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Verapamil| IV Dose | 0.075-0.150 mg/kg (max 10 mg) over 1-2 minutes. | | Oral dose | 4-17 mg/kg/day divided q 8 hours (BID or QD with slow release form) | | Levels | 0.1-0.3 ug/ml. | | Kinetics | Zero-order (half-life related to dose). Extensive first-pass metabolism. Elimination half-life 12 hours on chronic oral therapy, but 6 hours after single dose. | | Cautions | Do not use under 12 months of age, especially under 3 months, hypotension, CV collapse, death).
Use with caution long-term in patients with manifest preexcitation. (conversion of SVT is OK).
Do not pre-treat with calcium chloride, as it interferes with the therapeutic effect. Be prepared with calcium, fluids and dopamine if hypotension occurs following administration. | | Interactions | Contraindicated with beta blockers, due to synergistic negative inotropy.
Contraindicated with quinidine, due to synergistic negative inotropy. Increases digoxin levels 40-75% (quinidine-like). Therapeutic effect blocked by anticholinergic properties of disopyramide | | Preparations | Calan scored tablets: 80, 120 mg.
Calan SR scored tablets: 240 mg.
Calan injection: 5 mg/2 ml, 10 mg/4 ml amps, vials.
Isoptin: same
Verelan pellet-filled capsules: 120, 240 mg. (QD dosing) | | FDA approval in children | no |
Diltiazem| IV Dose | Initial bolus 0.25 mg/kg over 2 min (average 20 mg in adults). Second dose of 0.35 mg/kg over 2 minutes may be given (average 25 mg)
Continuous infusion: 5-15 mg/hr (usual 10 mg/hour) in adults. No pediatric dose. (suggest 0.125 mg/kg/hr = 2 ug/kg/min). | | Oral dose | 30-90 mg QID of short-acting preparation
60-180 mg BID of "SR" preparation
180-360 mg QD of "CD" preparation | | Levels | Therapeutic range undefined | | Kinetics | Maximum effect 2-5 minutes after bolus injection.
Plasma half-life 3-4.5 hours. Metabolized in lever, excreted in urine. | | Cautions | Same cautions as with verapamil. May be better tolerated with beta blockers than verapamil. Avoid in young children. | | Interactions | Increases levels of propranolol, digoxin (20%), cyclosporin, carbamazepine. Levels increased by cimetidine | | Preparations | Cardizem injectable, vials 25 mg/5 cc or 50 mg/10 cc.
Cardizem tablets, 30 mg (non-scored), 60, 90, 120 mg(scored).
Cardizem SR capsules, 60, 90, 120 mg
Cardizem CD capsules, 120, 180, 240, 300 mg. | | FDA approval in children | no |
Verapamil| IV Dose | 0.075-0.150 mg/kg (max 10 mg) over 1-2 minutes. | | Oral dose | 4-17 mg/kg/day divided q 8 hours (BID or QD with slow release form) | | Levels | 0.1-0.3 ug/ml. | | Kinetics | Zero-order (half-life related to dose). Extensive first-pass metabolism. Elimination half-life 12 hours on chronic oral therapy, but 6 hours after single dose. | | Cautions | Do not use under 12 months of age, especially under 3 months, hypotension, CV collapse, death).
Use with caution long-term in patients with manifest preexcitation. (conversion of SVT is OK).
Do not pre-treat with calcium chloride, as it interferes with the therapeutic effect. Be prepared with calcium, fluids and dopamine if hypotension occurs following administration. | | Interactions | Contraindicated with beta blockers, due to synergistic negative inotropy.
Contraindicated with quinidine, due to synergistic negative inotropy. Increases digoxin levels 40-75% (quinidine-like). Therapeutic effect blocked by anticholinergic properties of disopyramide | | Preparations | Calan scored tablets: 80, 120 mg.
Calan SR scored tablets: 240 mg.
Calan injection: 5 mg/2 ml, 10 mg/4 ml amps, vials.
Isoptin: same
Verelan pellet-filled capsules: 120, 240 mg. (QD dosing) | | FDA approval in children | no |
Diltiazem| IV Dose | Initial bolus 0.25 mg/kg over 2 min (average 20 mg in adults). Second dose of 0.35 mg/kg over 2 minutes may be given (average 25 mg)
Continuous infusion: 5-15 mg/hr (usual 10 mg/hour) in adults. No pediatric dose. (suggest 0.125 mg/kg/hr = 2 ug/kg/min). | | Oral dose | 30-90 mg QID of short-acting preparation
60-180 mg BID of "SR" preparation
180-360 mg QD of "CD" preparation | | Levels | Therapeutic range undefined | | Kinetics | Maximum effect 2-5 minutes after bolus injection.
Plasma half-life 3-4.5 hours. Metabolized in lever, excreted in urine. | | Cautions | Same cautions as with verapamil. May be better tolerated with beta blockers than verapamil. Avoid in young children. | | Interactions | Increases levels of propranolol, digoxin (20%), cyclosporin, carbamazepine. Levels increased by cimetidine | | Preparations | Cardizem injectable, vials 25 mg/5 cc or 50 mg/10 cc.
Cardizem tablets, 30 mg (non-scored), 60, 90, 120 mg(scored).
Cardizem SR capsules, 60, 90, 120 mg
Cardizem CD capsules, 120, 180, 240, 300 mg. | | FDA approval in children | no |
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