Calcium-channel blockers - rate limiting (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Refer to the Stable angina management guideline.

Note: Combination of beta-blockers (Beta-adrenoceptor blocking drugs) with diltiazem or verapamil may produce excessive bradycardia and should only be used under specialist advice.

DILTIAZEM

Therapy notes

Modified-release preparations of diltiazem:

  • specify the brand to be dispensed
  • select the most cost-effective brand when initiating therapy
  • hospitals will only stock some brands; contact Pharmacy to identify brands currently available
  • patients should continue on the same brand
  • consider once-daily preparations in new patients and when medicine is being changed.


  • off-label indication for Raynaud’s phenomenon.

Formulation and dosage details

Formulation:

Modified release capsules (once daily dosing) 120mg, 200mg, 240mg, 280mg, 300mg

Dosage:

When initiating therapy, Zemtard XL is currently the preferred brand (once daily, modified release capsules: 120mg, 180mg, 240mg, 300mg). 

Formulation and dosage details

Formulation:

Modified release capsules (twice daily dosing) 60mg, 90mg, 120mg, 180mg

VERAPAMIL

Therapy notes

Formulation and dosage details

Formulation:

Tablets 40mg, 80mg, 120mg

Dosage:

Supraventricular arrhythmias: 40mg to 120mg 3 times daily
Angina: 80mg to 120mg 3 times daily
Hypertension: 240mg to 480mg daily, in 2 to 3 divided doses.

Formulation and dosage details

Formulation:

Modified release tablets 120mg, 240mg

Dosage:

Angina: 240mg twice daily, may sometimes be reduced to once daily
Hypertension: 240mg once or twice daily, new patients initially 120mg
Prophylaxis after myocardial infarction: where beta-blockers inappropriate, 360mg daily in divided doses. 

Formulation and dosage details

Formulation:

Injection 5mg/2mL

Editorial Information

Document Id: F055