Diltiazem

Structural formula
General
Non-proprietary name	Diltiazem
other names	cis - (+) - 5- (2-dimethylaminoethyl) -2- (4-methoxyphenyl) -4-oxo-2,3,4,5-tetrahydro-1,5-benzothiazepin-3-ylacetate ( IUPAC ); (2 S , 3 S ) -5- (2-dimethylaminoethyl) -2- (4-methoxyphenyl) -4-oxo-2,3,4,5-tetrahydro-1,5-benzothiazepin-3-yl acetate;
Molecular formula	C 22 H 26 N 2 O 4 S
External identifiers / databases
EC number	255-796-4
ECHA InfoCard	100.050.707
PubChem	39186
ChemSpider	35850
DrugBank	DB00343
Wikidata	Q422229
Drug information
ATC code	C08 DB01
Drug class	Calcium antagonists
properties
Molar mass	414.52 g · mol -1
Physical state	firmly
Melting point	207–212 ° C (diltiazem hydrochloride)
safety instructions
	Please note the exemption from the labeling requirement for drugs, medical devices, cosmetics, food and animal feed
GHS labeling of hazardous substances Caution
H and P phrases	H: 302
	P: no P-phrases
Toxicological data	740 mg kg −1 ( LD 50 , mouse , oral )
	As far as possible and customary, SI units are used. Unless otherwise noted, the data given apply to standard conditions .

Diltiazem is a drug from the group of calcium antagonists or calcium channel blockers, which has a vasodilator and conduction delay in the AV node of the heart . Diltiazem is one of the benzothiazepines . In Germany it is sold as Dilzem by the Pfizer company and by numerous other providers under the generic name.

history

Diltiazem ( Dilzem ) was first developed in Japan in the early 1970s . Masanori Sato examined this for pharmacological properties. The calcium antagonistic effect was discovered in 1975 by Nakajima.

application

In patients with coronary artery disease , diltiazem is used for stable angina pectoris , for unstable angina pectoris and especially for vasospastic angina pectoris ( Prinzmetal's angina ).

As an antiarrhythmic for the treatment of cardiac arrhythmias , diltiazem can be prescribed as a preventive measure against paroxysmal supraventricular tachycardias and in patients without WPW syndrome to slow the pulse rate in atrial fibrillation and atrial flutter .

In the treatment of high blood pressure , diltiazem is used to lower blood pressure .

It is used locally to treat anal fissures , for example as an ointment or cream.

Diltiazem is also used in the treatment of diffuse esophageal spasms. Here it leads to a relaxation of the smooth muscles of the esophagus.

Contraindications and warnings

Diltiazem may be used with SA block II. And III. Degree and during pregnancy . Intravenous administration is also contraindicated in bradycardia (pulse <55 beats per minute) .

Careful monitoring is required in Grade I SA block, in elderly patients, in severely impaired renal function, and in concurrent therapy with beta-blockers .

Even if the baby has not been known to harm it, it should not be taken during breastfeeding , as it passes into breast milk .

Side effects

Increase in liver enzymes Gamma-GT and LDH , lymph node swelling , vomiting , heartburn , diarrhea , SA block , weakness, edema . Allergic skin symptoms, syncope , heart failure , insomnia , hallucinations and depressive moods and erectile dysfunction are rare . In diabetics can hyperglycaemia occur.

Trade names

Monopreparations

Coridil (CH), Dilsal (July 7, 1993 TAD Pharma GmbH, DE), Dil-Sanorania (D), Diltaretard (D), Diltiagamma (D), Dilzem (February 2, 1978 Pfizer GmbH D, A, CH), Tildiem (CH), various generics (D, A, CH)

Individual evidence

^ The Merck Index : An Encyclopedia of Chemicals, Drugs, and Biologicals, 14th Edition (Merck & Co., Inc.), Whitehouse Station, NJ, USA, 2006; P. 543, ISBN 978-0-911910-00-1 .
↑ ^a ^b Data sheet (+) - cis-Diltiazem hydrochloride from Sigma-Aldrich , accessed on March 25, 2011 ( PDF ).
↑ Entry on Diltiazem. In: Römpp Online . Georg Thieme Verlag, accessed on October 1, 2014.
^ Wolf-Dieter Müller-Jahncke , Christoph Friedrich , Ulrich Meyer: Medicinal history . 2., revised. and exp. Ed. Wiss. Verl.-Ges, Stuttgart 2005, ISBN 978-3-8047-2113-5 , pp. 174 .
^ Franz Bader, Hans-Peter Bruch, Oliver Schwandner: Topical diltiazem for the treatment of chronic anal fissures. In: Coloproctology . Volume 28, Number 6, pp. 309-313; doi : 10.1007 / s00053-006-6020-3 .
↑ Red List 2017.
↑ AM comp. d. Switzerland, as of September 2009.
↑ AGES-PharmMed, as of September 2009.

[MERCK_Index-1] The Merck Index : An Encyclopedia of Chemicals, Drugs, and Biologicals, 14th Edition (Merck & Co., Inc.), Whitehouse Station, NJ, USA, 2006; P. 543, ISBN 978-0-911910-00-1 .

[Sigma-2] Data sheet (+) - cis-Diltiazem hydrochloride from Sigma-Aldrich , accessed on March 25, 2011 ( PDF ).

[3] Entry on Diltiazem. In: Römpp Online . Georg Thieme Verlag, accessed on October 1, 2014.

[4] Wolf-Dieter Müller-Jahncke , Christoph Friedrich , Ulrich Meyer: Medicinal history . 2., revised. and exp. Ed. Wiss. Verl.-Ges, Stuttgart 2005, ISBN 978-3-8047-2113-5 , pp. 174 .

[5] Franz Bader, Hans-Peter Bruch, Oliver Schwandner: Topical diltiazem for the treatment of chronic anal fissures. In: Coloproctology . Volume 28, Number 6, pp. 309-313; doi : 10.1007 / s00053-006-6020-3 .

[6] Red List 2017.

[7] AM comp. d. Switzerland, as of September 2009.

[8] AGES-PharmMed, as of September 2009.