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A study in six healthy volunteers has shown a significant increase in peak diltiazem plasma levels58and area-under-the-curve53after a 1-week course of cimetidine at 1200 mg per day and a single dose of diltiazem 60 mgRanitidine produced smallernonsignificant increasesThe effect may be mediated by cimetidine’s known inhibition of hepatic cytochrome P-450the enzyme system responsible for the first-pass metabolism of diltiazemPatients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidineAn adjustment in the diltiazem dose may be warranted.

Intravenous diltiazem in doses of 20 mg prolongs AH conduction time and AV node functional and effective refractory periods approximately 20In a study involving single oral doses of 300 mg of CARDIZEM in six normal volunteersthe average maximum PR prolongation was 14with no instances of greater than first-degree AV blockDiltiazem-associated prolongation of the AH interval is not more pronounced in patients with first-degree heart blockIn patients with sick sinus syndromediltiazem significantly prolongs sinus cycle lengthup to 50in some cases

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