Matzim LA 360mg Tablets
It is used to treat high blood pressure.It is used to treat some types of chest pain (angina).It may be given to you for other reasons. Talk with the doctor.
Drug Class
Calcium Channel Blocker, Antihypertensive, Antianginal
Pharmacologic Class
Non-dihydropyridine Calcium Channel Blocker
Pregnancy Category
Category C
FDA Approved
Sep 1990
DEA Schedule
Not Controlled
Overview
What is this medicine?
Diltiazem is a medication that helps relax blood vessels and slow down your heart rate. This can lower your blood pressure, reduce chest pain (angina), and help control certain irregular heart rhythms. It works by blocking calcium from entering heart and blood vessel cells.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely.
Take your medication as directed by your doctor, swallowing the tablets whole without chewing, breaking, or crushing them.
Establish a routine by taking your medication at the same time every day.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start feeling well.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication:
Store it at room temperature, protected from light and moisture.
Keep it in a dry place, avoiding storage in a bathroom.
Keep all medications in a secure location, out of the reach of children and pets.
* Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist. Check with your pharmacist for guidance on the best disposal method, and consider participating in local drug take-back programs.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Avoid taking two doses at the same time or taking extra doses.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely.
Take your medication as directed by your doctor, swallowing the tablets whole without chewing, breaking, or crushing them.
Establish a routine by taking your medication at the same time every day.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start feeling well.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication:
Store it at room temperature, protected from light and moisture.
Keep it in a dry place, avoiding storage in a bathroom.
Keep all medications in a secure location, out of the reach of children and pets.
* Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist. Check with your pharmacist for guidance on the best disposal method, and consider participating in local drug take-back programs.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Avoid taking two doses at the same time or taking extra doses.
Lifestyle & Tips
- Take the medication exactly as prescribed, usually once daily. Do not crush, chew, or break the extended-release tablet.
- Swallow the tablet whole with a glass of water.
- Maintain a healthy diet, low in sodium and saturated fats.
- Engage in regular physical activity as advised by your doctor.
- Limit alcohol intake.
- Avoid sudden changes in position (e.g., standing up quickly) to prevent dizziness.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
- Do not stop taking this medication suddenly without consulting your doctor, as it can worsen your condition.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
360 mg orally once daily
Dose Range:
120 - 540 mg
Condition-Specific Dosing:
hypertension:
Initial: 180-240 mg once daily; Titrate up to 540 mg once daily based on response.
chronic_stable_angina:
Initial: 120-180 mg once daily; Titrate up to 480 mg once daily based on response.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed, monitor closely.
Moderate:
No specific adjustment needed, monitor closely.
Severe:
Use with caution, monitor for exaggerated effects. Dose reduction may be necessary.
Dialysis:
Not significantly dialyzable. Use with caution, monitor for exaggerated effects.
Hepatic Impairment:
Mild:
Use with caution, monitor for exaggerated effects.
Moderate:
Initiate at lower doses (e.g., 120 mg once daily) and titrate slowly with close monitoring.
Severe:
Contraindicated in severe hepatic impairment due to extensive hepatic metabolism and risk of accumulation.
Confidence:
Medium
Pharmacology
Mechanism of Action
Diltiazem is a non-dihydropyridine calcium channel blocker that inhibits the influx of extracellular calcium ions across the myocardial and vascular smooth muscle cell membranes. This leads to relaxation of vascular smooth muscle, resulting in peripheral and coronary vasodilation, and a reduction in systemic vascular resistance and blood pressure. In the heart, it decreases sinoatrial (SA) and atrioventricular (AV) nodal conduction, prolongs AV nodal refractory period, and reduces myocardial contractility, leading to a decrease in heart rate and myocardial oxygen demand.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 40-65% (due to extensive first-pass metabolism), variable.
Tmax:
Long-acting formulations: 6-11 hours.
FoodEffect:
Food may increase bioavailability of some extended-release formulations, but generally can be taken with or without food.
Distribution:
Vd:
Approximately 5.3 L/kg.
ProteinBinding:
Approximately 70-85%.
CnssPenetration:
Limited
Elimination:
HalfLife:
Parent drug: 5-10 hours (for extended-release formulations); Desacetyl diltiazem: 9-12 hours.
Clearance:
Approximately 1.1 L/min.
ExcretionRoute:
Mainly urine (60-65%), feces (35%).
Unchanged:
Less than 4% (urine).
Pharmacodynamics
OnsetOfAction:
Extended-release: 2-3 hours (for initial effect).
PeakEffect:
Extended-release: 6-11 hours (corresponds to Tmax).
DurationOfAction:
24 hours (for once-daily extended-release formulations).
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Immediately
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Severe dizziness or fainting
Slow heartbeat
New or worsening abnormal heartbeat
Worsening heart failure (if you have a history of heart failure, discuss this with your doctor). Seek immediate medical attention if you experience:
+ Shortness of breath
+ Sudden weight gain
+ Swelling in the arms or legs
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other severe skin reactions, which can be life-threatening. Seek medical help right away if you notice:
+ Red, swollen, blistered, or peeling skin
+ Other skin irritation (with or without fever)
+ Red or irritated eyes
+ Sores in your mouth, throat, nose, or eyes
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor or seek medical attention:
Headache
* Feeling dizzy, tired, or weak
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Severe dizziness or fainting
Slow heartbeat
New or worsening abnormal heartbeat
Worsening heart failure (if you have a history of heart failure, discuss this with your doctor). Seek immediate medical attention if you experience:
+ Shortness of breath
+ Sudden weight gain
+ Swelling in the arms or legs
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other severe skin reactions, which can be life-threatening. Seek medical help right away if you notice:
+ Red, swollen, blistered, or peeling skin
+ Other skin irritation (with or without fever)
+ Red or irritated eyes
+ Sores in your mouth, throat, nose, or eyes
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor or seek medical attention:
Headache
* Feeling dizzy, tired, or weak
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or lightheadedness, especially when standing up.
- Fainting spells.
- Unusual swelling in your ankles, feet, or hands.
- Shortness of breath or difficulty breathing, especially at rest or with mild exertion.
- Very slow heart rate (e.g., less than 50 beats per minute).
- New or worsening chest pain.
- Signs of liver problems (e.g., yellowing of skin/eyes, dark urine, persistent nausea/vomiting, severe stomach pain).
- Severe skin rash or allergic reaction.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain types of abnormal heart rhythms, as this medication is not suitable for use with some arrhythmias. If you are unsure, consult your doctor or pharmacist for guidance.
Existing health conditions, such as:
+ Fluid accumulation in the lungs
+ Low blood pressure
+ Recent heart attack
Current medications, including:
+ Ivabradine
+ Rifampin
* All other prescription and over-the-counter (OTC) medications, natural products, and vitamins you are taking, as this is not an exhaustive list of potential interactions.
To ensure safe use, it is crucial to discuss all your medications and health conditions with your doctor and pharmacist. Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor to confirm it is safe to do so.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain types of abnormal heart rhythms, as this medication is not suitable for use with some arrhythmias. If you are unsure, consult your doctor or pharmacist for guidance.
Existing health conditions, such as:
+ Fluid accumulation in the lungs
+ Low blood pressure
+ Recent heart attack
Current medications, including:
+ Ivabradine
+ Rifampin
* All other prescription and over-the-counter (OTC) medications, natural products, and vitamins you are taking, as this is not an exhaustive list of potential interactions.
To ensure safe use, it is crucial to discuss all your medications and health conditions with your doctor and pharmacist. Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor to confirm it is safe to do so.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
When starting this medication, be cautious when performing tasks that require your full attention, such as driving, until you understand how it affects you. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying down position, and exercise care when climbing stairs.
As directed by your doctor, regularly monitor your blood pressure and heart rate. You may need to undergo an electrocardiogram (ECG) before initiating treatment with this medication and at intervals during treatment. Discuss any concerns or questions with your doctor.
If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Additionally, if you consume grapefruit juice or eat grapefruit regularly, discuss this with your doctor. It is also recommended that you talk to your doctor before consuming alcohol while taking this medication.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
It is crucial to inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. You and your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby.
When starting this medication, be cautious when performing tasks that require your full attention, such as driving, until you understand how it affects you. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying down position, and exercise care when climbing stairs.
As directed by your doctor, regularly monitor your blood pressure and heart rate. You may need to undergo an electrocardiogram (ECG) before initiating treatment with this medication and at intervals during treatment. Discuss any concerns or questions with your doctor.
If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Additionally, if you consume grapefruit juice or eat grapefruit regularly, discuss this with your doctor. It is also recommended that you talk to your doctor before consuming alcohol while taking this medication.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
It is crucial to inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. You and your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe hypotension (very low blood pressure)
- Profound bradycardia (extremely slow heart rate)
- High-degree atrioventricular (AV) block
- Cardiogenic shock
- Asystole (cardiac arrest)
- Metabolic acidosis
- Hyperglycemia
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222. Treatment is supportive and may include IV fluids, vasopressors (e.g., norepinephrine), atropine, calcium gluconate/chloride, glucagon, and cardiac pacing.
Drug Interactions
Contraindicated Interactions
- Ivabradine (risk of severe bradycardia)
- Dantrolene (IV) (risk of cardiovascular collapse)
Major Interactions
- Beta-blockers (additive negative chronotropic and inotropic effects, risk of bradycardia, AV block, heart failure)
- Digoxin (increased digoxin levels, risk of toxicity)
- Statins (e.g., Simvastatin, Lovastatin - increased statin levels, risk of myopathy/rhabdomyolysis due to CYP3A4 inhibition)
- Amiodarone (risk of severe bradycardia, AV block, hypotension)
- Fentanyl (risk of severe bradycardia, hypotension)
- Midazolam, Triazolam (increased benzodiazepine levels due to CYP3A4 inhibition)
- Cyclosporine, Tacrolimus, Sirolimus (increased immunosuppressant levels)
- Carbamazepine, Phenytoin (increased anticonvulsant levels)
- Alpha-blockers (e.g., Prazosin, Doxazosin - risk of severe hypotension)
- Clonidine (risk of severe bradycardia, AV block)
Moderate Interactions
- Other antihypertensives (additive hypotensive effects)
- Grapefruit juice (may increase diltiazem levels)
- Cimetidine (may increase diltiazem levels)
- Rifampin (may decrease diltiazem levels)
- Theophylline (increased theophylline levels)
- Buspirone (increased buspirone levels)
Minor Interactions
- Not typically clinically significant interactions for minor category.
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing for hypertension/angina.
Timing: Prior to initiation.
Heart Rate (HR)
Rationale: To establish baseline and assess for bradycardia, especially with other rate-lowering drugs.
Timing: Prior to initiation.
Electrocardiogram (ECG)
Rationale: To assess for pre-existing conduction abnormalities (e.g., AV block) and PR interval.
Timing: Prior to initiation, especially in patients with cardiac history.
Liver Function Tests (LFTs)
Rationale: Diltiazem is extensively metabolized by the liver; baseline assessment is important.
Timing: Prior to initiation.
Renal Function (SCr, BUN)
Rationale: To assess kidney function, though renal elimination is minor, severe impairment requires caution.
Timing: Prior to initiation.
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly, especially during dose titration and periodically thereafter (e.g., weekly during titration, then monthly/quarterly).
Target: <130/80 mmHg (or individualized target)
Action Threshold: Persistent hypotension (<90/60 mmHg) or uncontrolled hypertension.
Heart Rate (HR)
Frequency: Regularly, especially during dose titration and periodically thereafter (e.g., weekly during titration, then monthly/quarterly).
Target: 50-90 bpm (or individualized target)
Action Threshold: Bradycardia (<50 bpm) or symptomatic bradycardia.
Electrocardiogram (ECG) / PR interval
Frequency: Periodically, especially if dose is increased or if patient develops symptoms of conduction disturbance or is on other AV nodal blocking agents.
Target: PR interval <0.20 seconds
Action Threshold: Significant PR prolongation (>0.24 seconds) or development of higher-degree AV block.
Symptoms of peripheral edema
Frequency: At each visit.
Target: Absence of significant edema.
Action Threshold: Development of new or worsening peripheral edema.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Fatigue
- Headache
- Peripheral edema (swelling of ankles/feet)
- Shortness of breath
- Chest pain (for angina management)
- Palpitations
- Bradycardia (slow heart rate)
Special Patient Groups
Pregnancy
Diltiazem is Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects, but there are no adequate and well-controlled studies in pregnant women.
Trimester-Specific Risks:
First Trimester:
Potential for teratogenicity observed in animal studies at high doses; human data limited.
Second Trimester:
Limited human data; generally avoided unless clearly indicated.
Third Trimester:
May cause fetal bradycardia or hypotension; generally avoided near term.
Lactation
Diltiazem is excreted in breast milk. The American Academy of Pediatrics considers it compatible with breastfeeding, but caution is advised. Monitor the infant for bradycardia, hypotension, and sedation.
Infant Risk:
L3 (Moderately safe - possible adverse effects, but generally considered compatible with monitoring).
Pediatric Use
Safety and efficacy have not been established in pediatric patients. Use is generally not recommended.
Geriatric Use
Geriatric patients may be more sensitive to the effects of diltiazem, particularly regarding hypotension and bradycardia. Initiate therapy at the lower end of the dosing range and titrate slowly with close monitoring of blood pressure and heart rate due to potential for decreased hepatic and renal function and polypharmacy.
Clinical Information
Clinical Pearls
- Matzim LA is an extended-release formulation designed for once-daily dosing. Emphasize to patients not to crush, chew, or break the tablets.
- Monitor heart rate and blood pressure regularly, especially during initial titration and when combining with other rate-lowering agents (e.g., beta-blockers).
- Diltiazem is a CYP3A4 inhibitor; be mindful of potential drug interactions with substrates of this enzyme (e.g., statins, immunosuppressants, digoxin).
- Peripheral edema is a common side effect, usually dose-dependent and often manageable. Differentiate from heart failure symptoms.
- Patients should be advised to report any signs of severe bradycardia, dizziness, or worsening heart failure symptoms immediately.
- While generally well-tolerated, caution is warranted in patients with sick sinus syndrome, second- or third-degree AV block (without a pacemaker), or severe hypotension.
Alternative Therapies
- Other calcium channel blockers (e.g., Amlodipine, Felodipine, Verapamil)
- ACE inhibitors (e.g., Lisinopril, Enalapril)
- Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan, Losartan)
- Beta-blockers (e.g., Metoprolol, Atenolol)
- Diuretics (e.g., Hydrochlorothiazide, Furosemide)
- Alpha-1 blockers (e.g., Prazosin, Doxazosin)
Cost & Coverage
Average Cost:
$30 - $150 per 30 tablets (360mg generic)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (for generic formulations)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide detailed information about the overdose, including the medication taken, the amount, and the time it occurred.