Skip to main content
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Jul 16;26(Suppl 4):16–24. doi: 10.1002/clc.4960261605

Diltiazem hydrochloride: New technologies and evolution of diltiazem

Stephen P Glasser 1,
PMCID: PMC6654580

Abstract

Graded extended‐release diltiazem (CARDIZEM® LA) (GRD) is a new formulation of diltiazem engineered to provide more precise blood pressure control than traditional antihypertensive agents. Unlike other diltiazem once‐daily formulations, CARDIZEM® LA is a tablet formulation. Its pharmacokinetic profile differs from that of CARDIZEM® CD, another extended‐release formulation of diltiazem, in that GRD exhibits a smoother drug‐release profile with a “one‐peak” plasma concentration time curve. Clinical results demonstrate therapeutic efficacy throughout its 24‐h dosing interval, regardless of time of administration; however, compared with morning administration, evening dosing results in significantly greater bioavailability, especially during the morning hours, when blood pressure is highest in most individuals. In hypertensive patients, GRD has demonstrated dose‐related efficacy superior to that of ramipril in patients with Stage I and II hypertension and superior to that of amlodopine in African American hypertensives during the critical morning period. In patients with chronic stable angina, evening doses of GRD have been shown to increase exercise tolerance and delay the time to onset of angina during the early morning hours and throughout the 24‐h dosing interval. Trials in patients with hypertension or angina have consistently demonstrated a side effect profile with GRD similar to that observed with placebo. Adverse events do not appear to be dose related up to the highest recommended dose of 540 mg/day. These trial results, demonstrating consistent 24‐h efficacy and excellent tolerability, suggest that GRD may be a beneficial option in the treatment of hypertension and angina.

Keywords: graded extended‐release diltiazem, hypertension, angina, nighttime dosing

Full Text

The Full Text of this article is available as a PDF (1,023.7 KB).

References

  • 1. Kannel WB: Risk factors in hypertension. J Cardiovasc Pharmacol 1989; 13: S4–S10 [DOI] [PubMed] [Google Scholar]
  • 2. Staessen JA, Fagard R, Thijs L, Hilde C, Arabidze GG, Birkenhager WH, Bulitt CJ, de Leeuw PW, Colin T Fletcher AE, Forette, F , Leonetti G, Nachev C, O'Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto, J , Zanchetti A: Randomised double‐blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757–764 [DOI] [PubMed] [Google Scholar]
  • 3. The Heart Outcomes Prevention Evaluation Study Investigators : Effects of an angiotensin‐converting‐enzyme inhibitor, ramipril, on cardiovascular events in high‐risk patients. N Engl J Med 2000; 342: 145–153 [DOI] [PubMed] [Google Scholar]
  • 4. Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, Horan MJ, LaBarthe D: Prevalence of hypertension in the US adult population: Results from the third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25: 305–313 [DOI] [PubMed] [Google Scholar]
  • 5. Neutel JM: The use of combination drug therapy in the treatment of hypertension. Prog Cardiovasc Nurs 2002; 17 (2): 81–88 [DOI] [PubMed] [Google Scholar]
  • 6. Grossman E, Messerli FH: Effect of calcium antagonists on plasma norepinephrine levels, heart rate, and blood pressure. Am J Cardiol 1997; 80: 1453–1458 [DOI] [PubMed] [Google Scholar]
  • 7. Palma‐Gamiz JL: High blood pressure and calcium antagonism. Cardiology 1997; 88 (suppl): 39–46 [DOI] [PubMed] [Google Scholar]
  • 8. Kelly JG, O'Malley K: Clinical pharmacokinetics of calcium antagonists: An update. Clin Pharmacokinet 1992; 22: 416–433 [DOI] [PubMed] [Google Scholar]
  • 9. Carter BL: Optimizing delivery systems to tailor pharmacotherapy to cardiovascular circadian events. Am J Health‐Syst Pharm 1998; 55 (suppl): S17–S23 [DOI] [PubMed] [Google Scholar]
  • 10. Millar‐Craig MW, Bishop CN, Raftery EB: Circadian variation of blood pressure. Lancet 1978; 795–797 [DOI] [PubMed]
  • 11. Elliott WJ: Cyclic and circadian variations in cardiovascular events. Am J Hypertens 2001; 14: 291S–295S [DOI] [PubMed] [Google Scholar]
  • 12. Muller JE, Ludmer PL, Willich SN, Tofler GH, Aylmer G, Klangos I, Stone PH: Circadian variation in the frequency of sudden cardiac death. Circulation 1987; 75: 131–138 [DOI] [PubMed] [Google Scholar]
  • 13. Muller JE, Stone PH, Turi ZG, Rutherford JD, Czeisler CA, Parker C, Poole K, Passamani E, Roberts R, Robertson T, Sobel BE, Willerson JT, Braunwald E, and the Milis Study Group : Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 1985; 313: 1315–1322 [DOI] [PubMed] [Google Scholar]
  • 14. Willich SN, Linderer T, Wegscheider K, Leizorovicz A, Alamereery I, Schroder R, and the ISAM Study Group : Increased morning incidence of myocardial infarction in the ISAM study: Absence with prior beta‐adrenergic blockade. Circulation 1989; 80: 853–858 [DOI] [PubMed] [Google Scholar]
  • 15. Deedwania PC, Nelson JR: Pathophysiology of silent myocardial ischemia during daily life. Circulation 1990; 82: 1296–1304 [DOI] [PubMed] [Google Scholar]
  • 16. Glasser SP, Neutel JM, Gana TJ, Albert KS: Efficacy and safety of a once daily graded‐release diltiazem formulation in essential hypertension. Am J Hypertens 2003; 16: 51–58 [DOI] [PubMed] [Google Scholar]
  • 17. Sista S, Lai JC, Eradiri O, Albert KS: Bioavailability of once‐daily dosing of graded‐release diltiazem in the morning versus evening (poster). Presented at 2002 American College of Clinical Pharmacy (ACCP) Annual Meeting, October 20–23, 2002, Albuquerque, N.M.
  • 18. Cardizem® LA (diltiazem HCl) (package insert) . Morrisville, N.C.: Biovail Pharmaceuticals, Inc., 2003.
  • 19. Thiffault J, Landriault H, Gossard D, Raymond M, Caille G, Spenard J: The influence of time of administration on the pharmacokinetics of a once‐a‐day diltiazem formulation: Morning against bedtime. Biopharm Drug Dispos 1996; 17: 107–115 [DOI] [PubMed] [Google Scholar]
  • 20. CARDIZEM® CD (diltiazem HCl) (package insert) . Morrisville, N.C.: Biovail Pharmaceuticals, Inc., 2000.
  • 21. Pool PE: Anomalies in the dosing of diltiazem. Clin Cardiol 2000; 23: 18–23 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. White WB, Smith DHG, Gana TJ, Pascual LG, Albert KS: Comparison of nocturnal dosing of diltiazem ER and ramipril on early morning blood pressure, heart rate and the rate‐pressure product (poster). Presented at 2003 American Society of Hypertension (ASH) Annual Meeting, May 14–17, 2003, New York, N.Y.
  • 23. Wright JT Jr, Gana TJ, Bohannon K, Pascual LG, Albert KS: Efficacy of nighttime dosing of graded‐release diltiazem versus morning dosing of amlodipine in African American patients with Stages I or II essential hypertension (poster). Presented at 2003 American Society of Hypertension (ASH) Annual Meeting, May 14–17, 2003, New York, N.Y.
  • 24. Frishman WH, Charlap S, Goldberger J, Kimmel B, Stroh J, Dorsa F, Allen L, Strom J: Comparison of diltiazem and nifedipine for both angina pectoris and systemic hypertension. Am J Cardiol 1985; 56: 41H–46H [DOI] [PubMed] [Google Scholar]
  • 25. Strauss WE, McIntyre KM, Parisi AF, Shapiro W: Safety and efficacy of diltiazem hydrochloride for the treatment of stable angina pectoris: Report of a cooperative clinical trial. Am J Cardiol 1982; 49: 560–566 [DOI] [PubMed] [Google Scholar]
  • 26. Rocco MB, Barry J, Campbell S, Nabel E, Cook F, Goldman L, Selwyn AP: Circadian variation of transient myocardial ischemia in patients with coronary artery disease. Circulation 1987; 75 (2): 395–400 [DOI] [PubMed] [Google Scholar]
  • 27. Glasser SP, Gana TJ, Pascual LG: Efficacy and safety of once‐daily graded‐release diltiazem HCl formulation dosed at bedtime (10 P.M.) compared to placebo and to morning dosing (8 A.M.) in chronic stable angina pectoris (poster). Presented at 2003 American College of Cardiology (ACC) Annual Meeting, March 30–April 2, 2003, Chicago, Ill.
  • 28. Gosse P, Cipriano C, Bemurat L, Mas D, Lemetayer P, N'Tela G, Clementy J: Prognostic significance of blood pressure measured on rising. J Hum Hypertens 2001; 15: 413–417 [DOI] [PubMed] [Google Scholar]
  • 29. Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, Mitsunobu M, Kuroda T, Schwartz, JE , Kazuyuki, S : Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives. Circulation 2003; 107: 1401–1406 [DOI] [PubMed] [Google Scholar]
  • 30. Drug Topics : Red Book. Montvale, N.J.: Medical Economics Company, Inc., 2003. [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES