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diltiazem hydrochloride injection is indicated for the following atrial fibrillation or atrial flutter temporary control of rapid ventricular rate in atrial fibrillation or atrial flutter it should not be used in patients with atrial fibrillation or atrial flutter associated with an accessory bypass tract such as in wolff parkinson white wpw syndrome or short pr syndrome paroxysmal supraventricular tachycardia rapid conversion of paroxysmal supraventricular tachycardias psvt to sinus rhythm this includes av nodal reentrant tachycardias and reciprocating tachycardias associated with an extranodal accessory pathway such as the wpw syndrome or short pr syndrome unless otherwise contraindicated appropriate vagal maneuvers should be attempted prior to administration of diltiazem hydrochloride injection the use of diltiazem hydrochloride injection should be undertaken with caution when the patient is compromised hemodynamically or is taking other drugs that decrease any or all of the following peripheral resistance myocardial filling myocardial contractility or electrical impulse propagation in the myocardium for either indication and particularly when employing continuous intravenous infusion the setting should include continuous monitoring of the ecg and frequent measurement of blood pressure a defibrillator and emergency equipment should be readily available in domestic controlled trials in patients with atrial fibrillation or atrial flutter bolus administration of diltiazem hydrochloride injection was effective in reducing heart rate by at least 2 in 95 of patients diltiazem hydrochloride injection rarely converts atrial fibrillation or atrial flutter to normal sinus rhythm following administration of one or two intravenous bolus doses of diltiazem injection response usually occurs within 3 minutes and maximal heart rate reduction generally occurs in 2 to 7 minutes heart rate reduction may last from 1 to 3 hours if hypotension occurs it is generally short lived but may last from 1 to 3 hours a 24 hour continuous infusion of diltiazem injection in the treatment of atrial fibrillation or atrial flutter maintained at least a 2 heart rate reduction during the infusion in 83 of patients upon discontinuation of infusion heart rate reduction may last from 5 hours to more than 1 hours median duration 7 hours hypotension if it occurs may be similarly persistent in the controlled clinical trials 3 2 of patients required some form of intervention typically use of intravenous fluids or the trendelenburg position for blood pressure support following diltiazem hydrochloride injection in domestic controlled trials bolus administration of diltiazem hydrochloride injection was effective in converting psvt to normal sinus rhythm in 88 of patients within 3 minutes of the first or second bolus dose symptoms associated with the arrhythmia were improved in conjunction with decreased heart rate or conversion to normal sinus rhythm following administration of diltiazem hydrochloride injection
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