INTRODUCTION

DTM contains Diltiazem which belongs to a group of medicines called Calcium channel blockers. DTM is used in adults to treat mild to moderate high blood pressure. It is also used to prevent and treat chest pain associated with angina pectoris. High blood pressure is a condition where blood pressure is too high against the walls of arteries which is characterized by blurry vision, headache, weakness, and lightheadedness. Angina pectoris is a type of chest pain that occurs due to reduced blood flow to the heart which includes symptoms like crushing pain in the chest, shortness of breath, weakness, and fatigue, and feeling faint.

Diltiazem works by affecting the movement of calcium into the cells of the heart and blood vessels which lowers blood pressure and increases the supply of blood and oxygen to the heart. Along with this treatment, your doctor might advise you to make lifestyle changes such as eating a diet that is low in fat and salt, managing your weight, exercising at least 30 minutes, avoid smoking, and taking alcohol in moderation limits.

Before taking DTM, inform your doctor if you have or ever had a heart attack and are allergic to diltiazem, or any other medications. If vitamins, nutritional supplements, and herbal products are taken, please inform your doctor before taking DTM. DTM is not recommended for use in pregnant, breast-feeding women and in children. Consult your doctor before taking it. The most common side effects of taking DTM are dizziness, headache, slow heartbeat, diarrhea, constipation, and cough. Contact your doctor if any of the gets worse.

USES OF DTM

• Treats and controls mild to moderate high blood pressure
• Prevents and treats chest pain

HOW DTM WORKS

DTM is a calcium channel blocker. It works by inhibiting the movement of calcium ions into both vascular smooth muscle and cardiac muscle resulting in lower blood pressure by relaxing the blood vessels and provides relief from chest pain by improving the flow of blood to the heart muscles.

DIRECTIONS FOR USE

Take DTM as advised by your physician. Swallow DTM with a glass of water and do not chew or crush the medicine. Your doctor will decide the correct dose and duration of DTM for you depending upon your age, body weight and disease condition.

SIDE EFFECTS OF DTM

HOW TO MANAGE SIDE EFFECTS

Headache:

Apply hot or cold-water bag on your head. Try taking rest in a quiet and dark room. Drink tea or coffee. If the symptom does not improve consult your doctor.

Dizzy and lightheadedness:

If DTM makes you feel dizzy, stop what you're doing and sit or lie down until you feel better. Do not drive, ride a bike, or operate tools or machinery until you feel well.

Tiredness and weakness:

Make sure you take rest and drink plenty of fluids. Do not drink too much alcohol. Try to take DTM at a time when you can sit down (or lie down) when the symptoms are at their worst. If problems persist after a week, speak to your doctor, as they may need to change you to a different type of medicine. Try not to drive or use tools or machinery until you feel ok.

Itching or burning on the skin:

If DTM causes itching or burning sensation on the skin then cool your skin with a damp towel or take cool baths or showers. If you have itchy skin, use an unperfumed moisturizer regularly. Keep your nails clean, short, and smooth and try to pat or tap your skin rather than scratching.

Stomach pain:

If DTM causes stomach pain then try to take rest and relax and have frequent smaller meals. Drink slowly and try to place a covered hot water bottle on your stomach to ease the pain. If you pain persists then, consult your doctor.

Indigestion:

Try to have smaller and more frequent meals and eat and drink slowly. Consult your doctor, if symptoms get worse.

Constipation:

Try to eat more high-fiber foods such as fresh fruit, vegetables, cereals, and drink plenty of water. Try doing exercise regularly (going for a daily walk or run). If this does not help, inform your doctor for receiving alternate treatments for constipation.

WARNING & PRECAUTIONS

INTERACTIONS

A. Drug-Drug Interactions:

Before taking DTM, inform your doctor, if you are taking any of the following:

• receiving an infusion of a muscle relaxant called dantrolene (given only in hospital)
• statins like simvastatin, or atorvastatin (medicines used to treat high cholesterol)
• lithium (used to treat mental problems)
• warfarin (used to thin the blood)
• nitrate derivatives (medicines used to treat angina) Ex. glyceryl trinitrate, isosorbide dinitrate)
• theophilline (used to treat asthma) 
• alpha blockers (used to treat high blood pressure) such as terazosin and doxazosin
• medicines used to treat heart problems (Ex. propranolol (betablocker), amiodarone or digoxin)
• methyldopa, nifedipine, diuretics (such as bendrofluazide), ACE inhibitors (such as enalapril), or any other medicines used to treat high blood pressure
• phenobarbital or carbamazepine (used to treat epilepsy) or rifampicin (used to treat tuberculosis)
• ranitidine or cimetidine (medicines used to treat stomach problems)
• ciclosporin (medicine used to suppress the body's immune or defense system)
• benzodiazepines (medicines used to treat insomnia) Ex. midazolam, triazolam
• methylprednisolone (a corticosteroid used to treat inflammation, severe allergies)
• clopidogrel (medicines used to reduce the risk of stroke or heart attack)
• ivabradine (medicine used for lower heart rate)
• digoxin, amiodarone (medicines used to suppress abnormal heart rhythm)

Overdosage:

If you or anyone else accidentally take more DTM, consult your doctor immediately or visit the nearby hospital. Symptoms of overdose can be severe low blood pressure leading to collapse, and a slow heartbeat which may be accompanied by changes in heart rhythm and conduction.

SYNOPSIS

MORE INFORMATION

• Keep DTM out of reach in children
• Store DTM at room temperature

FAQs ABOUT DTM

What DTM is used for?

DTM is used in adults to treat mild to moderate high blood pressure and also to prevent and treat chest pain associated with angina pectoris which is a type of chest pain that occurs due to reduced blood flow to the heart.

How DTM works on my body?

DTM works by inhibiting the movement of calcium ions into both vascular smooth muscle and cardiac muscle that results in reduced blood pressure and provides relief from chest pain by improving the blood flow to the heart muscles.

What are the side effects of DTM?

The most common side effects of taking DTM are headache, dizziness, tiredness, weakness, constipation, indigestion, stomach pain, swelling in ankle, feet, or fingers, and nausea. Consult your doctor if any of your symptoms get worsen over the time.

Is DTM safe to use in children?

No. DTM is not recommended for use in children and adolescents. If DTM is accidentally ingested by a child or adolescent, go to the hospital immediately and consult the doctor for further management.

Can DTM be taken by pregnant or breastfeeding women?

DTM is not recommended for use in pregnant women, or in women who might be expecting to get pregnant or who might be breast-feeding a baby.

How fast is DTM starting to work?

DTM controls high blood pressure and pain in the chest (angina) but does not cure it. It can take up to 2 weeks before you feel the full benefit of DTM.

REFERENCES

1. KD. Tripathi.  Antihypertensive, Anti-arrhythmic, Antianginal. Essentials of medical pharmacology. Seventh edition. 2013. Page – 517, 546, 547.

2. Gerald G. Briggs and Roger K. Freeman. D. A reference guide to fetal and neonatal risk: Drugs in Pregnancy and Lactation. Tenth Edition. 2015. Page – 1184-1186.

3. Hospital de la Mujer. Efficacy of Diltiazem for the Control of Blood Pressure in Puerperal Patients with Severe Preeclampsia. NIH U.S. National Library of Medicine ClinicalTrials.gov. [Revised in January 2020] [Accessed on 26th April 2022] https://clinicaltrials.gov/ct2/show/NCT04222855

4. Luis Rodríguez Padial, Gonzalo Barón-Esquivias, Antonio Hernández Madrid,3 Domingo Marzal Martín, Vicente Pallarés-Carratalá, and Alejandro de la Sierra. Clinical Experience with Diltiazem in the Treatment of Cardiovascular Diseases. NCBI; PMC US National Library of Medicine, National Institute of Health. March 2016 [Accessed on 26th April 2022] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906086/

5. Heng Yu Zhang, Ping Liao, Jue Jin Wang, De Jie Yu, and Tuck Wah Soong. Alternative splicing modulates diltiazem sensitivity of cardiac and vascular smooth muscle Cav1.2 calcium channels. NCBI; PMC US National Library of Medicine, National Institute of Health. August 2010 [Accessed on 26th April 2022] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936836/

6. Bard Pharmaceuticals Limited. Electronic Medicines Compendium (EMC). [Revised in November 2020] [Accessed on 26th Apr 2022] https://www.medicines.org.uk/emc/files/pil.1012.pdf

7. Teva UK Limited. Health Products Regulatory Authority (HPRA). [Revised in November 2015]. [Accessed on 26th April 2022] https://www.hpra.ie/img/uploaded/swedocuments/dilzem-sr-pil-clean%20-2168275-01122015164210-635845849342332500.pdf

8. AA Pharma Inc. Diltiazem Hydrochloride Tablets USP. [Revised in April 2020]. [Accessed on 26th April 2022] https://www.aapharma.ca/downloads/en/PIL/2020/Diltiaz-PrMono-ENG-Apr_24_2020.pdf

9. Bard Pharmaceuticals Limited. Health Products Regulatory Authority (HPRA). [Revised in October 2020]. [Accessed on 26th April 2022] https://www.hpra.ie/img/uploaded/swedocuments/5b45e281-50fb-455c-bec0-06ad5d91c1d0.pdf

USEFUL DIAGNOSTIC TESTS

• Kidney function test
• Liver function test