Diltiazem is a benzothiazepine derivative with antihypertensive and vasodilating properties. Approved in 1982 by the FDA, it is a member of the non-dihydropyridine calcium channel blockers drug class. It works through various mechanisms of action, but it primarily works by inhibiting the calcium influx into cardiac and vascular smooth muscle during depolarization.[L10556] Compared to dihydropyridine drugs, such as [nifedipine], that preferentially act on vascular smooth muscle and [verapamil] that directly acts on the heart muscle, diltiazem displays an intermediate specificity to target both the cardiac and vascular smooth muscle.[T28] Being a potent vasodilator, diltiazem is used clinically as an antihypertensive, anti-arrhythmic, and as an anti-anginal agent [L6289] for the management of cardiovascular conditions such as hypertension, chronic stable angina, atrial fibrillation, atrial flutter. Apart from its main FDA-approved indications, diltiazem has also been used for numerous off-label indications, such as anal fissures (in topical formulations), migraine prophylaxis, pulmonary hypertension, and rest-related cramps in the lower extremities.[L6289] Typically available in extended-release oral and intravenous formulations, diltiazem is marketed under various brand names with Cardizem and Tiazac being the most common ones.
**Oral** Indicated for the management of hypertension, to lower blood pressure, alone or in combination with other antihypertensive agents.[L10556] Indicated for use to improve exercise tolerance in patients with chronic stable angina.[L10556] Indicated for the management of variant angina (Prinzmetal's angina).[L6298] **Intravenous** Indicated for the short-term management of atrial fibrillation or atrial flutter for temporary control of rapid ventricular rate.[L6292] Indicated for the 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.[L6292] **Off-label** Indicated for off-label uses in anal fissures (as topical formulation), migraine prophylaxis, cramps in lower leg related to rest, pulmonary hypertension,[L6289] idiopathic dilated cardiomyopathy, and proteinuria associated with diabetic nephropathy.[L6298]
Categories
Agents causing hyperkalemia
Agents for Treatment of Hemorrhoids and Anal Fissures for Topical Use
Antiarrhythmic agents
Antihypertensive Agents
Antihypertensive Agents Indicated for Hypertension
Benzazepines
Benzothiazepine Derivatives
Bradycardia-Causing Agents
Calcium Channel Blockers
Calcium Channel Blockers (Nondihydropyridine)
Calcium-Regulating Hormones and Agents
Cardiovascular Agents
Cytochrome P-450 CYP2C19 Substrates
Cytochrome P-450 CYP2C8 Inhibitors
Cytochrome P-450 CYP2C8 Inhibitors (moderate)
Cytochrome P-450 CYP2C8 Substrates
Cytochrome P-450 CYP2C9 Substrates
Cytochrome P-450 CYP2D6 Substrates
Cytochrome P-450 CYP3A Inhibitors
Cytochrome P-450 CYP3A Substrates
Cytochrome P-450 CYP3A4 Inhibitors
Cytochrome P-450 CYP3A4 Inhibitors (moderate)
Cytochrome P-450 CYP3A4 Inhibitors (strong)
Cytochrome P-450 CYP3A4 Substrates
Cytochrome P-450 CYP3A5 Inhibitors
Cytochrome P-450 CYP3A5 Inhibitors (moderate)
Cytochrome P-450 CYP3A5 Substrates
Cytochrome P-450 CYP3A7 Inhibitors
Cytochrome P-450 CYP3A7 Inhibitors (moderate)
Cytochrome P-450 CYP3A7 Inhibitors (strong)
Cytochrome P-450 CYP3A7 Substrates
Cytochrome P-450 Enzyme Inhibitors
Cytochrome P-450 Substrates
Drugs causing inadvertant photosensitivity
Heterocyclic Compounds, Fused-Ring
Hypotensive Agents
Membrane Transport Modulators
Miscellaneous Calcium-channel Blocking Agents
Moderate Risk QTc-Prolonging Agents
Negative Inotrope
P-glycoprotein inhibitors
P-glycoprotein substrates
Photosensitizing Agents
QTc Prolonging Agents
Selective Calcium Channel Blockers With Direct Cardiac Effects
Drug Info/Drug Targets: DrugBank 3.0: a comprehensive resource for 'omics' research on drugs. Knox C, Law V, Jewison
T, Liu P, Ly S, Frolkis A, Pon A, Banco K, Mak C, Neveu V, Djoumbou Y, Eisner R, Guo AC, Wishart DS.
Nucleic Acids Res. 2011 Jan; 39 (Database issue):D1035-41. | PMID:21059682
