Drug Interactions of Diltiazem

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Diltiazem is a Calcium Channel Blocker (CCB) and it can interact significantly with drugs such as Cisapride, Colchicine, Lomitapide, Eryhthromycin, Amiodarone, Clopidogrel, Beta Blockers, Droperidol, Dantrolene, Lacosamide, Clonidine, Fingolimod, CYP3A4 inhibitors (Clarithromycin, Ceritinib, Atazanavir, etc.), CYP3A4 inducers (Carbamazepine, St.John’s wort, etc.), CYP3A4 substrates (Simvastatin, Atorvastatin, Lovastatin, Apixaban, Domperidone, Donepezil, Dronedarone, Clozapine, Fentanyl, Hydrocodone, Piperaquine, Erlotinib, Nilotinib, Crizotinib, Bosutinib, Ibratinib, Doxorubicin, Simeprevir, Lurasidone, Ranolazine, Eplerenone, Everolimus, Aripiprazole, Eliglustat, Cilostazol, Tolvaptan, Ivabradine, etc.) and P-gp substrates (Dabigatran, Apixaban, Everolimus, Vincristine, Nilotinib, Afatinib, Bosutinib, Trabectedin, Ombitasvir, Simeprevir, Dasabuvir, Paritaprevir, Topotecan, etc.).

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Drug Interactions of Antihypertensives (Part 6) (Drug Interactions of Calcium Channel Blockers (CCBs) – Diltiazem):

Drug Interactions of Antihypertensives (Part 6) (Drug Interactions of Calcium Channel Blockers (CCBs) – Diltiazem ) Dr. P.Naina Mohamed PhD Pharmacologist

Introduction:

Introduction An adverse drug interaction is defined as an interaction between one or more coadministered medications which leads to alteration of the effectiveness or toxicity of any of the coadministered medications . Drug interactions could be occurred between prescription and over-the-counter (OTC) medications, herbal products or vitamins , foods , diseases, and genetics ( family history ). It is estimated that people over 65 take an average of seven drugs at any one time to treat a variety of illnesses. With this amount of medicine use, the probability that a person will take two prescribed drugs that may interact with one another is very high.

Antihypertensives:

Antihypertensives The common Antihypertensives include… Angiotensin converting enzyme inhibitors (ACEIs) Angiotensin receptor blockers (ARBs) Direct Renin Inhibitors (DRIs) Calcium channel blockers (CCBs) Diuretics Adrenergic Beta Blockers Adrenergic Alpha Blockers

Calcium Channel blockers (CCBs):

Calcium Channel blockers (CCBs) The most common Calcium Channel blockers (CCBs ) include… Dihydropyridines : Amlodipine Nifidepine Nicardipine Felodipine Nisoldipine Isradipine Clevidipine Diphenyl alkylamine : Verapamil Benzothiazepine : Diltiazem

Diltiazem & Cisapride:

Diltiazem & Cisapride

Diltiazem & Colchicine :

Diltiazem & Colchicine

Diltiazem & Lomitapide :

Diltiazem & Lomitapide

Diltiazem & Eryhthromycin:

Diltiazem & Eryhthromycin Concomitant use of erythromycin and diltiazem should be avoided. Monitor QT interval, if concurrent use is clinically warranted.

Diltiazem & Amiodarone:

Diltiazem & Amiodarone Coadministration of Diltiazem and Amiodarone should be avoided in patients with sick sinus syndrome or partial AV block. Caution is advised if Diltiazem and Amiodarone are used together.

Diltiazem & Clopidogrel:

Diltiazem & Clopidogrel Use caution if Diltiazem and clopidogrel are used concurrently. Monitor patients for loss of clopidogrel efficacy.

Diltiazem & Beta Blockers:

Diltiazem & Beta Blockers Monitor cardiac function and blood pressure carefully, if concurrent therapy is required.

Diltiazem & Droperidol :

Diltiazem & Droperidol Droperidol should be administered with extreme caution in patients taking Diltiazem.

Diltiazem & Dantrolene:

Diltiazem & Dantrolene Monitor blood pressure and serum potassium, if concurrent use is necessary.

Diltiazem & Lacosamide :

Diltiazem & Lacosamide Obtain ECG prior to treatment and following dose titration , if concurrent use is required.

Diltiazem & Clonidine:

Diltiazem & Clonidine H eart rate should be monitored, when clonidine and d iltiazem are administered concurrently.

Diltiazem & Fingolimod:

Diltiazem & Fingolimod If concomitant use is necessary, continuous overnight ECG monitoring after the first dose of fingolimod is recommended.

Diltiazem & CYP3A4 Inhibitors:

Diltiazem & CYP3A4 Inhibitors Diltiazem may interact significantly with CYP3A4 inhibitors such as Clarithromycin, Ceritinib , Atazanavir , etc. Closely monitor drug levels and for increased adverse effects of Diltiazem. Consider dosage adjustments, if coadministration is clinically warranted.

Diltiazem & CYP3A4 Inducers:

Diltiazem & CYP3A4 Inducers CYP3A4 inducers such as Carbamazepine, St.John’s wort , etc. interact with Diltiazem significantly. Monitor patients for loss of efficacy, if Diltiazem is used concurrently with CYP3A4 inducers.

Diltiazem & CYP3A4 Substrates:

Diltiazem & CYP3A4 Substrates Diltiazem is also a CYP3A4 inhibitor and it can increase the plasma concentrations and toxicity of CYP3A4 substrates such as Simvastatin, Atorvastatin, Lovastatin, Apixaban , Domperidone , Donepezil, Dronedarone , Clozapine, Fentanyl, Hydrocodone, Piperaquine , Erlotinib , Nilotinib , Crizotinib , Bosutinib , Ibratinib , Doxorubicin, Simeprevir , Lurasidone , Ranolazine , Eplerenone , Everolimus , Aripiprazole, Eliglustat, Cilostazol , Tolvaptan , I vabradine , etc. Closely monitor for CYP3A4 substrates associated adverse events, if coadministered .

Diltiazem & P-gp Substrates:

Diltiazem & P- gp Substrates Diltiazem inhibits the efflux transport of P- gp substrates such as Dabigatran, Apixaban , Everolimus , Vincristine, Nilotinib , Afatinib , Bosutinib , Trabectedin , Ombitasvir , Simeprevir , Dasabuvir , Paritaprevir , Topotecan , etc. Use caution and monitor the patient for signs and symptoms of increased exposure of P- gp substrates.

References:

References Stockley’s Drug Interactions, 9e Karen Baxter http://www.micromedexsolutions.com http://dmd.aspetjournals.org/content/28/2/125.full http://onlinelibrary.wiley.com/doi/10.1002/j.1875-9114.1998.tb03866.x/abstract http://europepmc.org/abstract/med/11550401 http://onlinelibrary.wiley.com/doi/10.1016/S0009-9236(96)90052-1/abstract

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