2019 Jul;45(7):928-938. doi: 10.1007/s00134-019-05633-x. These guidelines are current until they are replaced on October 21, 2020. 2019 Jan;37(1):80-84. doi: 10.1016/j.ajem.2018.04.062. We compared the efficacy and safety of different doses of diltiazem in rapid AF.A retrospective chart review was undertaken in patients who presented to the emergency department with rapid AF. This blog post has been written, fact checked, and peer-reviewed by our team of medical professionals and subject matter experts. Titrate accordingly for goal heart rate average < 80 bpm in AFIB and sinus rhythm > 50 Calcium Channel Blockers **DO NOT USE diltiazem or verapamil if EF <40%** Diltiazem IV Dosing 0.25mg/kg (Max dose: 25mg) IV bolus x1. Some target atrial, AV nodal or ventricular cells, while some have the capacity to address both atrial and ventricular arrhythmias.Diltiazem has a COR I, LOE-b classification, used for rate control of atrial arrhythmias, predominantly Atrial Fibrillation, and COR IIa, LOE-b for treatment of SVT with a reentry pathway mechanism.2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. To avoid hypotension, we have empirically used a lower dose of diltiazem. To avoid hypotension, we have empirically used a lower dose of diltiazem.

2005 Jun;22(6):411-4. doi: 10.1136/emj.2003.012047.2016 Sep 10. Diltiazem oral capsule is available as both a generic and brand-name drug. doi: 10.1371/journal.pone.0209164. Clipboard, Search History, and several other advanced features are temporarily unavailable. Epub 2019 May 14.Chae MS, Park H, Choi HJ, Park M, Chung HS, Hong SH, Park CS, Choi JH, Lee HM.PLoS One. This site needs JavaScript to work properly. The recommended starting dose is an intravenous bolus of 0.25 mg/kg over 2 minutes. Starting with 30 mg four times daily, before meals and at bedtime, dosage should be increased gradually (given in divided doses three or four times daily) at 1- to 2-day intervals until optimum response is obtained. Bolus Injection:-Initial bolus dose: 0.25 mg/kg IV as a bolus administered over 2 minutes. 2016 Dec 15;73(24):2068-2076. doi: 10.2146/ajhp160126.Demircan C, Cikriklar HI, Engindeniz Z, Cebicci H, Atar N, Guler V, Unlu EO, Ozdemir B.Emerg Med J. If pre-excited atrial fibrillation (Atrial fibrillation in Wolff-Parkinson-White Syndrome) Avoid AV nodal blocking agents such as adenosine, digoxin, diltiazem, verapamil. J Am Coll Cardiol. Multivariate regression analysis was used to determine the effect of diltiazem dose on the occurrence of complications.A total of 180 patients were included in the analysis. Free PMC article Cham (CH): Springer; 2016.

Select one or more newsletters to continue. Please review our Applies to the following strengths: 30 mg; 60 mg; 90 mg; 120 mg; 5 mg/mL; 120 mg/24 hours; 180 mg/24 hours; 240 mg/24 hours; 300 mg/24 hours; 360 mg/24 hours; 420 mg/24 hours; 100 mg; 60 mg/12 hours; 90 mg/12 hours; 120 mg/12 hours; 25 mg; 125 mg/ 125 mL-D5%; 250 mg/ 250 mL-D5%; 100 mg/ 100 mL-D5%; 100 mg/100 mL-NaCl 0.9%; 125 mg/125 mL-NaCl 0.9%The nearest equivalent total daily dosage should be used when switching between different formulations of this drug.
Second dose: 12 mg IV push followed by saline bolus.

Download our printable treatment guidelines chart. A 50-year-old male with a history of hypertension (HTN) and atrial fibrillation (AF) presents to the Emergency Department with complaint of palpitations, which started while mowing the lawn.He is alert and oriented with a Glasgow Coma Scale (GCS) of 15 and no signs of Hypoperfusion.The patient is compliant with his medications and denies any allergies.Atrial fibrillation with rapid ventricular response (RVR) and generalized ST-segment depression indicative of subendocardial ischemia.The patient was treated with 20 mg of diltiazem (Cardizem) over 2 min, followed by 10 mg over 1 hr, and 0.25 mg digoxin (Lanoxin).A rhythm change was noted on the monitor and another 12-lead ECG was recorded.There is a sinus rhythm with left ventricular hypertrophy by limb lead voltage criteria and left atrial enlargement. 2015 Sep 16. pii: S0735-1097(15)06203-8. doi: 10.1016/j.jacc.2015.09.019.Although dosages may vary based on physician orders, protocols and age, a standard initial dose is 0.25 mg/kg, ranging between 10-20 mg over 2 minutes, with a second dose of 0.35 mg/kg, ranging between 20-25 mg over 2 minutes, often followed by a 5-10 mg/hr infusion.Treatment of hemodynamically unstable patients in narrow QRS complex AF with RVR requires synchronized cardioversion at 120-200 J initially, and should not be delayed for administration of an anti-arrhythmic agent.Ivan J Rios is Associate Editor of ACLSMedicalTraining.com (At ACLS Medical Training, we pride ourselves on the quality, research, and transparency we put into our content. Dosing in ACLS. If your employer verifies that they will absolutely not accept the provider card, you will be issued a prompt and courteous refund of your entire course fee. Diltiazem effectively reduced mean ventricular rate by 39 beats per minute (StDev 23, 95% CI 25-33, p<0.001) with a 7 mm Hg (StDev 13.8, CI 3.7-8.9, p=0.03) mean reduction in MAP. It is available as an immediate-release capsule and an extended …

In: MIT Critical Data, editor.

The recommended starting dose is an intravenous bolus of 0.25 mg/kg over 2 minutes.