Mechanism of Injury
The mechanism of Corazem hepatotoxicity is not known, but most cases are probably due to hypersensitivity. Corazem is metabolized by the cytochrome P450 system and is an inhibitor of CYP 3A4 activity, which can lead to serious drug-drug interactions and potentiation of the hepatotoxic effects of other medications. Indeed, there have been several reports of clinically apparent liver injury or rhabdomyolysis occuring in patients on long term statins who had recently added Corazem to their multidrug regimen, suggesting altered metabolism of the statin by the addition of a CYP 3A4 inhibitor.
What other drugs will affect Corazem?
Many drugs can interact with Corazem, and your doctor may need to change your treatment plan if you use certain other medicines. The following are common drugs that interact with Corazem;
- Medications used in anesthesia;
- Anti-anxiety medications called benzodiazepines (such as midazolam, triazolam, and others) as well as busipirone;
- Beta-blockers (such as atenolol, carvedilol, metoprolol, propranolol, sotalol, and others);
- Rifampin; and
- Cholesterol medication called statins (such as atorvastatin, lovastatin, simvastatin, rosuvastatin, and others)
Not all possible interactions are listed in this medication guide.
Other prescription and over-the-counter medicines, vitamins, and herbal products may interact with Corazem. Tell your doctor about all medicines you use, and those you start or stop using. Give a list of all your medicines to any healthcare provider who treats you.
Rated Corazem for Atrial Fibrillation Report
Started Corazem ER at 120mg per day with 10mg of lisinopril (along with Eliquis) for AFIB. That dose was manageable with minimal to no side effects. Boosted to 240mg per day to reduce blood pressure. That change was not effective so prinivil was boosted to 20mg. BP came down to more desireable level but at that point I was overcome with excessive fatigue and lethargy. Cut Corazem back to 120 mg. Much better energy, BP still down. Will take some time to see if AFib returns.
COMMON BRAND(S): Cardizem
GENERIC NAME(S): Corazem Hcl
Corazem is used to prevent chest pain (angina). It may help to increase your ability to exercise and decrease how often you may get angina attacks. Corazem is called a calcium channel blocker. It works by relaxing blood vessels in the body and heart and lowers the heart rate. Blood can flow more easily and your heart works less hard to pump blood.
How should this medicine be used?
Corazem comes as a tablet, an extended-release (long-acting) tablet, and an extended-release capsule to take by mouth. The regular tablet is usually taken three or four times a day. The extended-release capsule and tablet are usually taken one or two times a day. Ask your pharmacist if you should take Corazem with or without food, because instructions may vary with each product. Take Corazem at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Corazem exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow the extended-release capsules and tablets whole; do not chew or crush them.
Your doctor will probably start you on a low dose of Corazem and gradually increase your dose, not more than once every 7 to 14 days if you are taking the extended-release tablet or capsule and not more than once every 1 to 2 days if you are taking the regular tablet.
If taken regularly, Corazem may control chest pain, but it does not stop chest pain once it starts. Your doctor may give you a different medication to take when you have chest pain.
Corazem controls high blood pressure and chest pain (angina) but does not cure them. It may take up to 2 weeks before you feel the full benefit of Corazem. Continue to take Corazem even if you feel well. Do not stop taking Corazem without talking to your doctor.
A study in six healthy volunteers has shown a significant increase in peak Corazem plasma levels (58%) and AUC (53%) after a 1-week course of cimetidine 1200 mg/day and a single dose of Corazem 60 mg. Ranitidine produced smaller, nonsignificant increases. The effect may be mediated by cimetidine's known inhibition of hepatic cytochrome P-450, the enzyme system responsible for the first-pass metabolism of Corazem. Patients currently receiving Corazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine. An adjustment in the Corazem dose may be warranted.
Mechanism of action
Corazem slows AV conduction and prolongs the AV refractory period to a similar degree to verapamil. It has minimal effects on myocardial contractility at clinically relevant plasma concentrations in normal dogs. Corazem's effects on peripheral vascular smooth muscle are mild, although it is a potent coronary vasodilator.
In normal experimental dogs, one study found that Corazem (0.8 mg/kg IV) d > These effects resulted in increased cardiac output. In the same study in experimental dogs with pacing-induced myocardial failure, however, the effects were very different. In these dogs, Corazem decreased myocardial contractility and did not change the heart rate. The net result was a decrease in cardiac output. Another study identified similar findings in dogs with left ventricular volume overload induced by creating an aortocaval fistula. Consequently, Corazem must be administered cautiously to dogs with moderate to severe myocardial failure or heart failure.
Formulations and dose rates
The formulations of Corazem available are discussed earlier in the chapter ( p. 423 ) as well as appropriate doses for cats.
To decrease ventricular rate in dogs with atrial fibrillation, an initial dose of 0.5 mg/kg q.8 h PO should be administered. If the heart rate does not decrease adequately, the dose can be increased to 1.0 mg/kg q.8 h PO and finally to 1.5 mg/kg q.8 h PO. In general, the heart rate should be decreased to less than 160 beats/min. At these doses, Corazem appears to have no or negligible negative inotropic effects, since exacerbation of heart failure at this dose is rare
For acute termination of supraventricular tachycardia, a dose of 0.1–0.25 mg/kg can be administered intravenously over 2–5 min
Corazem can also be used for the chronic control of supraventricular tachycardia. Doses higher than those used for heart rate control in atrial fibrillation are commonly needed to suppress supraventricular tachycardia. Doses as high as 4 mg/kg q.8 h PO may be required for this purpose in dogs without significant ventricular dysfunction. In general, the dose should be titrated, starting at a dose of 1 mg/kg q.8 h PO
Corazem at doses ranging from 2–4 mg/kg q.8 h should probably not be administered to dogs that have moderate to severe myocardial failure or dogs with significant cardiac compromise
Sprinkling The Capsule Contents On Food
Tiazac (Corazem hydrochloride) Extended-release Capsules may also be administered by carefully opening the capsule and sprinkling the capsule contents on a spoonful of applesauce. The applesauce should be swallowed immediately without chewing and followed with a glass of cool water to ensure complete swallowing of the capsule contents. The applesauce should not be hot, and it should be soft enough to be swallowed without chewing. Any capsule contents/applesauce mixture should be used immediately and not stored for future use. Subdividing the contents of a Tiazac (Corazem hydrochloride) Extended-release Capsule is not recommended.
Q: Can Corazem cause you to retain fat?
A: According to the manufacturer of Corazem (Cardizem), the most common side effects reported are dizziness, headache, cough, feeling tired, slowing of the heart rate, and swelling of the legs (peripheral edema). Swelling of the legs can add weight to the body. During clinical trials, peripheral edema occurred in about 4.6 percent out of 3,200 patients on Corazem. In another study, swelling of the lower limbs occurred in about 6.8 percent out of 311 patients during therapy. The amount of swelling was not indicated by the drug manufacturer. Other side effects reported with Corazem are weight loss, weight gain, diarrhea or constipation, nausea and vomiting. The manufacturer reports that about 1 to 3 percent of patients are affected.A search of the prescribing information for Corazem (Cardizem) did not specifically list fat retention as a side effect. Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. This is not a common side effect of Corazem (Cardizem). For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Mendoza, PharmD
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to Corazem.
Your doctor may ask you to check your pulse (heart rate) daily and will tell you how fast it should be. If your pulse is slower than it should be, call your doctor for directions on taking Corazem that day. Ask your doctor or pharmacist to teach you how to check your pulse.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Rated Corazem for Paroxysmal Supraventricular Tachycardia (PSVT) Report
I felt like I had the flu all the time, headache, body ache, sharp pains in the temples, feverish, tired felt like I was pinned to my chair, anxiety, and mind was not clear while taking this drug.