Am J Emerg Med

IV calcium: Does it protect against diltiazem-induced hypotension?

May 9, 2025

IV calcium pretreatment effectively prevented diltiazem-induced hypotension in afib/atrial flutter patients with rapid ventricular response (RVR), without compromising diltiazem's efficacy in rate control. This approach offers a valuable strategy for managing hypotension in patients requiring diltiazem for afib/atrial flutter.

Study details: This randomized, double-blind, placebo-controlled trial (NCT06494007) assessed the efficacy and safety of IV calcium chloride pretreatment in preventing diltiazem-induced hypotension in adults with afib or atrial flutter with RVR. The study included 217 patients, divided into three groups: placebo (PD), 90 mg calcium chloride (C90D), and 180 mg calcium chloride (C180D) prior to IV diltiazem.

Results: The PD and C90D groups consistently had lower heart rates at 10 and 15 minutes compared with the C180D group. Mean systolic blood pressure (SBP) was lowest in the PD group, while at 10 minutes, it peaked in the C180D group. By 15 minutes, both C90D and C180D groups had higher SBP compared with PD. There were no significant differences in the need for additional diltiazem doses or adverse events between calcium pretreatment and placebo groups.

Source:

Az A, et al. (2025, February). Am J Emerg Med. Reducing diltiazem-related hypotension in atrial fibrillation: Role of pretreatment intravenous calcium. https://pubmed.ncbi.nlm.nih.gov/39577214/