Angizem Cd 120 Mg Tablets

Angizem CD 120 Mg Tablets — Diltiazem Hydrochloride 120 Mg Controlled Delivery for Angina and Hypertension

Angizem CD 120 Mg Tablets contain Diltiazem Hydrochloride 120 mg in a controlled delivery (CD) formulation, manufactured by Cadila Pharmaceuticals Ltd. This is the higher-strength formulation in the Angizem CD range, used for the management of stable angina pectoris, hypertension, and supraventricular tachycardias including atrial fibrillation, often allowing once-daily dosing. Angizem CD 120 Mg is a prescription-only medicine.

Composition

About Cadila Pharmaceuticals Ltd

Cadila Pharmaceuticals Ltd is one of India’s largest privately-held pharmaceutical companies, based in Ahmedabad, Gujarat. With WHO-GMP certified manufacturing and a broad cardiovascular portfolio, Cadila has established Angizem as a trusted diltiazem brand in the Indian market. The controlled-delivery technology in the Angizem CD range provides predictable 12–24 hour drug release profiles.

How Angizem CD 120 Works — Mechanism of Action

Diltiazem Hydrochloride is a benzothiazepine-class, non-dihydropyridine calcium channel blocker. It inhibits L-type voltage-gated calcium channels in both cardiac muscle and vascular smooth muscle:

• Cardiac rate and conduction: Slows spontaneous depolarisation of the SA node (heart rate reduction) and prolongs AV nodal conduction (rate control in AF and SVT prevention)
• Negative inotropy: Mild reduction in myocardial contractility reduces cardiac workload and oxygen demand — key antianginal mechanism
• Coronary vasodilation: Dilates coronary arteries to increase myocardial oxygen supply in effort and vasospastic angina
• Peripheral vasodilation: Reduces systemic vascular resistance → antihypertensive effect without the reflex tachycardia seen with dihydropyridines
• Controlled delivery advantage: The 120 mg CD formulation maintains therapeutic diltiazem levels for 12–24 hours, reducing peak-to-trough variation and improving tolerability compared to immediate-release forms

Clinical Indications

• Stable angina pectoris: Prevention and reduction of effort-induced and vasospastic anginal episodes
• Hypertension: Management of mild to moderate hypertension, alone or combined with other antihypertensive agents
• Atrial fibrillation / atrial flutter: Ventricular rate control in persistent or paroxysmal AF
• Supraventricular tachycardias: Prevention and rate control of AV nodal re-entrant and AV re-entrant tachycardias

Dosage and Administration

• Angina: 120 mg once or twice daily as directed, depending on severity and response.
• Hypertension: Often 120–240 mg once daily with the CD formulation.
• Atrial fibrillation rate control: Dose and frequency as directed by cardiologist.
• Swallow whole: Do NOT crush, break, or chew CD tablets. The controlled-release coating must remain intact to deliver the drug gradually and safely over 12–24 hours.
• Can be taken with or without food. Take at the same time each day.
• Titration: Start at the lower dose (90 mg) in dose-naïve patients; step up to 120 mg based on tolerance and response under medical guidance.

Special Populations

• Elderly: Increased sensitivity to bradycardia and hypotension. Consider starting with 90 mg before stepping up to 120 mg. Monitor closely.
• Pregnancy: Animal data indicate potential teratogenicity. Use only if clearly necessary; monitor foetus if used. Avoid in first trimester.
• Breastfeeding: Excreted in breast milk. Avoid if breastfeeding unless no suitable alternative; if used, monitor infant for bradycardia.
• Renal impairment: Diltiazem is not renally cleared significantly. No formal dose adjustment needed; monitor clinically.
• Hepatic impairment: Diltiazem is extensively hepatically metabolised (CYP3A4). Significant reduction in starting dose required; use 90 mg CD or lower under specialist guidance in moderate/severe hepatic impairment.

Precautions

• Bradycardia and AV block: Diltiazem slows AV conduction. Monitor pulse; avoid if resting heart rate <50 bpm or significant AV block is present.
• Heart failure: The negative inotropic effect can decompensate heart failure. Contraindicated in decompensated heart failure. Use only under specialist supervision in stable HFpEF.
• Beta-blocker interaction: High risk combination — severe bradycardia and AV block possible. Use only under specialist supervision with ECG monitoring.
• Do not stop abruptly: Gradual withdrawal under medical supervision; abrupt cessation may exacerbate angina.
• Liver function: Monitor LFTs if used long-term, particularly in those with liver disease or at risk.

Contraindications

• Hypersensitivity to diltiazem or any excipient
• Significant bradycardia (resting HR <50 bpm)
• Second or third degree AV block (without pacemaker)
• Sick sinus syndrome (without pacemaker)
• Decompensated heart failure (pulmonary congestion documented)
• Severe hypotension (systolic BP <90 mmHg)
• Accessory pathway (Wolff-Parkinson-White) with pre-excitation atrial fibrillation
• Concurrent IV beta-blocker use

Side Effects

Common (≥1/100): Peripheral oedema (ankle swelling), bradycardia, dizziness, headache, flushing, constipation, nausea, fatigue.

Uncommon (≥1/1,000): Hypotension, AV block (first degree), pruritus, skin rash, raised liver enzymes.

Rare but serious: Second/third-degree AV block, symptomatic heart failure, hepatotoxicity, Stevens-Johnson syndrome, erythema multiforme.

Seek immediate medical attention if you experience palpitations with slow heartbeat, significant oedema, difficulty breathing, or jaundice.

Drug Interactions

• Beta-blockers: Combined cardiac rate-slowing — increased risk of bradycardia, AV block, heart failure, and hypotension. Use with specialist oversight only.
• Digoxin: Diltiazem increases digoxin levels (reduces renal clearance) + both slow AV conduction. Monitor closely for digoxin toxicity.
• Statins (simvastatin, lovastatin): Diltiazem CYP3A4 inhibition → elevated statin levels → myopathy risk. Use lowest statin dose; prefer rosuvastatin or pravastatin.
• Ciclosporin: Marked increase in ciclosporin levels. Monitor levels and reduce ciclosporin dose.
• Amiodarone, flecainide: Additive negative cardiac effects — monitor ECG closely.
• Rifampicin (CYP3A4 inducer): Markedly reduces diltiazem levels and efficacy.
• Midazolam, triazolam: CYP3A4 inhibition by diltiazem significantly increases their sedative effect.

Storage Instructions

• Store below 30°C. Protect from direct sunlight and moisture.
• Keep in original blister packaging.
• Keep out of reach of children.
• Do not use past the expiry date on the pack.

Related Products

For patients starting diltiazem controlled delivery or requiring a lower dose, see Angizem CD 90 Mg Tablets — the 90 mg twice-daily formulation for initial titration and moderate dose requirements.

Frequently Asked Questions

What is the difference between Angizem CD 90 and Angizem CD 120?

Both contain diltiazem in a controlled-delivery form from Cadila Pharmaceuticals. Angizem CD 90 delivers 90 mg per dose, typically used twice daily, and is often the starting formulation. Angizem CD 120 delivers 120 mg and is typically the step-up formulation, often allowing once-daily dosing in hypertension and once or twice daily in angina. Your doctor will select the appropriate strength based on your condition and response.

What does “controlled delivery” mean for Angizem CD?

The CD (controlled delivery) coating allows diltiazem to be released gradually from the tablet over 12–24 hours, rather than all at once (as with immediate-release tablets). This maintains more consistent blood levels throughout the day, reduces the frequency of dosing, and minimises peak-dose side effects such as flushing and dizziness that occur with immediate-release diltiazem.

Can I take Angizem CD 120 for high blood pressure instead of amlodipine?

Both diltiazem (Angizem CD) and amlodipine are calcium channel blockers, but they work differently. Amlodipine (a dihydropyridine) primarily vasodilates without affecting heart rate. Diltiazem (a non-dihydropyridine) also slows heart rate and AV conduction. For patients with hypertension and a concurrent rapid heart rate or atrial fibrillation, diltiazem may be preferred. Your cardiologist will advise the most appropriate choice based on your overall cardiovascular profile.

Is Angizem CD 120 safe for patients who have already had a heart attack?

Diltiazem use in post-myocardial infarction patients requires careful evaluation. It may be used in selected patients with preserved left ventricular function and without conduction disturbances, but is generally avoided in patients with impaired LV function (EF <40%) or pulmonary congestion. Always consult your cardiologist before starting or continuing diltiazem after a cardiac event.

Can I take Angizem CD 120 with my grapefruit juice?

Avoid grapefruit juice while taking diltiazem. Grapefruit inhibits CYP3A4, the same enzyme that metabolises diltiazem — consuming grapefruit can significantly increase diltiazem blood levels, potentially causing excessive blood pressure lowering, bradycardia, or other side effects.

References

1. NHS — Diltiazem. National Health Service, UK.
2. MedlinePlus — Diltiazem. U.S. National Library of Medicine.
3. FDA Prescribing Information — Diltiazem Hydrochloride. U.S. Food and Drug Administration.
4. NHS — Angina: Treatment. National Health Service, UK.

Disclaimer: This product information is provided for general educational purposes only. Angizem CD 120 Mg is a prescription-only medicine. It must be used only as directed by a qualified healthcare professional. This content does not constitute medical advice. IndoGenMed.org supplies this product to licensed healthcare professionals and registered pharmacies only.