From the Guidelines
Taking diltiazem with rhabdomyolysis is not recommended without careful medical supervision due to potential worsening of the condition and interactions with compromised kidney function. Diltiazem, a calcium channel blocker used for high blood pressure and certain heart conditions, can potentially exacerbate muscle damage in some situations, and its primary processing through the kidneys may be compromised by rhabdomyolysis 1. The 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia highlights precautions for diltiazem use, including hypotension, worsening HF in patients with pre-existing ventricular dysfunction, bradycardia, and abnormal liver function studies 1.
Key Considerations
- Diltiazem's potential to worsen rhabdomyolysis due to its effects on muscle damage and kidney function
- The need for careful medical supervision when considering diltiazem use in patients with rhabdomyolysis
- Potential interactions with other medications, such as statins, which may increase the risk of rhabdomyolysis
- The importance of monitoring kidney function and adjusting medication as necessary to prevent further complications
Recommendations
- Consult a healthcare provider immediately for personalized guidance on taking diltiazem with rhabdomyolysis
- Monitor kidney function closely and adjust medication as necessary to prevent further complications
- Consider alternative treatments based on the specific situation and cause of rhabdomyolysis
- Be aware of potential interactions with other medications, such as statins, and take steps to minimize risks 1.
From the FDA Drug Label
Diltiazem is an inhibitor of CYP3A4 and has been shown to increase significantly the AUC of some statins. The risk of myopathy and rhabdomyolysis with statins metabolized by CYP3A4 may be increased with concomitant use of diltiazem
- Rhabdomyolysis is a potential adverse event associated with the use of statins, and diltiazem may increase this risk.
- The FDA drug label recommends close monitoring for signs and symptoms of any statin-related adverse events when diltiazem and statins are used concomitantly.
- However, the label does not provide direct information on the use of diltiazem in patients with rhabdomyolysis.
- Therefore, based on the available information, it is not possible to determine the safety of taking diltiazem with rhabdomyolosis, and a conservative approach would be to avoid concomitant use until more information is available 2.
From the Research
Rhabdomyolysis and Medication Interactions
- Rhabdomyolysis is a clinical syndrome of muscle injury associated with myoglobinuria, electrolyte abnormalities, and often acute kidney injury (AKI) 3.
- The pathophysiology involves injury to the myocyte membrane and/or altered energy production that results in increased intracellular calcium concentrations and initiation of destructive processes 3.
- Common causes of rhabdomyolysis in hospitalized patients include prescription and over-the-counter medications, alcohol, and illicit drugs 3.
Diltiazem and Rhabdomyolysis
- There is no direct evidence in the provided studies that specifically addresses the interaction between diltiazem and rhabdomyolysis.
- However, it is known that certain medications can contribute to the development of rhabdomyolysis 3, 4.
- Treatment of rhabdomyolysis is aimed at discontinuation of further skeletal muscle damage, prevention of acute renal failure, and rapid identification of potentially life-threatening complications 3, 5, 6, 7.
Management of Rhabdomyolysis
- Early and aggressive fluid resuscitation to restore renal perfusion and increase urine flow is agreed on as the main intervention for preventing and treating AKI 3, 5.
- The use of bicarbonate-containing fluids, mannitol, and loop diuretics is not supported by high-quality evidence 3, 5.
- Hyperkalemia and compartment syndrome are additional complications of rhabdomyolysis that must be treated effectively 3, 5.