Tapering Diltiazem CD 120mg
For patients on diltiazem CD 120mg who need to discontinue, the medication can typically be stopped abruptly without a formal taper, as this is already the lowest therapeutic dose and diltiazem does not require gradual withdrawal like beta-blockers. 1
Clinical Context for Discontinuation
The 120mg daily dose represents the minimum effective starting dose for diltiazem extended-release formulations according to ACC/AHA guidelines, with the therapeutic range extending from 120-360mg daily. 1 Since you are already at the lowest dose, further reduction is not practical or necessary.
Key Considerations Before Stopping
Indication Matters
- For hypertension: The 120mg dose is often subtherapeutic, as effective blood pressure control typically requires 240-360mg daily or higher 2, 3, 4
- For angina: The 120-180mg range may provide adequate symptom control, and discontinuation should be done cautiously 5
- For rate control (atrial fibrillation): Abrupt cessation may lead to rapid ventricular response returning 6
Critical Safety Points
- Unlike beta-blockers, diltiazem does not require gradual tapering to avoid rebound phenomena, as there is no significant withdrawal syndrome described in the literature 1
- Monitor for return of symptoms (elevated blood pressure, angina, rapid heart rate) after discontinuation rather than worrying about withdrawal effects 7, 8
- Ensure alternative therapy is in place if diltiazem was controlling a specific condition (hypertension, angina, or arrhythmia) 1
Practical Discontinuation Approach
Direct Cessation Protocol
- Simply stop the 120mg dose without intermediate steps 1
- Monitor blood pressure and heart rate for 1-2 weeks after stopping to assess for return of the underlying condition 7
- Watch for symptom recurrence: chest pain if used for angina, palpitations if used for rate control 7, 8
When to Exercise Extra Caution
- Patients with coronary artery disease: Ensure alternative antianginal therapy is established before stopping 7
- Patients with atrial fibrillation: Have a plan for alternative rate control (beta-blocker or digoxin) 8
- Patients on multiple antihypertensives: Coordinate discontinuation with overall blood pressure management strategy 1
Common Pitfalls to Avoid
- Do not attempt to "half" the 120mg CD capsule - extended-release formulations cannot be split or crushed 7
- Do not confuse with beta-blocker discontinuation - diltiazem does not cause rebound tachycardia or hypertension like beta-blockers do 1
- Do not leave the patient without rate/rhythm control if diltiazem was being used for atrial fibrillation 8