiomyopathy (Option A): Some cats tolerate 60 mg daily, but vomiting may be a problem.
- Treatment of hypertrophic cardiomyopathy (Option D): Also indicated for supraventricular arrhythmias.
- Treatment of hypertrophic cardiomyopathy (Option E): If cat has minimal tachycardia and a loud S4 gallop, many prefer using diltiazem (over a beta blocker).
- Chronic management of supraventricular tachyarrhythmias: Used in combination with digoxin for patients with CHF unless cat has hypertrophic cardiomyopathy and atrial fib, then digoxin not used.
- Emergency management of hypertension (when nitroprusside unavailable): If blood pressure not controlled, may add a betablocker (e.g., atenolol).
- Supraventricular tachyarrhythmias / Hypertrophic cardiomyopathy: Alternatively, one 10 mg tablet for cats of 3-6.25 kg PO q8h.
Hurones
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Hypertrophic cardiomyopathy | 2-7.5 mg/kg PO twice daily; adjust as necessary. | PO | BID | — | 🌎 NA |
- Hypertrophic cardiomyopathy: May result in heart block.
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
El diltiazem es un bloqueador de los canales de calcio no dihidropiridínico y un agente antiarrítmico de Clase IV utilizado principalmente en medicina veterinaria para el manejo de taquicardias supraventriculares (TSV), hipertensión sistémica, hipertensión pulmonar y miocardiopatía hipertrófica (MCH), particularmente en gatos.
- Efectos cardiovasculares: Actúa principalmente ralentizando la conducción a través del nodo AV y promoviendo la vasodilatación, lo que lo hace altamente eficaz para el control de la frecuencia en la fibrilación auricular.
- Utilidad clínica: Aunque históricamente fue un pilar para la MCH felina, su uso para esta indicación específica ha disminuido en los últimos años en favor de otras terapias, aunque sigue siendo una herramienta vital para las taquiarritmias.
- Perla clínica: A diferencia de las dihidropiridinas (p. ej., amlodipino), que son potentes vasodilatadores periféricos, el diltiazem tiene efectos más pronunciados sobre la conducción cardíaca, lo que lo hace superior para el control del ritmo pero menos potente para la hipertensión sistémica grave.
Mecanismo de acción
Diltiazem exerts its effects by binding to the alpha-1 subunit of L-type voltage-gated calcium channels.
- Mechanism: Inhibits transmembrane influx of extracellular calcium ions → decreases intracellular calcium in myocardial cells and vascular smooth muscle.
- Cardiac Conduction: Slows AV node conduction and prolongs refractory times (negative dromotropic effect). It rarely affects SA node conduction except in sick sinus syndrome.
- Vasodilation: Relaxes vascular smooth muscle → dilates main systemic and coronary arteries → reduces total peripheral resistance, blood pressure, and cardiac afterload.
- Inotropy: Can cause mild negative inotropic effects, though rarely of clinical significance compared to verapamil.
Seguridad y advertencias
Contraindicaciones
- Severe hypotension (<90 mm Hg systolic)
- Sick sinus syndrome (unless functioning pacemaker is in place)
- 2nd or 3rd degree AV block (unless functioning pacemaker is in place)
- Acute myocardial infarction
- Radiographically documented pulmonary congestion
- Hypersensitivity to diltiazem
- Second or third degree AV block
- Marked hypotension
- Acute or decompensated congestive heart failure (relative contraindication)
Efectos adversos
- Dogs: Bradycardia (most prominent)
- Cats: Vomiting (especially with 60 mg sustained-release pellets)
- Lethargy
- Anorexia / GI distress
- Hypotension
- Heart block or rhythm disturbances
- CNS effects
- Skin rashes
- Elevations in liver enzymes
- Bradycardia (most common in dogs)
- Vomiting (most common in cats)
- AV block
Precauciones
Warning: Use with extreme caution in geriatric patients, those with heart failure (especially if receiving beta-blockers), or patients with hepatic or renal impairment.
- IV Administration: If giving direct IV push, administer slowly over at least two minutes to prevent acute hypotension or collapse.
- Pregnancy: Potential teratogen at high doses (FDA Category C). Use only when benefits outweigh risks.
- Nursing: Excreted in milk at concentrations approximating serum levels; use with caution.
Interacciones farmacológicas
May increase cardiac depressant effects of diltiazem.
Diltiazem may increase benzodiazepine levels.
May increase the likelihood of bradycardia, AV block, or CHF. Diltiazem may substantially increase the bioavailability of propranolol.
Diltiazem may increase buspirone levels.
Could potentially increase risk for increased QT intervals.
Data conflicts regarding pharmacokinetic effects; diligent monitoring of digoxin serum concentrations is required.
May increase plasma diltiazem concentrations; increased monitoring warranted.
May affect diltiazem concentrations, but to a lesser extent than cimetidine.
Diltiazem may increase cyclosporine serum concentrations; monitoring and dosage adjustments may be required.
May decrease diltiazem levels.
Diltiazem may increase quinidine serum concentrations; monitoring and dosage adjustments may be required.
Additive negative inotropic and chronotropic effects. Co-administration is not recommended.
May adversely affect the activity of diltiazem.
May adversely affect the activity of diltiazem.
Diltiazem enhances the effect of theophylline, which may lead to toxicity.
Diltiazem may affect ciclosporin concentrations.
Diltiazem may displace these agents from plasma proteins.
Diltiazem may increase intracellular vincristine levels by inhibiting outflow of the drug from the cell.
Monitorización
- ECG / Heart rate
- Blood pressure
- Adverse effects (vomiting, lethargy)
- Heart rate and rhythm (ECG)
- Renal and hepatic function (periodically)
- Serum digoxin levels (if used concurrently)
Farmacocinética
Vida media
Absorción
In humans, ~80% absorbed orally but high first-pass effect limits systemic bioavailability to ~50%. In cats, bioavailability is 50-80% (peak at 45 mins); sustained-release products vary (Cardizem CD 22-59%, Dilacor XR ~94%). In dogs, bioavailability is low (~25%).
Distribución
Approximately 70-75% bound to serum proteins. Enters milk in concentrations approximating plasma levels.
Metabolismo
Rapidly and almost completely metabolized in the liver to several metabolites, including two active ones.
Eliminación
Renal impairment may slightly increase half-lives.
Sobredosis
The oral LD50 in dogs is >50 mg/kg.
- Clinical Signs: GI signs, heart block, severe bradycardia, hypotension, CNS depression, and heart failure.
- Treatment:
- Gut emptying protocols if recent ingestion.
- Bradycardia/AV Block: Atropine. If unresponsive to vagal blockade, cautious use of isoproterenol. Fixed block may require temporary transvenous cardiac pacing.
- Hypotension/Heart Failure: Inotropics (dobutamine, dopamine, isoproterenol) and pressors (norepinephrine).
- Antidote: A slow intravenous calcium infusion (1 mL/10 kg body weight of 10% calcium gluconate) may be useful for severe acute toxicity.
Productos disponibles
Formulaciones
- Oral Tablets
- Oral Extended/Sustained Release Capsules and Tablets
- Injection (solution and powder for reconstitution)
- 10 mg modified-release (-MR) tablets
- 60 mg modified-release (-MR) tablets
- 60 mg, 90 mg, 120 mg sustained-release (-SR) capsules
- 10 mg/ml injectable solution
Veterinario
- Hypercard 10 mg modified-release tablets
Etiquetado para humanos
- Diltiazem Oral Tablets: 30 mg, 60 mg, 90 mg, & 120 mg (Cardizem, generic)
- Diltiazem Extended/Sustained Release Capsules & Tablets: 60 mg, 90 mg, 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg (Cardizem CD & LA, Cartia XT, Dilacor XR, Tiazac, Diltia XT, Taztia XT, Dilt-CD & XR, generic)
- Diltiazem Injection: 5 mg/mL in 5 mL, 10 mL, 25 mL vials
- Diltiazem Powder for Injection: 25 mg in single-use containers
- Adizem
- Angitil
- Dilcardia SR (60 mg, 90 mg, 120 mg capsules)
- Diltiazem generic
- Dilzem
- Slozem
- Tildiem
- Viazem
- Zemret
Estado regulador
POM-V, POM. Hypercard is authorized for veterinary use.
POM-V, POM.
Sin datos reguladores para: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Oral products should be stored at room temperature in tight, light-resistant containers. Powder for injection should be stored between 15-30°C; discard after 24 hours once reconstituted.
Información para el cliente
El diltiazem es un medicamento utilizado para tratar ritmos cardíacos anormales y la presión arterial alta en mascotas.
- Administración: Administre exactamente según lo prescrito. No triture ni mastique las cápsulas de liberación prolongada a menos que su veterinario le indique específicamente lo contrario (algunas marcas específicas como Dilacor XR a veces se pueden abrir para usar las tabletas del interior, pero solo bajo estricta supervisión veterinaria).
- Efectos secundarios: Esté atento a signos de letargo, debilidad, desmayos o vómitos (especialmente comunes en gatos). Comuníquese con su veterinario de inmediato si su mascota se desploma o parece inusualmente cansada.
- Consistencia: Los medicamentos para el corazón requieren una adherencia estricta al programa de dosificación. No omita dosis ni suspenda el medicamento abruptamente sin consultar a su veterinario.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.