Diakordin 60
Instructions for use:
- 1. Release form and composition
- 2. Indications for use
- 3. Contraindications
- 4. Method of application and dosage
- 5. Side effects
- 6. Special instructions
- 7. Drug interactions
- 8. Analogs
- 9. Terms and conditions of storage
- 10. Terms of dispensing from pharmacies
Diakordin 60 is a calcium channel blocker with antihypertensive, antianginal and antiarrhythmic action.
Release form and composition
Dosage form - tablets: flat, with a notch, Ø ~ 10.5 mm, with a specific smell of auxiliary ingredients, color, white with a yellowish tinge (10 pcs. In blisters, 5 blisters in a cardboard box).
Composition for 1 tablet:
- active substance: diltiazem hydrochloride - 60 mg;
- auxiliary components: mountain wax, lactose, magnesium stearate, methylated silicon dioxide.
Indications for use
- arterial hypertension - therapy;
- supraventricular arrhythmias (atrial fibrillation / flutter, paroxysmal supraventricular tachycardia, extrasystole) - prevention;
- attacks of angina pectoris (including Prinzmetal's angina pectoris) - prevention.
Contraindications
Absolute:
- atrioventricular (AV) blockade II – III degree (except for patients with a pacemaker);
- severe bradycardia;
- sick sinus syndrome (SSS);
- cardiogenic shock;
- atrial fibrillation in WPW (Wolff - Parkinson - White) and LGL (Launa - Ganonga - Levine) syndromes;
- myocardial infarction, complicated by congestion in the lungs;
- arterial hypotension;
- acute heart failure;
- chronic heart failure (CHF) II B – III stage;
- hemodynamically significant aortic stenosis;
- severe renal / hepatic impairment;
- the period of pregnancy and lactation (lactation);
- individual hypersensitivity to diltiazem, other benzodiazepine derivatives and any of the auxiliary ingredients of the drug.
Relative contraindications (Diakordin 60 is used with caution): intraventricular conduction disturbances, grade I AV block, tendency to arterial hypotension and chronic heart failure, myocardial infarction with left ventricular failure, ventricular tachycardia with expansion of the QRS complex, hepatic / renal failure, old age, children's age (in pediatric practice, the safety and efficacy of diltiazem have not been studied).
Method of administration and dosage
Diakordin 60 tablets are taken orally, without chewing, with a small amount of water or other neutral liquid, before meals.
The recommended starting dose, unless otherwise prescribed, is 90 mg 2 times a day or 60 mg 3 times a day.
If the effect of the drug is not effective enough, it is recommended to increase the dose to 180 mg 2 times a day (i.e., to a maximum daily dose of 360 mg).
Side effects
- central and peripheral nervous system: dizziness, headache, fainting, asthenia, increased fatigue, anxiety, dyssomnia, drowsiness, depression, extrapyramidal disorders (mask-like face, ataxia, shuffling gait, trembling of fingers and hands, stiffness of the hands and / or legs, difficulty swallowing); with high-dose therapy - tremor, paresthesia, visual impairment (transient blindness);
- cardiovascular system: asymptomatic decrease in blood pressure (BP); rarely - arrhythmia (including flutter and fibrillation of the ventricles), angina pectoris, bradycardia (<50 beats / min) or tachycardia, AV block II and III degree (up to asystole), development / worsening of heart failure; with high-dose therapy - bradycardia, angina pectoris, AV blockade, worsening of chronic heart failure, a marked decrease in blood pressure;
- digestive system: increased appetite, dry mouth, nausea / vomiting, diarrhea, constipation, increased activity of liver enzymes, gingival hyperplasia (soreness, swelling, bleeding);
- hematopoietic system: rarely - agranulocytosis, thrombocytopenia;
- hypersensitivity reactions: skin rash, facial flushing, exudative erythema multiforme (up to Stevens-Johnson syndrome inclusive), arthritis;
- other reactions: during therapy with high doses - pulmonary edema (cough, shortness of breath, stridor); peripheral edema (lower extremities - feet, legs, ankles), increased serum creatinine; rarely - galactorrhea, weight gain.
special instructions
Sudden discontinuation of diltiazem may trigger the development of an anginal attack.
Correction of the dosage regimen should be carried out in case of impaired liver / kidney function and in elderly patients.
Diakordin 60 is contraindicated for use by pregnant and lactating women, since the results of experiments have shown that diltiazem may have a teratogenic effect.
During the course of therapy, one should not consume ethanol-containing drinks and engage in potentially hazardous activities that require an increased concentration of attention and speed of psychophysical reactions (including driving).
Drug interactions
When Diakordin 60 is used together with other substances / drugs, the following effect of diltiazem on them is possible:
- beta-blockers (including propranolol, atenolol, metoprolol, pindolol, sotalol): a total cardiodepressive effect is possible, in some cases with an increase in the antianginal effect; with a previous impairment of left ventricular function or conduction disturbance, the risk of developing severe threatening bradycardia increases; diltiazem inhibits the metabolism of metoprolol and propranolol, but not atenolol;
- amiodarone: negative inotropic effect, conduction disturbance, bradycardia, AV block is aggravated;
- lovastatin and simvastatin: diltiazem inhibits the CYP3A4 isoenzyme involved in the metabolism of atorvastatin, therefore, in theory, the manifestation of drug interactions due to an increase in plasma concentrations of statins is possible; episodes of rhabdomyolysis development were recorded;
- buspirone: its concentration in blood plasma increases, its therapeutic and side effects increase;
- vecuronium chloride: likely to increase the duration of neuromuscular blockade;
- digoxin, digitoxin: an increase in their concentrations in blood plasma is possible;
- imipramine, trimipramine and nortriptyline: their plasma concentration increases, due to which there is a risk of unwanted changes in the electrocardiogram (ECG) due to a decrease in clearance and the additive inhibitory effect of their combined use on AV conductivity;
- insulins: there is evidence of a decrease in their effectiveness;
- anticonvulsants (carbamazepine, phenytoin): due to inhibition by diltiazem of their metabolism in the liver with a decrease in clearance, their concentrations in blood plasma may increase and the risk of toxic reactions may increase;
- lithium carbonate: episodes of development of acute parkinsonism syndrome, psychosis are described;
- benzodiazepines (midazolam, triazolam): their plasma concentration increases due to inhibition of the CYP3A4 isoenzyme under the influence of diltiazem, metabolism increases, aggravating their therapeutic and side effects;
- sodium amidotrizoate, nifedipine: can enhance the antihypertensive effect of diltiazem;
- sodium nitroprusside: can significantly increase efficacy in controlled arterial hypotension;
- rifampicin: enhances the induction of hepatic enzymes, accelerating the metabolism of diltiazem and decreasing its effectiveness;
- theophylline: its metabolism in the liver may decrease slightly;
- cisapride: there is evidence of impaired consciousness in patients, apparently associated with a pronounced lengthening of the QT interval; perhaps diltiazem inhibits the activity of the CYP3A4 isoenzyme, which results in an increase in the plasma concentration of cisapride and an increase in its cardiotoxicity;
- cyclosporine: diltiazem inhibits its metabolism in the liver, which leads to a decrease in the excretion of cyclosporine and an increase in its concentration in the blood plasma; nephrotoxicity is reduced, and the immunosuppressive effect is enhanced;
- cimetidine: increases the plasma concentration of diltiazem as a result of inhibition of its oxidative metabolism in the liver, with a possible increase in the effects;
- enflurane: there is evidence of abnormalities in myocardial AV conduction.
Analogs
Analogs of Diakordin 60 are: Diakordin 90 Retard, Diakordin 120 Retard, Altiazem, Cardil, Diltiazem, Diltiazem Lannacher, Blokaltsin, Dilcem, Tiakem, Silden, etc.
Terms and conditions of storage
Store in a dry, dark place at temperatures between 10 and 25 ° C. Keep out of the reach of children.
Shelf life is 2 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
