딜티아젬
Diltiazem
Diltiazem Hydrochloride
다른 이름: 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
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
페렛
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Hypertrophic cardiomyopathy | 2-7.5 mg/kg PO twice daily; adjust as necessary. | PO | BID | — | 🌎 NA |
- Hypertrophic cardiomyopathy: May result in heart block.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
딜티아젬은 비디히드로피리딘계 칼슘 채널 차단제이자 제4군 항부정맥제로, 수의학에서는 주로 고양이의 상심실성 빈맥(SVT), 전신 고혈압, 폐동맥 고혈압 및 비대성 심근병증(HCM) 관리에 사용됩니다.
- 심혈관계 효과: 주로 방실결절(AV node) 전도를 늦추고 혈관 확장을 촉진하여 심방세동의 심박수 조절에 매우 효과적입니다.
- 임상적 유용성: 과거에는 고양이 HCM 치료의 핵심이었으나, 최근에는 다른 치료법이 선호되면서 이 적응증에 대한 사용이 감소했습니다. 하지만 빈맥성 부정맥 치료에는 여전히 중요한 약물입니다.
- 임상 요점: 강력한 말초 혈관 확장제인 디히드로피리딘계(예: 암로디핀)와 달리, 딜티아젬은 심장 전도에 미치는 영향이 더 커서 리듬 조절에는 우수하지만 중증 전신 고혈압에 대한 강압 효과는 상대적으로 약합니다.
작용 기전
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.
안전성·주의사항
금기사항
- 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)
부작용
- 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
주의
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.
약물 상호작용
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.
모니터링
- 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)
약동학
반감기
흡수
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%).
분포
Approximately 70-75% bound to serum proteins. Enters milk in concentrations approximating plasma levels.
대사
Rapidly and almost completely metabolized in the liver to several metabolites, including two active ones.
배설
Renal impairment may slightly increase half-lives.
과다투여
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.
제품
제형
- 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
동물용의약품
- Hypercard 10 mg modified-release tablets
인용의약품
- 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
규제 현황
POM-V, POM. Hypercard is authorized for veterinary use.
POM-V, POM.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
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.
보호자 정보
딜티아젬은 반려동물의 비정상적인 심장 박동과 고혈압을 치료하는 데 사용되는 약물입니다.
- 투여 방법: 수의사의 처방에 따라 정확히 투여하십시오. 수의사의 특별한 지시가 없는 한 서방형 캡슐을 부수거나 씹어 먹이지 마십시오 (Dilacor XR과 같은 특정 브랜드는 수의사의 엄격한 지도 하에 캡슐을 열어 내부의 알약을 사용하는 경우가 있습니다).
- 부작용: 무기력, 쇠약, 기절 또는 구토(특히 고양이에서 흔함) 증상이 있는지 관찰하십시오. 반려동물이 쓰러지거나 평소보다 비정상적으로 피곤해 보이면 즉시 수의사에게 연락하십시오.
- 투약의 일관성: 심장 약은 투약 일정을 엄격하게 준수해야 합니다. 수의사와 상의 없이 임의로 투약을 건너뛰거나 약물을 갑자기 중단하지 마십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.