From the Guidelines
You should wait 15 minutes before increasing the diltiazem (dilt) drip to allow the medication to reach steady state and evaluate its effect on the patient's heart rate and blood pressure. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, the maintenance infusion dose of diltiazem is 5 mg/hour to 15 mg/hour, titrated to heart rate. After administering a dose change, it is crucial to monitor vital signs closely, particularly heart rate and blood pressure, as diltiazem can cause hypotension. If the target heart rate has not been achieved after this waiting period and the patient's blood pressure remains stable, you may consider increasing the dose according to the protocol. However, if the patient develops hypotension (systolic blood pressure <90 mmHg) or bradycardia (heart rate <60 beats per minute), do not increase the dose and consider decreasing it instead. The 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care also support the use of diltiazem for supraventricular tachyarrhythmias, but the more recent guideline 1 provides more specific dosing recommendations. Key considerations when adjusting the diltiazem dose include:
- Monitoring vital signs closely, especially heart rate and blood pressure
- Avoiding dose increases if the patient develops hypotension or bradycardia
- Titration of the dose to achieve the target heart rate while minimizing adverse effects
- Being aware of potential interactions with other medications, such as AV nodal blocking agents, and using caution when combining these medications 1.
From the FDA Drug Label
The infusion rate may be increased in 5 mg/h increments up to 15 mg/h as needed, if further reduction in heart rate is required. The answer to how long you should wait until increasing the dilt drip is not explicitly stated in the provided drug label. However, it can be inferred that the infusion rate can be increased in 5 mg/h increments as needed, without a specified time interval.
- Key points:
- Infusion rate can be increased up to 15 mg/h.
- Increase in 5 mg/h increments as needed.
- No specific time interval is provided for increasing the infusion rate. 2
From the Research
Diltiazem Drip Increase
- The provided studies do not directly address the question of how long to wait before increasing the diltiazem drip.
- However, the studies discuss the use of diltiazem and other antiarrhythmic agents in various contexts, including atrial fibrillation and ventricular rate control 3, 4, 5, 6.
- Diltiazem is classified as a Class IV antiarrhythmic agent, which includes calcium channel blockers 3.
- The studies suggest that diltiazem can be effective in controlling heart rate in patients with atrial fibrillation, both at rest and during exercise 4, 6.
- However, the studies also note that diltiazem can cause sinus arrest or severe sinus bradycardia, particularly when used in combination with beta-blockers 5.
- There is no specific guidance on when to increase the diltiazem drip, as this would depend on individual patient factors and clinical circumstances.
Relevant Considerations
- The decision to increase the diltiazem drip would likely depend on factors such as the patient's heart rate, blood pressure, and overall clinical condition.
- Monitoring of the patient's hemodynamic effects, rather than therapeutic drug monitoring, is generally recommended for calcium channel blockers like diltiazem 3.
- The use of diltiazem in combination with other agents, such as beta-blockers, should be done with caution due to the potential for additive effects on heart rate and blood pressure 5.