Dilor

Generic Name: dyphylline (Oral route)

DYE-fi-lin

Commonly used brand name(s)

In the U.S.

• Dilor-200


• Dilor-400


• Dylix


• Lufyllin


• Lufyllin-400

In Canada

• Protophylline Alcohol And Sugar Free

Available Dosage Forms:

• Tablet


• Elixir

Therapeutic Class: Bronchodilator

Chemical Class: Methylxanthine

Uses For Dilor

Dyphylline is used to treat and/or prevent the symptoms of bronchial asthma, chronic bronchitis, and emphysema. It works by opening up the bronchial tubes (air passages of the lungs) and increasing the flow of air through them.

This medicine is available only with your doctor's prescription.

Before Using Dilor

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Use of other bronchodilator medicines is preferred.

Geriatric

As in younger patients, use of other bronchodilator medicines is preferred. Also, older patients with kidney disease may require a lower dose of dyphylline than do older adults without kidney disease.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Heart or blood vessel disease or


• Stomach ulcer (or history of) or other stomach problems—May make these conditions worse.

• Heart failure or


• Kidney disease—The effects of the medicine may be increased.

Proper Use of dyphylline

This section provides information on the proper use of a number of products that contain dyphylline. It may not be specific to Dilor. Please read with care.

This medicine works best when there is a constant amount in the blood. To help keep the amount constant, dyphylline must be taken at regularly spaced times, as ordered by your doctor. Do not miss any doses.

This medicine also works best when taken with a glass of water on an empty stomach (either 30 minutes to 1 hour before meals or 2 hours after meals). However, in some cases your doctor may want you to take this medicine with meals or right after meals to lessen stomach upset.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage forms (elixir or tablets):
  
  • For asthma, bronchitis, or emphysema:
    
    • Adults—Dose is based on body weight. The usual dose is 15 milligrams (mg) per kilogram (kg) of body weight up to four times per day.
    
    
    • Children—Dose must be determined by your doctor.
    
    
  
  

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Do not refrigerate. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Dilor

Your doctor will check your progress at regular visits, especially during the first few weeks of your treatment with this medicine.

Before you have any kind of surgery that requires general anesthesia, tell the medical doctor in charge that you are using this medicine.

Dilor Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common

• Heartburn


• vomiting

Symptoms of overdose

• Abdominal pain (continuing or severe)


• confusion or change in behavior


• convulsions (seizures)


• dark or bloody vomit


• diarrhea


• fast or irregular heartbeat


• nervousness or restlessness (continuing)


• trembling (continuing)

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

• Fast heartbeat


• headache


• increased urination


• nausea


• nervousness


• trembling


• trouble with sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Dilor side effects (in more detail)

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

More Dilor resources

• Dilor Side Effects (in more detail)
• Dilor Use in Pregnancy & Breastfeeding
• Drug Images
• Dilor Drug Interactions
• Dilor Support Group
• 0 Reviews for Dilor - Add your own review/rating

• Dilor MedFacts Consumer Leaflet (Wolters Kluwer)


• Dilor Concise Consumer Information (Cerner Multum)


• Dyphylline Professional Patient Advice (Wolters Kluwer)


• Dylix Elixir MedFacts Consumer Leaflet (Wolters Kluwer)


• Lufyllin Prescribing Information (FDA)

Compare Dilor with other medications

• Asthma
• Bronchitis
• COPD

Dimetapp Allergy Sinus

Generic Name: acetaminophen/brompheniramine/phenylpropanolamine (a see ta MIH noe fen/brome feh NEER a meen/fen ill proe pa NOLE a meen)

Brand Names: Dimetapp Allergy Sinus, Dimetapp Cold and Flu

What is Dimetapp Allergy Sinus (acetaminophen/brompheniramine/phenylpropanolamine)?

Acetaminophen is a pain reliever and a fever reducer. It is used to treat many conditions, such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers.

Brompheniramine is an antihistamine. It blocks the effects of the naturally occurring chemical histamine in the body. Brompheniramine prevents sneezing; itchy, watery eyes and nose; and other symptoms of allergies and hay fever.

Phenylpropanolamine is a decongestant. It constricts (shrinks) blood vessels (veins and arteries). This reduces the blood flow to certain areas, which allows nasal passages to open up.

Acetaminophen/brompheniramine/phenylpropanolamine is used to treat nasal congestion; itchy, watery eyes; itchy throat; sneezing; headache; fever; and other symptoms associated with allergies, hay fever, and the common cold.

Phenylpropanolamine, an ingredient in this product, has been associated with an increased risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain) in women. Men may also be at risk. Although the risk of hemorrhagic stroke is low, the U.S. Food and Drug Administration (FDA) recommends that consumers not use any products that contain phenylpropanolamine.

Acetaminophen/brompheniramine/phenylpropanolamine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Dimetapp Allergy Sinus (acetaminophen/brompheniramine/phenylpropanolamine)?

Phenylpropanolamine, an ingredient in this product, has been associated with an increased risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain) in women. Men may also be at risk. Although the risk of hemorrhagic stroke is low, the U.S. Food and Drug Administration (FDA) recommends that consumers not use any products that contain phenylpropanolamine.

Use caution when driving, operating machinery, or performing other hazardous activities. Acetaminophen/brompheniramine/phenylpropanolamine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking acetaminophen/brompheniramine/phenylpropanolamine. Alcohol may also cause damage to the liver when taken with acetaminophen.

Who should not take Dimetapp Allergy Sinus (acetaminophen/brompheniramine/phenylpropanolamine)?

Do not take this medication without first talking to your doctor if you drink more than three alcoholic beverages per day or if you have had alcoholic liver disease. You may not be able to take acetaminophen if you have these conditions. Do not take acetaminophen/brompheniramine/phenylpropanolamine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

Before taking this medication, tell your doctor if you have

• kidney disease,


• liver disease,


• 
  

  diabetes,

  
  


• 
  

  glaucoma,

  
  


• 
  

  any type of heart disease or high blood pressure,

  
  


• 
  

  thyroid disease,

  
  


• 
  

  emphysema or chronic bronchitis, or

  
  


• 
  

  difficulty urinating or have an enlarged prostate.

  
  

You may not be able to take acetaminophen/brompheniramine/phenylpropanolamine, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

It is not known whether acetaminophen/brompheniramine/phenylpropanolamine will harm an unborn baby. Do not take acetaminophen/brompheniramine/phenylpropanolamine without first talking to your doctor if you are pregnant. This medication passes into breast milk and can harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects from acetaminophen/brompheniramine/phenylpropanolamine. Read the package label for directions or consult your doctor or pharmacist before treating a child with this medication. Children are more susceptible than adults to the effects of medicines and may have unusual reactions.

How should I take Dimetapp Allergy Sinus (acetaminophen/brompheniramine/phenylpropanolamine)?

Take acetaminophen/brompheniramine/phenylpropanolamine exactly as directed. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Do not crush, chew, or break the long-acting or sustained-release tablets or capsules. Swallow them whole. If you are unsure about the formulation of the medicine, ask your pharmacist for help. If you have difficulty swallowing tablets or capsules, look for a liquid form of the medication.

To ensure that you get a correct dose, measure the liquid forms of acetaminophen/brompheniramine/phenylpropanolamine with a special dose-measuring spoon or cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

Never take more of this medication than is directed. The maximum amount of acetaminophen for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Taking more acetaminophen could damage your liver. If you drink more than three alcoholic beverages per day, talk to your doctor before taking acetaminophen and never take more than 2 grams (2000 mg) per day.

Do not take acetaminophen/brompheniramine/phenylpropanolamine for longer than 7 to 10 days in a row. If your symptoms do not improve, if they get worse, or if you have a fever, see your doctor.

Store acetaminophen/brompheniramine/phenylpropanolamine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of an acetaminophen/brompheniramine/phenylpropanolamine overdose include a dry mouth, large pupils, flushing, nausea, vomiting, abdominal pain, diarrhea, seizures, confusion, sweating, and an irregular heartbeat.

What should I avoid while taking Dimetapp Allergy Sinus (acetaminophen/brompheniramine/phenylpropanolamine)?

Use caution when driving, operating machinery, or performing other hazardous activities. Acetaminophen/brompheniramine/phenylpropanolamine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking acetaminophen/brompheniramine/phenylpropanolamine. Alcohol may also cause damage to the liver when taken with acetaminophen.

Acetaminophen/brompheniramine/phenylpropanolamine may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, other antihistamines, pain relievers, anxiety medicines, seizure medicines, and muscle relaxants. Dangerous sedation, dizziness, or drowsiness may occur if acetaminophen/brompheniramine/phenylpropanolamine is taken with any of these medications.

Dimetapp Allergy Sinus (acetaminophen/brompheniramine/phenylpropanolamine) side effects

If you experience any of the following serious side effects, stop taking acetaminophen/brompheniramine/phenylpropanolamine and seek emergency medical attention or contact your doctor immediately:

• 
  

  an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

  
  


• 
  

  liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, or severe fatigue);

  
  


• 
  

  blood problems (easy or unusual bleeding or bruising); or

  
  


• 
  

  low blood sugar (fatigue, increased hunger or thirst, dizziness, or fainting).

  
  

Other, less serious side effects may be more likely to occur including:

• 
  

  dryness of the eyes, nose, and mouth;

  
  


• 
  

  drowsiness or dizziness;

  
  


• 
  

  blurred vision;

  
  


• 
  

  difficulty urinating; or

  
  


• 
  

  excitation in children.

  
  

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Dimetapp Allergy Sinus (acetaminophen/brompheniramine/phenylpropanolamine)?

Do not take acetaminophen/brompheniramine/phenylpropanolamine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

Urine glucose tests for diabetics may produce false results while taking acetaminophen. Talk to your doctor if you have diabetes and you notice changes in blood glucose levels during therapy with acetaminophen/brompheniramine/phenylpropanolamine.

Do not take other over-the-counter cough, cold, allergy, diet, pain, or sleep medicines while taking acetaminophen/brompheniramine/phenylpropanolamine without first talking to your doctor or pharmacist. Other medications may also contain brompheniramine, phenylpropanolamine, acetaminophen, or other similar drugs, and you may accidentally take too much of these medicines.

Acetaminophen/brompheniramine/phenylpropanolamine may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, other antihistamines, pain relievers, anxiety medicines, seizure medicines, and muscle relaxants. Dangerous sedation, dizziness, or drowsiness may occur if acetaminophen/brompheniramine/phenylpropanolamine is taken with any of these medications.

Drugs other than those listed here may also interact with acetaminophen/brompheniramine/phenylpropanolamine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More Dimetapp Allergy Sinus resources

• Dimetapp Allergy Sinus Drug Interactions
• Dimetapp Allergy Sinus Support Group
• 0 Reviews · Be the first to review/rate this drug

Where can I get more information?

• Your pharmacist has additional information about acetaminophen/brompheniramine/phenylpropanolamine written for health professionals that you may read.

What does my medication look like?

Acetaminophen/brompheniramine/phenylpropanolamine is available over-the-counter under the brand names Dimetapp Cold and Flu and Dimetapp Allergy Sinus. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Dihydroxyaluminum Sodium Chewable Tablets

Pronunciation: dye-hye-DROX-ee-a-LOO-mi-num SOE-dee-um
Generic Name: Dihydroxyaluminum Sodium
Brand Name: Rolaids

Dihydroxyaluminum Sodium Chewable Tablets are used for:

Treating acid indigestion, heartburn, and sour stomach. It may also be used for other conditions as determined by your doctor.

Dihydroxyaluminum Sodium Chewable Tablets are an antacid. It works by neutralizing acid in the stomach.

Do NOT use Dihydroxyaluminum Sodium Chewable Tablets if:

• you are allergic to any ingredient in Dihydroxyaluminum Sodium Chewable Tablets


• you are taking citrate salts (found in some calcium supplements, antacids, and laxatives)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Dihydroxyaluminum Sodium Chewable Tablets:

Some medical conditions may interact with Dihydroxyaluminum Sodium Chewable Tablets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you have Alzheimer disease, appendicitis, constipation, a blockage of your bowel, low blood phosphate levels, or kidney problems

Some MEDICINES MAY INTERACT with Dihydroxyaluminum Sodium Chewable Tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Cation exchange resins (eg, sodium polystyrene sulfonate) and citrate salts (found in some calcium supplements, antacids, and laxatives) because the actions and side effects of Dihydroxyaluminum Sodium Chewable Tablets may be increased


• Bisphosphonates (eg, risedronate), cephalosporins (eg, cephalexin), imidazoles (eg, ketoconazole), mycophenolate, penicillamine, quinolones (eg, ciprofloxacin), tetracyclines (eg, doxycycline), or thyroid hormones (eg, levothyroxine) because the effectiveness of these medicines may be decreased, especially when taken at the same time as Dihydroxyaluminum Sodium Chewable Tablets

This may not be a complete list of all interactions that may occur. Ask your health care provider if Dihydroxyaluminum Sodium Chewable Tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Dihydroxyaluminum Sodium Chewable Tablets:

Use Dihydroxyaluminum Sodium Chewable Tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Dihydroxyaluminum Sodium Chewable Tablets may be taken with or without food.


• Chew thoroughly before swallowing.


• Do not use Dihydroxyaluminum Sodium Chewable Tablets within 2 hours before or after taking a bisphosphonate (eg, risedronate), cephalosporin (eg, cephalexin), imidazole (eg, ketoconazole), or penicillamine because dihydroxyaluminum may decrease the effectiveness of these medicines.


• If you miss a dose of Dihydroxyaluminum Sodium Chewable Tablets and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Dihydroxyaluminum Sodium Chewable Tablets.

Important safety information:

• Do not exceed the recommended dose or use the maximum dose for more than 2 weeks without checking with your doctor.


• If your symptoms do not improve within 2 weeks or if they become worse, or if you experience black, tarry stools or vomit that looks like coffee grounds, check with your doctor.


• Dihydroxyaluminum Sodium Chewable Tablets contains aluminum. Before you begin taking any new prescription or over-the-counter medicine, read the ingredients to see if it also contains aluminum. If it does or if you are uncertain, contact your doctor or pharmacist.


• PREGNANCY and BREAST-FEEDING: It is unknown if Dihydroxyaluminum Sodium Chewable Tablets can cause harm to the fetus. If you become pregnant while taking Dihydroxyaluminum Sodium Chewable Tablets, discuss with your doctor the benefits and risks of using Dihydroxyaluminum Sodium Chewable Tablets during pregnancy. It is unknown if Dihydroxyaluminum Sodium Chewable Tablets are excreted in breast milk. If you are or will be breast-feeding while you are using Dihydroxyaluminum Sodium Chewable Tablets, check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects of Dihydroxyaluminum Sodium Chewable Tablets:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); loss of appetite; muscle weakness; nausea; slow reflexes; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Dihydroxyaluminum Sodium side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Dihydroxyaluminum Sodium Chewable Tablets:

Store Dihydroxyaluminum Sodium Chewable Tablets in a tightly closed container at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Dihydroxyaluminum Sodium Chewable Tablets out of the reach of children and away from pets.

General information:

• If you have any questions about Dihydroxyaluminum Sodium Chewable Tablets, please talk with your doctor, pharmacist, or other health care provider.


• Dihydroxyaluminum Sodium Chewable Tablets are to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Dihydroxyaluminum Sodium Chewable Tablets. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Dihydroxyaluminum Sodium resources

• Dihydroxyaluminum Sodium Side Effects (in more detail)
• Dihydroxyaluminum Sodium Use in Pregnancy & Breastfeeding
• Dihydroxyaluminum Sodium Drug Interactions
• Dihydroxyaluminum Sodium Support Group
• 0 Reviews · Be the first to review/rate this drug

Dimetapp Elixir

Pronunciation: brome-fen-EER-ah-meen/soo-doe-eh-FED-rin
Generic Name: Brompheniramine/Pseudoephedrine
Brand Name: Examples include Cardec and Dimetapp

Dimetapp Elixir is used for:

Relieving symptoms of sinus congestion, pressure, runny nose, and sneezing due to colds, upper respiratory infections, and allergies. It may also be used for other conditions as determined by your doctor.

Dimetapp Elixir is an antihistamine and decongestant combination. The antihistamine works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing. The decongestant promotes sinus and nasal drainage, which relieves congestion and pressure.

Do NOT use Dimetapp Elixir if:

• you are allergic to any ingredient in Dimetapp Elixir


• you have severe high blood pressure, severe heart blood vessel disease, rapid heartbeat, or severe heart problems


• you take sodium oxybate (GHB) or if you have taken furazolidone or a monoamine oxidase (MAO) inhibitor (eg, phenelzine) within the last 14 days

Contact your doctor or health care provider right away if any of these apply to you.

Before using Dimetapp Elixir:

Some medical conditions may interact with Dimetapp Elixir. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you have a fast, slow, or irregular heartbeat; heart blood vessel problems; or other heart problems


• if you have a history of asthma; lung problems (eg, emphysema); adrenal gland problems (eg, adrenal gland tumor); high blood pressure; diabetes; stroke; glaucoma; a blockage of your stomach, bladder, or intestines; ulcers; trouble urinating; an enlarged prostate; seizures; or an overactive thyroid

Some MEDICINES MAY INTERACT with Dimetapp Elixir. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Beta-blockers (eg, propranolol), COMT inhibitors (eg, tolcapone), furazolidone, indomethacin, MAO inhibitors (eg, phenelzine), sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because side effects of Dimetapp Elixir may be increased


• Digoxin or droxidopa because the risk of irregular heartbeat or heart attack may be increased


• Bromocriptine or hydantoins (eg, phenytoin) because side effects may be increased by Dimetapp Elixir


• Guanadrel, guanethidine, methyldopa, mecamylamine, or reserpine because effectiveness may be decreased by Dimetapp Elixir

This may not be a complete list of all interactions that may occur. Ask your health care provider if Dimetapp Elixir may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Dimetapp Elixir:

Use Dimetapp Elixir as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Dimetapp Elixir may be taken with or without food.


• Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.


• If you miss a dose of Dimetapp Elixir, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Dimetapp Elixir.

Important safety information:

• Dimetapp Elixir may cause dizziness, drowsiness, or blurred vision. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Dimetapp Elixir. Using Dimetapp Elixir alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.


• Do not take diet or appetite control medicines while you are taking Dimetapp Elixir without checking with your doctor.


• Dimetapp Elixir contains pseudoephedrine. Before you begin taking any new prescription or nonprescription medicine, read the ingredients to see if it also contains pseudoephedrine. If it does or if you are uncertain, contact your doctor or pharmacist.


• Do NOT exceed the recommended dose or take Dimetapp Elixir for longer than prescribed without checking with your doctor.


• If your symptoms do not improve within 5 to 7 days or if they become worse, check with your doctor.


• Dimetapp Elixir may cause increased sensitivity to the sun. Avoid exposure to the sun, sunlamps, or tanning booths until you know how you react to Dimetapp Elixir. Use a sunscreen or protective clothing if you must be outside for a prolonged period.


• If you are scheduled for allergy skin testing, do not take Dimetapp Elixir for several days before the test because it may decrease your response to the skin tests.


• Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Dimetapp Elixir.


• Use Dimetapp Elixir with caution in the ELDERLY because they may be more sensitive to its effects.


• Caution is advised when using Dimetapp Elixir in CHILDREN because they may be more sensitive to its effects.


• PREGNANCY and BREAST-FEEDING: If you become pregnant while taking Dimetapp Elixir, discuss with your doctor the benefits and risks of using Dimetapp Elixir during pregnancy. It is unknown if Dimetapp Elixir is excreted in breast milk. Do not breast-feed while taking Dimetapp Elixir.

Possible side effects of Dimetapp Elixir:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; excitability; headache; loss of appetite; nausea; nervousness or anxiety; trouble sleeping; upset stomach; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); difficulty urinating or inability to urinate; fast or irregular heartbeat; hallucinations; seizures; severe dizziness, lightheadedness, or headache; tremor; trouble sleeping; vision changes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Dimetapp side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include blurred vision; confusion; hallucinations; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; unusually fast, slow, or irregular heartbeat; vomiting.

Proper storage of Dimetapp Elixir:

Store Dimetapp Elixir at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Dimetapp Elixir out of the reach of children and away from pets.

General information:

• If you have any questions about Dimetapp Elixir, please talk with your doctor, pharmacist, or other health care provider.


• Dimetapp Elixir is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Dimetapp Elixir. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Dimetapp resources

• Dimetapp Side Effects (in more detail)
• Dimetapp Use in Pregnancy & Breastfeeding
• Dimetapp Drug Interactions
• Dimetapp Support Group
• 6 Reviews for Dimetapp - Add your own review/rating

• Andehist NR Syrup Concise Consumer Information (Cerner Multum)


• B-Vex PD Concise Consumer Information (Cerner Multum)


• Dimaphen Concise Consumer Information (Cerner Multum)

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• Hay Fever
• Nasal Congestion

Dilaudid

Pronunciation: HYE-droe-MOR-fone
Generic Name: Hydromorphone
Brand Name: Dilaudid

Dilaudid is used for:

Treating severe pain in certain patients.

Dilaudid is an opioid (narcotic) analgesic. It works by binding to certain receptors in the brain and nervous system to reduce pain.

Do NOT use Dilaudid if:

• you are allergic to any ingredient in Dilaudid or any other codeine- or morphine-related medicine (eg, morphine, codeine, oxycodone)


• you have difficult or slowed breathing, chronic obstructive pulmonary disease (COPD), or right-sided heart problems (cor pulmonale), or you are having a severe asthma attack


• you are in labor


• you have severe diarrhea or other bowel problems caused by antibiotics or poisoning


• you have a brain injury or growths in the brain along with increased pressure in the brain


• you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Dilaudid:

Some medical conditions may interact with Dilaudid. Tell your health care provider if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding


• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement


• if you have allergies to medicines, foods, or other substances


• if you are allergic to latex


• if you have a history of lung or breathing problems (eg, asthma, emphysema, bronchitis), seizures (eg, epilepsy), adrenal gland problems, an enlarged prostate, heart problems, low blood pressure, dehydration, low blood volume, an underactive thyroid, or urinary blockage


• if you have severe drowsiness, a recent head injury, spinal problems, growths in the brain, or increased pressure in the brain


• if you have liver or kidney problems, gallbladder problems, or stomach or bowel problems (eg, inflammation), or if you have had recent stomach or bowel surgery


• if you drink alcohol regularly, have symptoms of alcohol withdrawal, or have a history of suicidal thoughts or attempts


• if you have a personal or family history of mental or mood problems, alcohol abuse, or other substance abuse or dependence


• if you are in poor health or shock, or will be having surgery

Some MEDICINES MAY INTERACT with Dilaudid. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Phenothiazines (eg, chlorpromazine) because the risk of low blood pressure may be increased


• Barbiturate anesthetics (eg, thiopental), cimetidine, or sodium oxybate (GHB) because the risk of severe drowsiness, coma, or slowed or difficult breathing may be increased


• Agonist/antagonist analgesics (eg, pentazocine) or naltrexone because they may decrease Dilaudid's effectiveness and withdrawal may occur

This may not be a complete list of all interactions that may occur. Ask your health care provider if Dilaudid may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Dilaudid:

Use Dilaudid as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Dilaudid is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Dilaudid at home, a health care provider will teach you how to use it. Be sure you understand how to use Dilaudid. Follow the procedures you were taught when you use a dose. Contact your health care provider if you have any questions.


• Do not use Dilaudid if it is cloudy or discolored, or if the vial is cracked or damaged.


• Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.


• If you are taking Dilaudid for persistent pain, take it on a regular schedule to help control the pain more effectively.


• Do not change your dose or suddenly stop taking Dilaudid without checking with your doctor.


• If Dilaudid is no longer needed, dispose of it as soon as possible. Ask your doctor or pharmacist how to dispose of Dilaudid properly.


• If you miss a dose of Dilaudid and you are taking it regularly, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Dilaudid.

Important safety information:

• Dilaudid may cause drowsiness, dizziness, blurred vision, or lightheadedness. These effects may be worse if you take it with alcohol, other opiate pain medicines, or certain other medicines. Use Dilaudid with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you take Dilaudid; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


• Dilaudid may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.


• Dilaudid may be habit-forming. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. Misuse or abuse of Dilaudid may cause severe side effects, including severe breathing problems, seizures, coma, and possibly death.


• Constipation is a common side effect of Dilaudid. Talk to your doctor about using laxatives or stool softeners to prevent or treat constipation while you use Dilaudid.


• If your pain continues or becomes worse or if you have side effects that concern you, contact your doctor.


• Tell your doctor or dentist that you take Dilaudid before you receive any medical or dental care, emergency care, or surgery.


• Use Dilaudid with caution in the ELDERLY; they may be more sensitive to its effects, especially drowsiness and breathing problems.


• Dilaudid should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: Dilaudid may cause harm to the fetus. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Dilaudid while you are pregnant. Dilaudid is found in breast milk. Do not breast-feed while taking Dilaudid.

When used for long periods of time or at high doses, Dilaudid may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Dilaudid stops working well. Do not take more than prescribed.

Some people who use Dilaudid for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction. Dependence is unlikely to be an issue in terminally ill patients where comfort is more important. If you are taking Dilaudid regularly, do not suddenly stop taking it without checking with your doctor. WITHDRAWAL symptoms have occurred when Dilaudid is suddenly stopped and may include anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea and vomiting; pain; rigid muscles; seeing, hearing, or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping. Contact your doctor if you notice any of these symptoms after stopping Dilaudid.

Possible side effects of Dilaudid:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; dizziness, drowsiness; dry mouth; flushing; lightheadedness; nausea; sweating; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); fainting; fast, slow, or irregular heartbeat; hallucinations; mental or mood changes; seizure; severe or persistent dizziness or drowsiness; severe or persistent headache or vomiting; shallow, slowed, or difficult breathing; tremor; trouble urinating; vision changes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Dilaudid side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include bluish skin; chest pain; cold and clammy skin; coma; difficult or slow breathing; excessive sweating; limp muscles; nausea and vomiting; numbness of an arm or leg; pinpoint pupils; seizures; severe drowsiness or dizziness; slow or irregular heartbeat.

Proper storage of Dilaudid:

Store Dilaudid at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Do not store Dilaudid in the bathroom. Keep Dilaudid out of the reach of children and away from pets.

General information:

• If you have any questions about Dilaudid, please talk with your doctor, pharmacist, or other health care provider.


• Dilaudid is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Dilaudid. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Dilaudid resources

• Dilaudid Side Effects (in more detail)
• Dilaudid Use in Pregnancy & Breastfeeding
• Drug Images
• Dilaudid Drug Interactions
• Dilaudid Support Group
• 136 Reviews for Dilaudid - Add your own review/rating

• Dilaudid Advanced Consumer (Micromedex) - Includes Dosage Information


• Dilaudid Consumer Overview


• Dilaudid Prescribing Information (FDA)


• Dilaudid-HP Prescribing Information (FDA)


• Dilaudid-HP Advanced Consumer (Micromedex) - Includes Dosage Information


• Exalgo Prescribing Information (FDA)


• Exalgo Consumer Overview


• Hydromorphone Prescribing Information (FDA)


• Hydromorphone Hydrochloride Monograph (AHFS DI)


• Palladone Prescribing Information (FDA)

Compare Dilaudid with other medications

• Cough
• Pain

diltiazem Intravenous

dil-TYE-a-zem

Commonly used brand name(s)

In the U.S.

• Cardizem

Available Dosage Forms:

• Powder for Solution


• Solution

Therapeutic Class: Cardiovascular Agent

Pharmacologic Class: Calcium Channel Blocker

Chemical Class: Benzothiazepine

Uses For diltiazem

Diltiazem is used to control rapid heartbeats or abnormal heart rhythms. It belongs to a group of drugs called calcium channel blocking agents. Diltiazem affects the movement of calcium into the cells of the heart and blood vessels. As a result, the heart beats slower and the blood vessels relax, thus, increasing the supply of blood and oxygen to the heart while reducing its workload.

diltiazem is available only with your doctor's prescription.

Before Using diltiazem

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For diltiazem, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to diltiazem or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of diltiazem in the pediatric population. Safety and efficacy have not been established.

Geriatric

No information is available on the relationship of age to the effects of diltiazem in geriatric patients. However, elderly patients are more likely to have age-related kidney or liver problems, which may require an adjustment in the dose for patients receiving diltiazem.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving diltiazem, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using diltiazem with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Cisapride

Using diltiazem with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acebutolol


• Alprenolol


• Amiodarone


• Aprepitant


• Atazanavir


• Atenolol


• Atorvastatin


• Betaxolol


• Bevantolol


• Bisoprolol


• Bucindolol


• Carteolol


• Carvedilol


• Celiprolol


• Clonidine


• Clozapine


• Colchicine


• Crizotinib


• Dantrolene


• Dilevalol


• Dronedarone


• Droperidol


• Erythromycin


• Esmolol


• Everolimus


• Fentanyl


• Labetalol


• Levobunolol


• Lurasidone


• Mepindolol


• Metipranolol


• Metoprolol


• Nadolol


• Nebivolol


• Oxprenolol


• Penbutolol


• Pindolol


• Propranolol


• Ranolazine


• Simvastatin


• Sotalol


• Talinolol


• Tertatolol


• Timolol


• Tolvaptan

Using diltiazem with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Alfentanil


• Alfuzosin


• Amlodipine


• Aspirin


• Buspirone


• Carbamazepine


• Celecoxib


• Cilostazol


• Cimetidine


• Clopidogrel


• Cyclosporine


• Dalfopristin


• Digitoxin


• Digoxin


• Dutasteride


• Efavirenz


• Enflurane


• Fosaprepitant


• Fosphenytoin


• Guggul


• Indinavir


• Lithium


• Lovastatin


• Methylprednisolone


• Midazolam


• Moricizine


• Nevirapine


• Nifedipine


• Phenytoin


• Quinupristin


• Rifampin


• Rifapentine


• Ritonavir


• Sirolimus


• St John's Wort


• Tacrolimus


• Triazolam

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of diltiazem. Make sure you tell your doctor if you have any other medical problems, especially:

• Atrial fibrillation (type of abnormal heart rhythm) or


• Cardiogenic shock (shock caused by heart attack) or


• Heart block (type of abnormal heart rhythm, can use if have a pacemaker) or


• Severe hypotension (blood pressure too low) or


• Short PR syndrome (type of abnormal heart rhythm) or


• Sick sinus syndrome (type of abnormal heart rhythm, can use if have a pacemaker) or


• Ventricular tachycardia (type of abnormal heart rhythm) or


• Wolff-Parkinson-White syndrome (type of abnormal heart rhythm)—Should not use in patients with these conditions.

• Kidney disease or


• Liver disease or—Use with caution. The effects of diltiazem may be increased because of slower removal from the body.

Proper Use of diltiazem

A nurse or other trained health professional will give you diltiazem. diltiazem is given through a needle placed into one of your veins.

Precautions While Using diltiazem

Your doctor will only give you a few doses of diltiazem until your condition improves, and then you will be switched to an oral medicine that works the same way. If you have any concerns about this, talk to your doctor.

diltiazem Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

• Blurred vision


• confusion


• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly


• sweating


• unusual tiredness or weakness

Less common

• Fast, slow, or irregular heartbeat

Rare

• Anxiety


• chest pain


• decreased urine output


• difficult or labored breathing


• dilated neck veins


• dry mouth


• extreme fatigue


• hyperventilation


• irregular breathing


• irritability


• joint pain, stiffness, or swelling


• lower back, side, or stomach pain


• nervousness


• no heartbeat


• palpitations


• restlessness


• shaking


• shortness of breath


• swelling of feet or lower legs


• tightness in chest


• trouble sleeping


• troubled breathing


• weight gain


• wheezing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

• Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site


• feeling of warmth or heat


• flushing or redness of the skin, especially on the face and neck


• headache

Rare

• Change in vision


• constipation


• impaired vision


• itching skin


• lack or loss of strength


• nausea


• vomiting

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

More diltiazem Intravenous resources

• Diltiazem Intravenous Side Effects (in more detail)
• Diltiazem Intravenous Use in Pregnancy & Breastfeeding
• Drug Images
• Diltiazem Intravenous Drug Interactions
• Diltiazem Intravenous Support Group
• 31 Reviews for Diltiazem Intravenous - Add your own review/rating

Compare diltiazem Intravenous with other medications

• Angina Pectoris Prophylaxis
• Atrial Fibrillation
• Atrial Flutter
• Heart Failure
• High Blood Pressure
• Raynaud's Syndrome
• Supraventricular Tachycardia

Diltiazem Hydrochloride

Class: Calcium-Channel Blocking Agents, Miscellaneous
VA Class: CV200
CAS Number: 33286-22-5
Brands: Cardizem, Cartia XT, Dilacor XR, Diltia XT, Dilt XR, Taztia XT, Tiazac

Introduction

Calcium-channel blocking agent; nondihydropyridine-derivative.^{271 331}

Uses for Diltiazem Hydrochloride

Angina

Used in the management of Prinzmetal variant angina and chronic stable angina pectoris.^{a 331}

Calcium channel blockers considered the drugs of choice in management of Prinzmetal variant angina.^a

Appears to be as effective as β-adrenergic blocking agents (e.g., propranolol) and/or oral nitrates in the management of chronic stable angina pectoris; however, generally should be used only when the patient cannot tolerate adequate doses of or is refractory to these drugs.^a

Management of unstable angina† in patients who have continuing or ongoing ischemia when therapy with β-blocking agents and nitrates is inadequate, not tolerated, or contraindicated and when severe left ventricular dysfunction, pulmonary edema, or other contraindications are not present.³¹⁵

Hypertension

Management of hypertension (alone or in combination with other classes of antihypertensive agents).^{138 140 187 188 189 190 195 271 272}

Only extended-release formulations currently are recommended for management of hypertension.²⁷¹

One of several preferred initial therapies for hypertensive patients with a high risk of developing coronary artery disease, including those with diabetes mellitus.³¹⁹

Can be used as monotherapy for initial management of uncomplicated hypertension; however, thiazide diuretics are preferred for monotherapy by JNC 7.³¹⁹

Supraventricular Tachyarrhythmias

Management of supraventricular tachyarrhythmias, including rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardias (PSVT) (e.g., those associated with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome) and temporary control of rapid ventricular rate in atrial flutter or fibrillation.^{237 238 239 244 245 247 250 252 253 256 257 258 262 270 331}

One of several preferred antiarrhythmic agents for the treatment of stable, narrow-complex supraventricular tachycardias (e.g., paroxysmal supraventricular tachycardia [reentry supraventricular tachycardia], ectopic or multifocal atrial tachycardia†, junctional tachycardia†) if the rhythm is not controlled by vagal maneuvers or adenosine and to control the ventricular response rate in atrial fibrillation or flutter.³³¹

AMI

Calcium-channel blocking agents have not proved beneficial in the early treatment or secondary prevention of AMI† and the possibility that they may be harmful has been raised.^{270 331}

May be used for relief of ongoing ischemia or to control rapid ventricular response with atrial fibrillation after an AMI† when β-adrenergic blocking agents are ineffective or contraindicated, but only in patients in whom there is no evidence of CHF, left-ventricular dysfunction, or AV block and only after weighing carefully the potential benefits versus risks, particularly negative inotropic effects and concerns about short-acting formulations of the drugs.^{270 331}

Hyperthyroidism

Short-term adjunctive therapy in the treatment of tachycardia and tachyarrhythmias in patients with hyperthyroidism† and/or thyrotoxicosis† in whom therapy with β-adrenergic blocking agents is contraindicated or not tolerated.^{172 173 174}

Diltiazem Hydrochloride Dosage and Administration

Administration

Administer by direct IV injection, continuous IV infusion, or orally.^{138 187 190 237 270 271 323 331}

Oral Administration

Conventional Tablets

Administer tablets orally 3–4 times daily before meals and at bedtime.¹⁰⁰

Extended-release Capsules

Administer orally; directions for administration (e.g., frequency, whether to administer with or without food, potential for opening capsules and mixing with food) may vary by manufacturer and formulation; consult specific manufacturer's information for additional information.

Cardizem CD, Dilacor XR, Dilt-XR, Tiazac, Taztia XT, Cartia XT, or Diltia XT may be administered once daily;^{187 190 271 278 324 325 326} diltiazem hydrochloride extended-release capsules (12 hours) are administered twice daily.^b

Cardizem CD and Cartia XT may be administered without regard to meals.^{188 325} However, Dilacor XR, Diltia XT, and Dilt-XR should be taken on an empty stomach, swallowed whole and not opened, chewed, or crushed.^{190 278 324}

Tiazac and Taztia XT may be opened and the entire contents sprinkled on a small amount of applesauce (not hot) immediately prior to administration; subdividing the contents of capsules is not recommended.^{305 326} Swallow the entire mixture without chewing.^{305 326} Immediately drink a glass of cool water to ensure that all of the mixture is swallowed.^{305 326} Do not store the sprinkle/food mixture for use at a later time.^{305 326}

Extended-release Tablets

Administer orally once daily without regard to meals.³²³ Tablet should be swallowed whole and not chewed or crushed.³²³

IV Injection

Monitor ECG and BP continuously during IV administration.²³⁷

Reconstitution

Prepare solutions from the powder for injection (Lyo-Ject) according to the manufacturer's directions.^{237 293}

Dilution

Injection solutions containing 5 mg/mL or powder for injection that has been reconstituted according to manufacturer's directions may be administered by direct IV injection without any further dilution.²³⁷

Rate of Administration

Administer over 2 minutes.²³⁷

IV Infusion

Reconstitution

Prepare solutions from the powder for injection (Lyo-Ject) according to the manufacturer's directions.^{237 293}

Dilution

Dilute 5 mg/mL injection solution or reconstituted powder for injection in the appropriate volume of a compatible infusion solution (i.e., 0.9% sodium chloride, 5% dextrose, or 5% dextrose and 0.45% sodium chloride) to produce a final diltiazem hydrochloride concentration of 1, 0.83, or 0.45 mg/mL, respectively.²³⁷

Dilution of Commercially Available Injection or Reconstituted Lyo-Ject 5 mg/mL solution.237

Quantity of 5 mg/mL Solution	Diluent Volume	Final Concentration
25 mL	100 mL	1 mg/mL
50 mL	250 mL	0.83 mg/mL
50 mL	500 mL	0.45 mg/mL

Rate of Administration

Usually 10 mg/hour; however, may range from 5–15 mg/hour.²³⁷

Dosage

Available as diltiazem hydrochloride; dosage expressed in terms of the salt.^{179 236 237}

Adults

Prinzmetal Variant Angina

Conventional Tablets

Oral

Initially, 30 mg 4 times daily.¹⁰⁰ Increase gradually at 1- to 2-day intervals until optimum control is obtained. Usual maintenance dosage is 180–360 mg daily.¹⁰⁰ After manifestations are controlled, reduce dosage to lowest level that will maintain relief of symptoms.^a

Extended-release Capsules

Oral

Initially, 120 or 180 mg once daily when administered as extended-release capsules (Cardizem CD, Cartia XT).^{187 325} Individualize dosage based on response; titrate dosage increases over 7–14 days.^{187 325} Some patients may respond to higher dosages of up to 480 mg once daily.^{187 325}

Chronic Stable Angina

Conventional Tablets

Oral

Initially, 30 mg 4 times daily.¹⁰⁰ Increase gradually at 1- to 2-day intervals until optimum control is obtained. Usual maintenance dosage is 180–360 mg daily.¹⁰⁰ After manifestations are controlled, reduce dosage to lowest level that will maintain relief of symptoms.^a

Extended-release Capsules

Oral

Initially, 120 (Dilacor XR, Diltia XT, Dilt-XR) or 120–180 mg (Cardizem CD, Cartia XT, Tiazac, Taztia XT) once daily when administered as extended-release capsules.^{187 190 274 278 324 325 326} Individualize dosage based on response; titrate dosage increases over 7–14 days.^{187 190 274 278 324 325 326} Some patients may respond to higher dosages of up to 480 (Cardizem CD, Cartia XT, Dilacor XR, Diltia XT, Dilt-XR) to 540 mg (Tiazac, Taztia XT) once daily.^{187 190 274 278 324 325 326}

Extended-release Tablets

Oral

Initially, 180 mg once daily when administered as extended-release tablets (Cardizem LA).³²³ Individualize dosage based on response; titrate dosage increases over 7–14 days.³²³ Some patients may respond to higher dosages of up to 360 mg once daily.³²³

Hypertension

Extended-release Capsules

Oral

Maximum hypotensive effect associated with a given dosage level usually is observed within 14 days.^{138 187 274 275 325 326}

JNC 7 recommends a usual maximum dosage of 420 mg daily for these preparations.³¹⁹

Recommended Dosages for Management of Hypertension

Preparation	Initial Dosage	Usual Maintenance Dosage
Cardizem LA	180–240 mg once daily323	120–540 mg323
Cardizem CD	180–240 mg once daily187	240–360 mg daily187
Cartia XT	180–240 mg once daily325	240–360 mg daily325
Dilacor XR	180–240 mg once daily190	180–480 mg once daily190
Diltia XT	180–240 mg once daily278	180–480 mg once daily278
Diltiazem hydrochloride extended-release capsules (12 hours)	60–120 mg twice dailyb	240–360 mg dailyb
Dilt-XR	180–240 mg once daily324	180–480 mg once daily324
Tiazac	120–240 mg once daily274	120–540 mg once daily274
Taztia XT	120–240 mg once daily326	120–540 mg once daily326

Switching to Cardizem CD Extended-release Capsules

Oral

Patients whose BP is adequately controlled with diltiazem therapy (as tablets or other extended-release capsules) alone or in combination with another antihypertensive agent may be safely switched to Cardizem CD or Cartia XT extended-release capsules or Cardizem LA extended-release tablets at the nearest equivalent daily dosage.^{187 323 325} Subsequent titration of dosage is based on the clinical response of the patient.^{187 323 325}

Conventional Tablets†

Oral

Initially, 30 mg 3 times daily; may be increased to a maximum dosage of 360 mg daily given in 3 or 4 divided doses.^{140 195}

Extended-release Tablets

Oral

Initially, 180–240 mg daily; however, some patients may respond to a lower dosage.³²³ Individualize dosage based on response; maximum hypotensive effect associated with a given dosage level usually is observed within 14 days.³²³ Usual maintenance dosage is 120–540 mg daily;³²³ however, JNC 7 recommends a usual maximum dosage of 420 mg daily.³¹⁹

Supraventricular Tachyarrhythmias

Paroxysmal Supraventricular Tachycardia, Junctional Tachycardia†, Ectopic Tachycardia†, Multifocal Atrial Tachycardia†)

IV

Initially, 15–20 mg (or 0.25 mg/kg) by direct IV injection over 2 minutes.^{237 256 270 331} If response is inadequate (i.e., conversion to normal sinus rhythm does not occur) give a second dose of 20–25 mg (or 0.35 mg/kg) 15 minutes after the initial dose.^{237 257 270 331}

Maintenance infusion: 5–15 mg/hour; titrate dose to heart rate.³³¹

Patients with low body weights should be dosed on a mg/kg basis.²³⁷

Ventricular Rate Control in Atrial Fibrillation and Flutter

IV

Initially, 15–20 mg (or 0.25 mg/kg) by direct IV injection over 2 minutes.^{237 270 331} If response is inadequate, give 20–25 mg (or 0.35 mg/kg) 15 minutes after the initial dose.^{237 246 270 331}

Maintenance infusion: 5–15 mg/hour; titrate dose to heart rate.³³¹

Prescribing Limits

Adults

Angina

Oral

Cardizem LA extended-release tablets: Maximum 360 mg daily.³²³

Cardizem CD, Dilacor XR, Diltia XT, Dilt-XR, and Cartia XT extended-release capsules: Maximum 480 mg daily.^{187 190 278 324 325}

Tiazac and Taztia XT extended-release capsules: Maximum 540 mg daily.^{274 326}

Hypertension

Oral

Cardizem conventional tablets†: Maximum 360 mg daily.^{140 195}

Cardizem CD and Cartia XT extended release capsules: Maximum 480 mg daily.^{187 325}

Dilt-XR, Dilacor XR, Diltia XT, Taztia XT, and Tiazac extended-release capsules and Cardizem LA extended-release tablets: maximum 540 mg daily.^{190 274 278 323 324 326 a}

However, JNC 7 recommends a usual maximum dosage of 420 mg daily for these preparations.³¹⁹

Supraventricular Tachyarrhythmias

IV

Maintenance infusion: Maximum 15 mg/hour for ≤24 hours.^{237 244 293}

Special Populations

Hepatic Impairment

Supraventricular Tachyarrhythmias

Atrial Fibrillation and Flutter

IV

Maintenance infusion: Dosage requirements may be lower.^{237 245}

Geriatric Patients

Angina

Select dosage cautiously; geriatric patients may respond to lower dosages.^{100 138 187 274 323 326 a}

Hypertension

Select dosage cautiously.^{138 187 274 323 326} The manufacturers of Dilacor XR, Dilt-XR, and Diltia XT state that patients 60 years of age or older may respond to an initial daily dosage of 120 mg.^{190 278 324}

Atrial Fibrillation and Flutter

Maintenance IV infusion: Dosage requirements may be lower.^{237 245}

Cautions for Diltiazem Hydrochloride

Contraindications

• 
  

  Contraindicated in patients with known hypersensitivity to the drug.^{237 252 253 256 258}

  
  


• 
  

  Sick sinus syndrome (unless a functioning ventricular pacemaker is in place).^{237 252 253 256 258}

  
  


• 
  

  Second- or third-degree AV block (unless a functioning ventricular pacemaker is in place).^{237 252 253 256 258}

  
  


• 
  

  Severe hypotension (SBP <90 mm Hg).^{237 252 253 256 258}

  
  


• 
  

  Oral preparations contraindicated in patients with AMI with radiographically documented pulmonary congestion.^{138 187 190 200 237}

  
  


• 
  

  IV diltiazem contraindicated in patients with cardiogenic shock.^{237 252 253 256 258}

  
  


• 
  

  IV diltiazem contraindicated in patients with VT.^{237 257}

  
  


• 
  

  IV diltiazem contraindicated in patients with atrial flutter or fibrillation with an accessory pathway (e.g., those with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome).^{237 262}

  
  


• 
  

  IV diltiazem contraindicated if concurrent or recent (e.g., within a few hours) administration of IV β-adrenergic blockers.²³⁷

  
  

Warnings/Precautions

Warnings

Cardiac Conduction

Potential for abnormally slow heart rate (particularly in patients with sick sinus syndrome) or second- or third-degree AV block.^{100 138 187 237 274 323}

Additive effects on cardiac conduction (e.g., prolonging AV node conduction) possible with concomitant use of diltiazem with β-adrenergic blocking agents or digoxin.^{100 138 187 237 274 323}

If high-degree AV block occurs in patients with sinus rhythm receiving IV diltiazem, discontinue the drug and institute appropriate supportive measures.²³⁷

CHF

Risk of CHF, especially in those with preexisting ventricular impairment; limited experience in patients with impaired ventricular function receiving concomitant β-adrenergic blocking agents.^{100 138 187 237 251 254 256 258 274 323} Use with caution.^{100 138 187 274 323}

Hypotension

Possible symptomatic hypotension.^{100 138 187 237 274 323}

Acute Hepatic Injury

Substantial elevations in hepatic function test results (e.g., serum AST [SGOT], ALT [SGPT], LDH, alkaline phosphatase) and phenomena associated with hepatocellular injury rarely reported.^{100 138 187 237 274 323} Usually occurs early in therapy (e.g., 1–8 weeks); reversible upon discontinuation of therapy.^{100 138 187 237 274 323}

Ventricular Premature Beats

With IV administration, possible transient VPB on conversion of PSVT to sinus rhythm;²³⁷ appear to be benign and of little clinical importance.^{237 250}

Sensitivity Reactions

Possible diltiazem-induced skin eruptions with oral preparations; may infrequently progress to severe dermatologic reactions (e.g., erythema multiforme, exfoliative dermatitis).^{100 138 237} If effects persist during therapy, the drug should be discontinued.^{100 138 237} Potential for occurrence with IV administration.²³⁷

Specific Populations

Pregnancy

Category C.^{100 138 187 190 274 278 323 324 325 326}

Lactation

Distributed into milk;^{100 101 138 187 190 274 278 323 324 325 326} discontinue nursing.^{100 138 187 190 274 278 323 324 325 326}

Pediatric Use

Safety and efficacy not established.^{100 138 187 190 274 278 323 324 325 326}

Injection in single-use (Lyo-Ject) syringes contains benzyl alcohol as a preservative and should not be used in neonates.²³⁷

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.^{100 138 187 274 323 326} Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.^{100 138 187 274 323 326}

Hepatic Impairment

Use with caution.^{100 138 187 237 274 323}

Renal Impairment

Use with caution.^{100 138 187 237 274 323}

Common Adverse Effects

With oral therapy, edema, headache, dizziness, asthenia, first-degree AV block.^{138 187 274 323}

With IV therapy, hypotension, injection site reactions, vasodilation, arrhythmia.²³⁷

Interactions for Diltiazem Hydrochloride

Metabolized principally by CYP3A4.^{100 138 187 274} Inhibits CYP3A4.²⁷⁴

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors, inducers, and substrates of CYP3A4: potential pharmacokinetic interaction (altered plasma diltiazem concentrations).^{100 138 187 274 323}

Drugs Metabolized by Microsomal Enzymes

Potential pharmacokinetic interaction: altered bioavailability and/or clearance of drugs metabolized by CYP3A4.^{100 116 132 133 138 187 274}

Specific Drugs

Drug	Interaction	Comments
Anesthetics, general	Possible increased depression of cardiac contractility, conductivity, and automaticity as well as vascular dilation100 138 187 237 274 323	Titrate dosage of each drug carefully100 138 187 237 274 323
Atazanavir	Possible increased plasma diltiazem concentrations and additive effect on PR interval prolongation318	Use concomitantly with caution.318 Reduce diltiazem dosage by 50%; monitor ECG318
β-Adrenergic blockers	Potential for additive negative effects on myocardial contractility, heart rate, and prolonging AV conduction100 138 187 190 237 263 264 274 295 323 Increased plasma concentrations of propranolol and metoprolol295 296	Do not administer IV diltiazem and IV β-adrenergic blocking agents within a few hours of each other237 Propranolol dosage adjustment may be necessary when diltiazem is initiated or discontinued100
Benzodiazepines (e.g., midazolam, triazolam)	Possible increased benzodiazepine plasma concentrations and AUC resulting in increased adverse effects (e.g., prolonged sedation, respiratory depression)100 138 187 274 299 300 323
Buspirone	Increased plasma concentration and AUC of buspirone100 138 187 Potential for increased effects and toxicity of buspirone100 138 187	Dosage adjustment of buspirone may be necessary based on clinical assessments100 138 187
Carbamazepine	Possible increased serum or plasma carbamazepine concentrations and associated neurologic and sensory manifestations of carbamazepine toxicity138 200 201 202 203 204 205 206 207 208	Avoid concurrent use, if possible203 Monitor for manifestations of carbamazepine toxicity; adjust carbamazepine dosage accordingly138 200 201 202 203 204 205 206 207 208
Cyclosporine	Possible increased blood cyclosporine concentrations112 113 237 297 298 and consequent nephrotoxicity112 297 298	Monitor cyclosporine concentration in biologic fluid (especially when diltiazem therapy is initiated, adjusted, or discontinued); adjust cyclosporine dosage as needed100 138 187 237 274 275 276 291 292 297 298
Digoxin	Possible increased serum digoxin concentrations102 105 107 108 Potential for additive effects on cardiac conduction (e.g., prolonging AV node conduction)100 138 187 237 274 323	Monitor serum digoxin concentrations carefully and observe the patient closely for signs of digoxin toxicity when administered concomitantly, especially in geriatric patients, patients with unstable renal function, or those with serum digoxin concentrations in the upper therapeutic range before diltiazem is administered103 105 107 108 111 Reduce digoxin dosage if necessary103 105 107 108 111
Histamine H2-receptor antagonists (e.g., cimetidine, ranitidine)	Possible increased plasma diltiazem concentrations with concomitant administration of cimetidine100 125 126 127 Ranitidine coadministration produced smaller and not substantial alterations in diltiazem pharmacokinetics100 125 126 127	Monitor effects of diltiazem carefully when cimetidine therapy is initiated or discontinued in patients receiving diltiazem; adjust diltiazem dosage, if necessary100 126 127
HMG-CoA reductase inhibitors (e.g., lovastatin, pravastatin)	Possible increased mean AUCs and peak plasma concentrations of lovastatin with concomitant use of diltiazem and lovastatin274 301 302 Interaction not observed when diltiazem was used concomitantly with pravastatin274 302	Monitor patients receiving lovastatin concomitantly with diltiazem for evidence of lovastatin toxicity (e.g., rhabdomyolysis, myositis)301 302
Nitrates	Interaction unlikely100 187
Quinidine	Possible increased AUC and decreased clearance of quinidine100 138 187	Monitor for adverse effects of quinidine; adjust dosage accordingly100 138 187
Rifampin	Decreased bioavailability and increased clearance of diltiazem304	Avoid concomitant use; consider alternative therapy100 138 187 274 304

Diltiazem Hydrochloride Pharmacokinetics

Absorption

Bioavailability

Following oral administration of conventional tablets, approximately 80% of a dose is rapidly absorbed from the GI tract.^a

Absolute bioavailability is about 40%; undergoes extensive first-pass metabolism.^{100 138 187 274 323}

Time to Peak Serum Concentrations Following Administration

Preparation	Time (hours)
Conventional tablets (e.g., Cardizem)	2–4100
Cardizem CD extended-release capsules	10–14187
Cardizem LA extended-release tablets	11–18323
Diltiazem hydrochloride extended-release capsules (12 hours)	6–11b

Onset

Following direct IV injection, reductions in heart rate usually occur within 3 minutes^{237 247 252} and hemodynamic effects (e.g., decrease in BP) generally occur within 2 minutes;^{237 246 247 252} effects on the AV node generally occur within minutes following initiation of a continuous IV infusion.^{237 242}

Duration

Following direct IV injection, reductions in heart rate generally persist for 1–3 hours;^{237 247 252} blood pressure reductions following direct IV injection generally are short-lived but may last 1–3 hours.²³⁷ Effects on the AV node may persist for 0.5–10 hours following a continuous IV infusion.^{237 242}

Food

Rate of absorption may be increased if Tiazac extended-release capsules are taken with a high-fat meal.²⁷⁴ Food may affect the extent of absorption of some extended-release capsules (Dilacor XR, Diltia XT).^{190 278 294}

Distribution

Extent

Rapidly and extensively distributed into body tissues.^{191 245 259}

Distributed into milk, in concentrations approximately equal to maternal serum concentrations.^{100 101 237}

Plasma Protein Binding

About 70–85% is bound to plasma proteins, but only 30–40% is bound to albumin.^{135 237 259}

Elimination

Metabolism

Rapidly and almost completely metabolized in the liver to several active and at least 5 inactive metabolites principally via CYP enzyme system, mainly CYP3A4.^{100 132 134 135 136 137 182 183 237 241 242}

Elimination Route

Excreted principally in urine as metabolites,^a with approximately 2–4% of a dose excreted unchanged.^{135 237 259}

Half-life

2–11 hours.^{191 237}

Special Populations

In geriatric patients, plasma half-life of the drug may be increased.^{191 237 239}

In patients with severe renal impairment, pharmacokinetics were unchanged.³²³

Oral clearance may be reduced and half-life prolonged in patients with liver cirrhosis.²³⁷

Stability

Storage

Oral

Conventional Tablets

Tight containers at 25°C (may be exposed to 15–30°C).^{100 a}

Protect from excessive humidity.¹⁰⁰

Extended-release Capsules

25°C (may be exposed to 15–30°C).^{138 187 274}

Protect from excessive humidity.¹³⁸