地爾硫卓
Diltiazem
Diltiazem Hydrochloride
別名: 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
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
雪貂
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Hypertrophic cardiomyopathy | 2-7.5 mg/kg PO twice daily; adjust as necessary. | PO | BID | — | 🌎 NA |
- Hypertrophic cardiomyopathy: May result in heart block.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
地爾硫卓是一種非二氫吡啶類鈣離子通道阻斷劑和第四類抗心律不整藥物，在獸醫學中主要用於控制貓的上心室性心搏過速 (SVTs)、全身性高血壓、肺動脈高壓以及肥厚性心肌病 (HCM)。
- 心血管作用： 主要透過減緩房室結 (AV node) 傳導並促進血管擴張發揮作用，對於心房顫動的速率控制非常有效。
- 臨床應用： 雖然過去是治療貓 HCM 的基石，但近年來針對此適應症的使用已減少，轉而使用其他療法，不過它仍是治療心搏過速的重要藥物。
- 臨床要點： 與二氫吡啶類（如氨氯地平，為強效周邊血管擴張劑）不同，地爾硫卓對心臟傳導的影響更顯著，因此在節律控制方面較優，但對於嚴重全身性高血壓的降壓效果較弱。
作用機制
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.
安全性與警告
禁忌症
- 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)
不良反應
- 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
注意事項
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.
藥物相互作用
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.
監測
- 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)
藥物動力學
半衰期
吸收
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%).
分佈
Approximately 70-75% bound to serum proteins. Enters milk in concentrations approximating plasma levels.
代謝
Rapidly and almost completely metabolized in the liver to several metabolites, including two active ones.
排除
Renal impairment may slightly increase half-lives.
過量
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.
可用產品
劑型
- 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
獸醫用
- Hypercard 10 mg modified-release tablets
人用標示
- 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
各地核准狀態
POM-V, POM. Hypercard is authorized for veterinary use.
POM-V, POM.
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
地爾硫卓是一種用於治療寵物心律不整和高血壓的藥物。
- 給藥方式： 請嚴格按照獸醫師的指示給藥。請勿壓碎或咀嚼長效型膠囊，除非獸醫師特別指示（某些特定品牌如 Dilacor XR 有時會在獸醫指導下打開使用裡面的藥片）。
- 副作用： 請觀察寵物是否有嗜睡、虛弱、昏厥或嘔吐（在貓咪中特別常見）的跡象。如果您的寵物突然倒下或顯得異常疲倦，請立即聯繫您的獸醫師。
- 用藥規律性： 心臟藥物需要嚴格遵守給藥時間表。請勿在未諮詢獸醫師的情況下自行停藥或漏餵。
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