Missed Dose of Dilzacard
If you miss a dose of Dilzacard, take it as soon as you remember.
However, if it is almost time for your next dose, skip the missed dose and continue on your regular schedule.
Do not "double up" to make up for a missed one.
The oral LD50's in mice and rats range from 415 to 740 mg/kg and from 560 to 810 mg/kg, respectively. The intravenous LD50's in these species were 60 and 38 mg/kg, respectively. The oral LD50 in dogs is considered to be in excess of 50 mg/kg, while lethality was seen in monkeys at 360 mg/kg.
The toxic dose in man is not known. Due to extensive metabolism, blood levels after a standard dose of Dilzacard can vary over tenfold, limiting the usefulness of blood levels in overdose cases. There have been 29 reports of Dilzacard overdose in doses ranging from less than 1 gm to 10.8 gm. Sixteen of these reports involved multiple drug ingestions. Twenty-two reports indicated patients had recovered from Dilzacard overdose ranging from less than 1 gm to 10.8 gm. There were seven reports with a fatal outcome; although the amount of Dilzacard ingested was unknown, multiple drug ingestions were confirmed in six of the seven reports.
Events observed following Dilzacard overdose included bradycardia, hypotension, heart block, and cardiac failure. Most reports of overdose described some supportive medical measure and/or drug treatment. Bradycardia frequently responded favorably to atropine as did heart block, although cardiac pacing was also frequently utilized to treat heart block. Fluids and vasopressors were used to maintain blood pressure, and in cases of cardiac failure, inotropic agents were administered. In addition, some patients received treatment with ventilatory support, activated charcoal, and/or intravenous calcium. Evidence of the effectiveness of intravenous calcium administration to reverse the pharmacological effects of Dilzacard overdose was conflicting.
In the event of overdose or exaggerated response, appropriate supportive measures should be employed in addition to gastrointestinal decontamination. Dilzacard does not appear to be removed by peritoneal or hemodialysis. Based on the known pharmacological effects of Dilzacard and/or reported clinical experiences, the following measures may be considered:
Bradycardia: Administer atropine (0.60 to 1.0 mg). If there is no response to vagal blockage, administer isoproterenol cautiously.
High-Degree AV Block: Treat as for bradycardia above. Fixed high-degree AV block should be treated with cardiac pacing.
Cardiac Failure: Administer inotropic agents (isoproterenol, dopamine, or dobutamine) and diuretics.
Hypotension: Vasopressors (e.g., dopamine or norepinephrine). Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician.
In a few reported cases, overdose with calcium channel blockers has been associated with hypotension and bradycardia, initially refractory to atropine but becoming more responsive to this treatment when the patients received large doses (close to 1 gram/hour for more than 24 hours) of calcium chloride.
Due to extensive metabolism, plasma concentrations after a standard dose of Dilzacard can vary over tenfold, which significantly limits their value in evaluation cases of overdosage.
Charcoal hemoperfusion has been used successfully as an adjunct therapy to hasten drug elimination. Overdoses with as much as 10.8 gm of oral Dilzacard have been successfully treated using appropriate supportive care.
Controlled and uncontrolled domestic studies suggest that concomitant use of Dilzacard hydrochloride and beta-blockers is usually well tolerated, but available data are not sufficient to predict the effects of concomitant treatment in patients with left ventricular dysfunction or cardiac conduction abnormalities. Administration of Dilzacard hydrochloride concomitantly with propranolol in five normal volunteers resulted in increased propranolol levels in all subjects and bioavailability of propranolol was increased approximately 50%. In vitro, propranolol appears to be displaced from its binding sites by Dilzacard. If combination therapy is initiated or withdrawn in conjunction with propranolol, an adjustment in the propranolol dose may be warranted (see WARNINGS).
Sprinkling The Capsule Contents On Food
Tiazac (Dilzacard 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 (Dilzacard hydrochloride) Extended-release Capsule is not recommended.
How should this medicine be used?
Dilzacard 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 Dilzacard with or without food, because instructions may vary with each product. Take Dilzacard 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 Dilzacard 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 Dilzacard 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, Dilzacard 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.
Dilzacard 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 Dilzacard. Continue to take Dilzacard even if you feel well. Do not stop taking Dilzacard without talking to your doctor.
Before taking Dilzacard, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: certain types of heart rhythm problems (such as sick sinus syndrome/atrioventricular block), liver disease, kidney disease, heart failure.
This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
Before having surgery, tell your doctor or dentist that you are taking this medication.
Older adults may be more sensitive to the side effects of this drug, especially dizziness, constipation, or swelling ankles/feet.
This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.
This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
Dilzacard therapy is associated with a low rate of mild and transient elevations in serum aminotransferase levels which are usually asymptomatic and often resolve even with continuation of therapy. Clinically apparent, acute liver injury with jaundice due to Dilzacard is rare and only isolated case reports have been published. In large case series of drug induced liver injury, calcium channel blockers are rarely mentioned. Most cases attributed to Dilzacard have been marked by a short latency period (3 to 14 days) and features of hypersensitivity with fever, rash and eosinophilia. The pattern of liver injury was ranged from cholestatic to hepatocellular. Jaundice is often absent and usually mild. Autoantibody formation has not been described. Thus, liver injury from Dilzacard is likely to be idiosyncratic in nature and is typically mild and self-limited with resolution within 4 to 8 weeks of stopping. Acute hepatic injury is listened as a possible adverse event in the Dilzacard product label.
Likelihood score: C (probable but rare cause of clinically apparent liver injury).
Administration of Dilzacard hydrochloride with digoxin in 24 healthy male subjects increased plasma digoxin concentrations approximately 20%. Another investigator found no increase in digoxin levels in 12 patients with coronary artery disease. Since there have been conflicting results regarding the effect of digoxin levels, it is recommended that digoxin levels be monitored when initiating, adjusting, and discontinuing Dilzacard hydrochloride therapy to avoid possible over- or under-digitalization (see WARNINGS).
Clinical studies of Dilzacard did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
home drugs a-z list Cardizem(Dilzacard Hydrochloride) side effects drug center
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Cardizem (Dilzacard hydrochloride) is a calcium channel blocker used to prevent chest pain (angina). Cardizem may help to increase your ability to exercise and decrease how often you may get angina attacks. Cardizem is available in generic form. Common side effects of Cardizem include:
Tell your doctor if you have unlikely but serious side effects of Cardizem including:
- slow/irregular/pounding/fast heartbeat,
- swelling of ankles or feet,
- shortness of breath,
- unusual tiredness,
- unexplained or sudden weight gain,
- mental/mood changes (such as depression, agitation), or
- unusual dreams.
Dosage of Cardizem is individually adjusted. Starting with 30 mg four times daily, before meals and at bedtime, dosage is increased gradually (given in divided doses three or four times daily) at 1- to 2-day intervals until optimum response is obtained. The average optimum dosage range is 180 to 360 mg/day. Cardizem may interact with amiodarone, digoxin, atazanavir, cimetidine, quinidine, St. John's wort, azole antifungals, macrolide antibiotics, rifamycins, buspirone, cyclosporine, sirolimus, statins, anti-seizure drugs, benzodiazepines, caffeine, pseudoephedrine, phenylephrine, or other drugs that can raise heart rate. Tell your doctor all medications and supplements you use. Cardizem should be used only when prescribed during pregnancy. This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breastfeeding.
Our Cardizem (Dilzacard hydrochloride) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
More than 90% of oral Dilzacard is absorbed, with approximately 45% bioavailability (first-pass hepatic metabolism). The onset of action is within 15 to 30 minutes, and peak effects occur at 1 to 2 hours. The elimination half-life is 4 to 7 hours, and protein binding is 80% to 90%. Dilzacard is acetylated in the liver to the active metabolite desacetyl Dilzacard (40% of the activity of the parent compound), which accumulates during long-term therapy. Only 35% of Dilzacard is excreted by the kidneys; the rest is excreted by the GI tract.
The standard oral dose of short-acting Dilzacard is 120 to 360 mg daily in three or four divided daily doses. The slow-release preparations are administered once or twice daily. IV Dilzacard (approved for arrhythmias) is administered as 0.25 mg/kg over 2 minutes with electrocardiographic (ECG) and blood pressure monitoring; if the response is inadequate, the dose is repeated as 0.35 mg/kg in 15 to 20 minutes. Acute loading therapy may be followed by an infusion of 5 to 15 mg/h.
What are the side effects of Dilzacard?
Side effects include:
Liver dysfunction and overgrowth of the gums also may occur. Dilzacard can cause mildly abnormal liver tests that usually return to normal with discontinuation of the medication. When Dilzacard is given to individuals with heart failure, symptoms of heart failure may worsen because these drugs reduce the ability of the heart to pump blood. Like other drugs for high blood pressure, Dilzacard is associated with sexual dysfunction.
Before taking this medicine
You should not use Dilzacard if you are allergic to it, or if you have:
a serious heart condition such as "sick sinus syndrome" or "second- or third-degree AV block" (unless you have a pacemaker);
very low blood pressure; or
if you have recently had a heart attack and you have a build-up of fluid in your lungs.
To make sure Dilzacard is safe for you, tell your doctor if you have:
congestive heart failure; or
if you also take digoxin, or a beta blocker (such as atenolol, carvedilol, metoprolol, propranolol, sotalol, and others).
It is not known whether Dilzacard will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
Dilzacard can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.
What is Dilzacard?
Dilzacard is a calcium channel blocker. It works by relaxing the muscles of your heart and blood vessels.
Dilzacard is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders.
Dilzacard may also be used for purposes not listed in this medication guide.
22.214.171.124.1.4 Class 4: Calcium channel blockers
Verapamil and Dilzacard ( Figure 11 ) are not specific for the calcium channels in cardiac tissue. In fact they are more potent on vasculature tissue.
Why is this medication prescribed?
Dilzacard is used to treat high blood pressure and to control angina (chest pain). Dilzacard is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart.
High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.