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Diltiazem for Veterinary Use
by Barbara Forney, VMD
Diltiazem is a calcium channel blocker which is used in veterinary medicine to treat hypertension and certain cardiac arrhythmias. This drug is approved in human medicine under the trade names Cardizem, Dilacor, or Tiazac. Diltiazem causes vasodilatation, decreases peripheral resistance, blood pressure, and cardiac afterload. Diltiazem also slows the sinus firing rate. At normal doses it is less likely to affect cardiac contractility than some other Ca channel blockers.
Diltiazem is rapidly absorbed following oral administration and is metabolized by the liver. Bioavailability is less in dogs than in cats and the levels reported in both species are less than those reported in humans. It may be given orally and intravenously.
Dogs and Cats
Diltiazem is used in dogs to treat hypertension and SVTs. It is frequently used with digoxin in the treatment or management of dogs with atrial fibrillation and congestive heart failure. Diltiazem is used both in emergency situations for stabilization, and for longer term for management of arrhythmias.
Diltiazem is used in cats to treat
supraventricular tachyarrhythmias, hypertension, and hypertrophic cardiomyopathy. It may reduce myocardial oxygen demand and prolong ventricular filling time.
It is considered a good choice for heart rate reduction in cats with atrial fibrillation.
Although the treatment of pre-clinical hypertrophic cardiomyopathy is controversial, some clinicians use diltiazem in combination with other cardiac drugs in the asymptomatic cat
Dogs: Bradycardia is the most common side effect.
Cats: Vomiting is the most frequent side effect.
Side effects seen in both species include vomiting, anorexia, lethargy, heart block or other arrhythmias, hypotension, central nervous system disturbances, and rashes.
- Diltiazem should not be used in animals with severe hypotension, sick sinus syndrome, 2
degree heart block, myocardial infarction, or pulmonary congestion. It should be used with additional caution in animals in congestive heart failure and those in kidney or liver failure.
- Cats should not receive the sustained release human formulation due to an increased incidence in adverse side effects.
- Diltiazem should only be used during pregnancy or lactation when the benefits outweigh the risks.
- General anesthesia and beta blockers may increase the frequency and degree of cardiac side effects. Diltiazem is sometimes used with beta blockers, but there is an increased risk of bradycardia.
- Diltiazem may increase blood levels of the following drugs: benzodiazepines, buspirone, cyclosporine, and quinidine.
- Cimetidine and possibly other histamine H
receptor antagonists may increase levels of diltiazem.
- Diltiazem levels may be decreased by rifampin.
- There is a wide margin of safety for clopidogrel. Based on experience in human medicine, bleeding and vomiting are the most likely clinical signs of overdose.
- Platelet transfusion may be considered in an acute overdose.
About the Author
Dr. Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania. She has a master's degree in animal science from the University of Delaware and graduated from the University of Pennsylvania School of Veterinary Medicine in 1982.
She began to develop her interest in client education and medical writing in 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
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