Generic Name: Cartia
What is Cartia?
Ergotamine: Because of the potential to cause coronary vasospasmergotamine theoretically could antagonize the therapeutic effects of calcium-channel blockers. Erlotinib: Use caution if coadministration of erlotinib with diltiazem is necessary due to the risk of increased erlotinib-related adverse reactions, and avoid coadministration with erlotinib if the patient is additionally taking a CYP1A2 inhibitor.
Diltiazem is a moderate CYP3A4 inhibitor. Erlotinib is primarily metabolized by CYP3A4, and to a lesser extent by CYP1A2. Erythromycin: Avoid administration of erythromycin and a calcium-channel blocker, particularly in geriatric patients. Coadministration has been associated with an increased risk of hypotension and shock. Azithromycin may be preferred if the use of a macrolide antibiotic is necessary in a patient receiving calcium-channel blocker therapy.
Erythromycin may also decrease the clearance of calcium-channel blockers e. Concurrent use of erythromycin with diltiazem and verapamil has been associated with sudden cardiac death.
Cabergoline: Diltiazem is an inhibitor of the CYP3A4 isoenzyme. Co-administration with diltiazem may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as cabergoline. Cabozantinib: Monitor for an increase in cabozantinib- and diltiazem-related adverse events if concomitant use of cabozantinib and diltiazem is necessary. Cabozantinib is primarily metabolized by CYP3A4 and diltiazem is a CYP3A4 inhibitor.
However, the clinical relevance of this finding is unknown. Theoretically, concentrations of either drug may be increased. Patients should be monitored for changes in glycemic control and possible adverse reactions. Carbamazepine: Carbamazepine is metabolized by the hepatic isoenzyme CYP3A4. Diltiazem inhibits CYP3A4 and may increase carbamazepine plasma concentrations as a result of inhibition of carbamazepine metabolism. Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers.
Cariprazine: Cariprazine and its active metabolites are extensively metabolized by CYP3A4. Diltiazem is a moderate inhibitor of CYP3A4 and may reduce the hepatic metabolism of CYP3A4 substrates, although the impact of moderate CYP3A4 inhibitors on cariprazine metabolism has not been studied.
Monitoring for adverse effects, such as CNS effects and extrapyramidal symptoms, is advisable during coadministration.
In addition, orthostatic vital signs should be monitored in patients who are at risk for hypotension, such as those receiving cariprazine in combination with antihypertensive agents.
How should I take Cartia?
Consider a cariprazine dose reduction if hypotension occurs. Celecoxib: If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy.
NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage.
What should I avoid while taking Cartia?
Use caution when administering these drugs concomitantly. Bupivacaine: Diltiazem may inhibit the CYP3A4-mediated metabolism of bupivacaine. Monitor for lidocaine toxicity if used together. Diltiazem may inhibit the CYP3A4-mediated metabolism of bupivacaine. Buprenorphine: Diltiazem is an inhibitor of the CYP3A4 isoenzyme. Co-administration with diltiazem may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as buprenorphine.
Buspirone: Coadministration of buspirone with diltiazem substantially increases the plasma concentration of buspirone. During coadministration with diltiazem, close monitoring is suggested, with adjustment of buspirone dosage if needed.
Cartia side effects
The OBRA guidelines also caution that antiarrhythmic agents can have serious adverse effects e. However, because beta-blockers and diltiazem are negative inotropes and chronotropes, the combination of beta-blockers and diltiazem may cause heart failure, excessive bradycardia, hypotension, cardiac conduction abnormalities, or heart block.
Monitor blood pressure and heart rate. Patients taking antihypertensive agents may need to have their therapy modified. Careful blood pressure monitoring is recommended.
Common Cartia ide effects may include:
One case of a possible verapamil-clarithromycin interaction was reported, which was associated with hypotension.
Bradycardia has been reported when fluvoxamine has been added to a stable diltiazem regimen.
The exposure to lomitapide was increased 27-fold in the presence of ketoconazole, a strong CYP3A4 inhibitor.
Diltiazem and verapamil are substrates and inhibitors of CYP3A4.
Halofantrine: Drugs which significantly inhibit cytochrome CYP3A4, such as diltiazem, may lead to an inhibition of halofantrine metabolism, placing the patient at risk for halofantrine cardiac toxicity. If concurrent use of halofantrine and a CYP3A4 inhibitor is warranted, it would be prudent to use caution and monitor the ECG periodically.
Haloperidol: In general, antipsychotics like haloperidol should be used cautiously with antihypertensive agents due to the possibility of additive hypotension. Diltiazem and verapamil are substrates and inhibitors of CYP3A4.
Where can I get more information?
Upon diltiazem discontinuation, the guanfacine ER dosage should be increased back to the recommended dose.
If initiating a moderate CYP3A4 inhibitor following flibanserin use, start the moderate CYP3A4 inhibitor at least 2 days after the last dose of flibanserin.