Diltiazem
Rate control (atrial fibrillation/flutter), SVT (second-line)
Indications
- Rate control (atrial fibrillation/flutter)
- SVT (second-line)
Adult dosing
- bolus: dose: 0.25; unit: mg/kg; route: IV over 2min; weightBased: true; maxDose: 25; maxDoseAbsolute: true; repeat bolus: dose: 0.35; unit: mg/kg; route: IV over 2min; interval: if inadequate response after 15min; weightBased: true; maxDose: 35; maxDoseAbsolute: true; drip: dose: 5; maxDose: 15; unit: mg/hr; route: IV; fixed: true
Pediatric dosing
- iv: dose: 0.25; unit: mg/kg; maxDose: 20; maxDoseAbsolute: true; route: IV over 2min; weightBased: true; pedNote: Avoid in children <1 year; use adenosine for SVT
Contraindications
- SBP < 90
- Acute heart failure
- Wide-complex tachycardia of unknown origin
- Pre-excited AF (WPW)
- Second/third degree AV block
Clinical pearls
- More effective than metoprolol for acute rate control in AF
- Bolus: 0.25 mg/kg IV over 2 min — typical 70kg patient gets ~17.5mg
- Start drip at 5 mg/hr after bolus — titrate to HR goal
- Do NOT use in pre-excited AF (WPW) — can cause VF
Source and review
- ACC/AHA Atrial Fibrillation Guidelines 2023. Last reviewed: 2024-10-01