Diltiazem hydrochloride is a calcium channel blocker widely used to manage cardiovascular conditions such as hypertension, angina, and certain arrhythmias. Nurses play a critical role in its administration, monitoring, and patient education to ensure safety and efficacy. This guide outlines key nursing considerations and management strategies for diltiazem hydrochloride.
Thank you for reading this post, don't forget to subscribe!
Drug Overview
Generic Name
- Diltiazem hydrochloride
Brand Names
- Cardizem, Tiazac, Dilacor XR, Cartia XT, Dilt-XR
Classification
- Calcium channel blocker (non-dihydropyridine)
- Antihypertensive
- Antiarrhythmic
- Antianginal
Mechanism of Action
- Blocks calcium influx into cardiac and smooth muscle cells
- Causes vasodilation, reducing blood pressure
- Slows AV conduction, controlling heart rate
- Decreases myocardial oxygen demand
Dosage and Administration
Dosage Forms
- Oral Immediate-Release Tablets: 30 mg, 60 mg, 90 mg, 120 mg
- Extended-Release Capsules: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg
- Injectable Solution: 5 mg/mL
Recommended Dosages
- Hypertension: Extended-release, 180–240 mg once daily (up to 540 mg/day)
- Angina: Immediate-release, 30 mg four times daily (up to 360 mg/day); Extended-release, 120–180 mg once daily (up to 480 mg/day)
- Atrial Fibrillation/Flutter: IV bolus, 0.25 mg/kg over 2 minutes; repeat with 0.35 mg/kg if needed; IV infusion, 5–15 mg/hour
Administration
- Oral: Take with or without food; swallow extended-release forms whole
- IV: Administer bolus slowly over 2 minutes; use infusion pump for continuous infusion
Indications
- Hypertension: Lowers blood pressure
- Angina Pectoris: Reduces chest pain
- Atrial Fibrillation/Flutter: Controls ventricular rate
- Paroxysmal Supraventricular Tachycardia (PSVT): Converts to sinus rhythm
Adverse Effects
Common
- Headache, dizziness, fatigue, nausea, peripheral edema
Serious
- Bradycardia, heart block, hypotension, worsening heart failure, hepatotoxicity, severe skin reactions (e.g., Stevens-Johnson syndrome, rare)
Contraindications
- Hypersensitivity to diltiazem
- Sick sinus syndrome or second-/third-degree AV block (without pacemaker)
- Severe hypotension
- Acute myocardial infarction with pulmonary congestion
- Wolff-Parkinson-White syndrome with atrial fibrillation
Nursing Considerations
Assessment
- History: Check for heart conditions, liver/kidney disease, allergies
- Medications: Screen for interactions (e.g., beta-blockers, digoxin)
- Vital Signs: Record baseline blood pressure, heart rate, respiratory rate
- ECG: Monitor in patients with arrhythmias or on IV diltiazem
- Symptoms: Evaluate chest pain, shortness of breath, palpitations
Interventions
- Administration: Verify dosage and route; use infusion pump for IV
- Monitoring: Regularly check heart rate and blood pressure; watch for edema
- Lab Tests: Assess liver function periodically
- Positioning: Advise slow position changes to avoid dizziness
Patient Education
- Take as prescribed; do not skip doses
- Avoid grapefruit juice (increases drug levels)
- Report dizziness, fatigue, swelling, or shortness of breath
- Follow heart-healthy lifestyle (diet, exercise, no smoking)
- If dose missed, take soon unless near next dose; do not double up
Special Considerations
- Elderly: Start with lower doses due to risk of hypotension and bradycardia
- Pregnancy: Category C; use if benefits outweigh risks
- Breastfeeding: Excreted in milk; use with caution
- Hepatic Impairment: Adjust doses due to metabolism changes
Conclusion
Effective nursing management of diltiazem hydrochloride involves careful assessment, precise administration, and ongoing monitoring. By educating patients and addressing potential risks, nurses ensure safe and optimal treatment outcomes for cardiovascular conditions.
