page150
Calcicard CR
c
(IVAX) A
Tablets
, m/r, both f/c, diltiazem hydrochloride 90 mg,
net price 56-tab pack = £6.33; 120 mg, 56-tab pack =
£7.04.
Label:
25
Dose
mild to moderate hypertension,
initially 90 mg or 120 mg
twice daily;
up to 360 mg daily may be required:
ELDERLY and in
hepatic and renal
impairment,
initially 120 mg once daily;
up to
240 mg daily may be required
Angina, initially 90 mg or 120 mg twice daily; up to 480 mg daily in
divided doses may be required; ELDERLY and in hepatic and renal
impairment, dose form not appropriate for initial dose titration; up
to 240 mg daily may be required
Dilcardia SR
c
(Generics) A
Capsules
, m/r, diltiazem hydrochloride 60 mg (pink/
white),
net price 56-cap pack = £6.03;
90 mg (pink/
yellow), 56-cap pack = £10.33; 120 mg (pink/orange),
56-cap pack = £11.49.
Label:
25
Dose
angina and mild to moderate hypertension,
initially 90 mg
twice daily; increased if necessary to 180 mg twice daily;
ELDERLY
and in hepatic or renal
impairment,
initially 60 mg twice daily,
max.
90 mg twice daily
Dilzem SR
c
(Cephalon) A
Capsules
,
m/r,
all beige, diltiazem hydrochloride
60 mg,
net price 56-cap pack = £6.03;
90 mg,
56-cap
pack = £11.29;
120 mg,
56-cap pack = £12.89.
Label:
25
Dose
angina and mild to moderate hypertension,
initially 90 mg
twice daily (elderly 60 mg twice daily);
up to 180 mg twice daily
may be required
Dilzem XL
c
(Cephalon) A
Capsules
,
m/r,
diltiazem hydrochloride 120 mg,
net
price 28-cap pack = £7.78;
180 mg,
28-cap pack =
£11.55;
240 mg,
28-cap pack = £11.03.
Label:
25
Dose
angina and mild to moderate hypertension, initially 180 mg
once daily (elderly and in hepatic and renal
impairment,
120 mg
once daily);
if necessary may be increased to 360 mg once daily
Slozem
c
(Merck Serono) A
Capsules
,
m/r,
diltiazem hydrochloride 120 mg
(pink/clear),
net price 28-cap pack = £7.00;
180 mg
(pink/clear), 28-cap pack = £7.80; 240 mg (red/clear),
28-cap pack = £8.20; 300 mg (red/white), 28-cap pack
= £8.50.
Label:
25
Dose
angina and mild to moderate hypertension, initially 240 mg
once daily (elderly and in hepatic and renal
impairment,
120 mg
once daily);
if necessary may be increased to 360 mg once daily
Tildiem LA
c
(Sanofi-Aventis) A
Capsules
,
m/r,
diltiazem hydrochloride 200 mg
(pink/grey, containing white pellets), net price 28-cap
pack = £6.27; 300 mg (white/yellow, containing white
pellets),
28-cap pack = £7.22.
Label:
25
Dose
angina and mild to moderate hypertension, initially 200 mg
once daily before or with food,
increased if necessary to 300–
400 mg daily, max.
500 mg daily;
ELDERLY and in hepatic or renal
impairment,
initially 200 mg daily,
increased if necessary to
300 mg daily
Tildiem Retard
c
(Sanofi-Aventis) A
Tablets
, m/r, diltiazem hydrochloride 90 mg, net price
56-tab pack = £7.27;
120 mg,
56-tab pack = £7.15.
Label:
25
Counselling
Tablet membrane may pass through gastro-intestinal
tract unchanged,
but being porous has no effect on efficacy
Dose
mild to moderate hypertension,
initially 90 mg or 120 mg
twice daily;
increased if necessary to 360 mg daily in divided
doses;
ELDERLY and in hepatic or renal
impairment,
initially
120 mg once daily;
increased if necessary to 120 mg twice daily
Angina,
initially 90 mg or 120 mg twice daily;
increased if neces-
sary to 480 mg daily in divided doses;
ELDERLY and in hepatic or
renal
impairment,
dose form not appropriate for initial
titration;
up to 120 mg twice daily may be required
Viazem XL
c
(Genus) A
Capsules
,
m/r,
diltiazem hydrochloride 120 mg
(lavender),
net price 28-cap pack = £6.60;
180 mg
(white/blue-green),
28-cap pack = £7.36;
240 mg
(blue-green/lavender),
28-cap pack = £7.74;
300 mg
(white/lavender), 28-cap pack = £8.03; 360 mg (blue-
green), 28-cap pack = £13.85.
Label:
25
Dose
angina and mild to moderate hypertension, initially 180 mg
once daily,
adjusted according to response to 240 mg once daily;
max.
360 mg once daily;
ELDERLY and in hepatic or renal impair-
ment, initially 120 mg once daily, adjusted according to response
Zemtard
c
(Galen) A
Zemtard 120XL capsules
,
m/r,
brown/orange,
dilti-
azem hydrochloride 120 mg,
net price 28-cap pack =
£6.10.
Label:
25
Zemtard 180XL capsules
,
m/r,
grey/pink,
diltiazem
hydrochloride 180 mg,
net price 28-cap pack = £6.20
Label:
25
Zemtard 240XL capsules
,
m/r,
blue,
diltiazem
hydrochloride 240 mg, net price 28-cap pack = £6.30.
Label:
25
Zemtard 300XL capsules
, m/r, white/blue, diltiazem
hydrochloride 300 mg, net price 28-cap pack = £6.70.
Label:
25
Dose
angina and mild to moderate hypertension,
180–300 mg
once daily,
increased if necessary to 360 mg once daily in hyper-
tension and to 480 mg once daily in angina;
ELDERLY and in
hepatic or renal impairment,
initially 120 mg once daily
FELODIPINE
Indications
hypertension,
prophylaxis of angina
Cautions
withdraw if ischaemic pain occurs or existing
pain worsens shortly after initiating treatment or if
cardiogenic shock develops;
severe left ventricular
dysfunction;
avoid grapefruit juice (may affect
metabolism); acute porphyria (but see section 9.8.2);
interactions: Appendix 1 (calcium-channel blockers)
Contra-indications
unstable angina,
uncontrolled
heart failure;
significant aortic stenosis;
within 1
month of myocardial infarction
Hepatic impairment
reduce dose
Pregnancy
avoid; toxicity in
animal
studies;
may
inhibit labour
Breast-feeding
present in milk
Side-effects
flushing, headache, palpitation, dizziness,
fatigue,
gravitational oedema; rarely rash,
pruritus,
cutaneous vasculitis,
gum hyperplasia,
urinary fre-
quency,
impotence,
fever
Dose
. Hypertension,
initially 5 mg (elderly 2.5 mg) daily in
the morning;
usual maintenance 5–10 mg once daily;
doses above 20 mg daily rarely needed
. Angina, initially 5 mg daily in the morning, increased if
necessary to 10 mg once daily
Felodipine
(Non-proprietary) A
Tablets
, m/r, felodipine 2.5 mg, net price 28-tab pack
= £6.31; 5 mg, 28-tab pack = £4.21; 10 mg, 28-tab pack
= £5.66,
30-tab pack = £12.87.
Label:
25
Brands include
Cardioplen XL
c
,
Felogen XL
c
,
Felotens XL
c
,
Keloc SR
c
,
Neofel XL
c
,
Parmid XL
c
,
Vascalpha
c
Plendil
c
(AstraZeneca) A
Tablets
, m/r, f/c, felodipine 2.5 mg (yellow), net price
28-tab pack = £6.31; 5 mg (pink), 28-tab pack = £4.21;
10 mg (brown),
28-tab pack = £5.66.
Label:
25
130
2.6.2 Calcium-channel blockers
BNF 61
2
Cardiovascular system