From the Guidelines
Cardizem (diltiazem) is not specifically contraindicated in patients with scleroderma, but caution is warranted when using this medication in this patient population. According to the most recent guidelines, dihydropyridine-type calcium antagonists, such as nifedipine, are recommended as first-line therapy for systemic sclerosis-related Raynaud's phenomenon 1. While diltiazem is a calcium channel blocker, its use in scleroderma patients requires careful consideration due to potential gastrointestinal side effects, including worsening of gastroesophageal reflux disease (GERD) symptoms, and hypotension. The European Alliance of Associations for Rheumatology recommends dihydropyridine-type calcium antagonists over other types of calcium channel blockers for the treatment of Raynaud's phenomenon in scleroderma patients 1. Therefore, when prescribing diltiazem to scleroderma patients, it's essential to start with lower doses and monitor closely for side effects, weighing the benefits of treating Raynaud's phenomenon against potential risks. Alternative treatments, such as nifedipine, may be considered if side effects become problematic.
Some key points to consider when using diltiazem in scleroderma patients include:
- Potential worsening of GERD symptoms due to relaxation of the lower esophageal sphincter
- Risk of hypotension, which may be problematic in patients with vascular dysfunction
- Importance of starting with lower doses (e.g., 30 mg three times daily) and monitoring closely for side effects
- Weighing the benefits of treating Raynaud's phenomenon against potential risks and considering alternative treatments if necessary.
It's also worth noting that other guidelines, such as those from the European Society of Cardiology, recommend caution when using non-dihydropyridine calcium channel blockers, like diltiazem, in patients with heart failure due to their negative inotropic effects 1. However, the most recent and relevant guideline for scleroderma treatment recommends dihydropyridine-type calcium antagonists as first-line therapy for Raynaud's phenomenon 1.
From the Research
Cardizem Contraindication in Scleroderma
- There is no direct evidence to suggest that Cardizem (diltiazem) is contraindicated in patients with scleroderma 2, 3, 4, 5, 6.
- In fact, diltiazem has been used to treat calcinosis in patients with scleroderma, with reports of reduction or disappearance of calcific lesions and clinical improvement 3, 5.
- Calcium channel blockers, including diltiazem, were not associated with an increased risk of scleroderma renal crisis in a case-control study 6.
- The treatment of scleroderma typically involves the use of vasodilators, immunosuppressant drugs, and antifibrotic agents, and diltiazem may be considered as a vasodilator option in certain cases 2.
- However, it is essential to note that the treatment of scleroderma should be individualized and guided by a healthcare professional, taking into account the specific needs and circumstances of each patient.