Diltiazem

Non-DHP CCB·Cardiovascular - Antihypertensives

Hypertension, chronic stable angina, AF rate control

PBSNON-DHP CCBCardizem CD, Vasocardol CD, Dilzem120 mgS4+1

Max Dose

360 mg/day

Half-life

4–9 h

Bradycardia

RISK

Heart Block

AVOID

Rapid Summary

Overview

Non-dihydropyridine CCB. A 'middle ground' between Amlodipine and Verapamil, offering both coronary vasodilation and mild AV nodal slowing.

Maximum Dose

Max 360 mg/day (usually extended-release).

Clinical Focus

Excellent for angina and rate control in AF, but carries the same dangerous interaction with beta-blockers as Verapamil.

Bottom Line

Diltiazem is a versatile non-DHP CCB for rate control and angina with fewer GI side effects than Verapamil, but must not be combined with beta-blockers and inhibits CYP3A4.

Formulation & Access

Brand Names

Cardizem CD, Vasocardol CD, Dilzem

Oral Routes

Controlled Delivery (CD) capsules (120 mg, 180 mg, 240 mg, 360 mg). Do not chew.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Hypertension, chronic stable angina, AF rate control.

Clinical Place

Preferred over Verapamil when less negative inotropy is desired, but rate control is still required.

Quick reference

Class & Role

Non-DHP CCB — Non-dihydropyridine CCB.

Route / Formulation

Controlled Delivery (CD) capsules (120 mg, 180 mg, 240 mg, 360 mg). Do not chew. (Cardizem CD, Vasocardol CD, Dilzem)

Usual Dose & Max

PO 180-240 mg CD/XR OD. Titrate up to Max 360 mg/day.

Key Indication Doses

Angina / Hypertension: PO 180-240 mg CD/XR OD. Titrate up to Max 360 mg/day. AF Rate Control: PO 180-360 mg CD/XR OD. Elderly / Frail: Start at PO 120 mg CD OD.

Best Uses

Diltiazem is a versatile non-DHP CCB for rate control and angina with fewer GI side effects than Verapamil, but must not be combined with beta-blockers and inhibits CYP3A4.

Avoid / Cautions

Left ventricular failure (HFrEF), 2nd/3rd degree heart block, sick sinus syndrome. Pregnancy Category C.

Key Risks

Cardiovascular: Bradycardia, AV block, worsening of HFrEF. MODERATE — Peripheral oedema (less than amlodipine). Gastrointestinal: Constipation (much less severe than Verapamil). Neurological: Dizziness, headache.

Key Interactions

Beta-blockers. High risk of complete heart block and severe bradycardia if combined. Moderate CYP3A4 inhibitor. Markedly increases statin levels (myopathy) and increases Digoxin concentrations by ~20%.

Monitoring

Baseline and routine ECG to assess PR interval. Monitor HR and BP. Check LFTs periodically. No specific U&E shifts expected.

Clinical Pearl

Like Verapamil, Diltiazem reduces cardiac contractility. It must be avoided in patients with heart failure with reduced ejection fraction (HFrEF).

Access

Cardizem CD, Vasocardol CD, Dilzem120 mg

Brand: Cardizem CD, Vasocardol CD, Dilzem
Formulation: Controlled Delivery (CD) capsules (120 mg, 180 mg, 240 mg, 360 mg)

Diltiazem

Non-DHP CCB·Cardiovascular - Antihypertensives

Hypertension, chronic stable angina, AF rate control

PBSNON-DHP CCBCardizem CD, Vasocardol CD, Dilzem120 mgS4+1

Max Dose

360 mg/day

Half-life

4–9 h

Bradycardia

RISK

Heart Block

AVOID

Rapid Summary

Overview

Non-dihydropyridine CCB. A 'middle ground' between Amlodipine and Verapamil, offering both coronary vasodilation and mild AV nodal slowing.

Maximum Dose

Max 360 mg/day (usually extended-release).

Clinical Focus

Excellent for angina and rate control in AF, but carries the same dangerous interaction with beta-blockers as Verapamil.

Bottom Line

Diltiazem is a versatile non-DHP CCB for rate control and angina with fewer GI side effects than Verapamil, but must not be combined with beta-blockers and inhibits CYP3A4.

Formulation & Access

Brand Names

Cardizem CD, Vasocardol CD, Dilzem

Oral Routes

Controlled Delivery (CD) capsules (120 mg, 180 mg, 240 mg, 360 mg). Do not chew.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Hypertension, chronic stable angina, AF rate control.

Clinical Place

Preferred over Verapamil when less negative inotropy is desired, but rate control is still required.

Quick reference

Class & Role

Non-DHP CCB — Non-dihydropyridine CCB.

Route / Formulation

Controlled Delivery (CD) capsules (120 mg, 180 mg, 240 mg, 360 mg). Do not chew. (Cardizem CD, Vasocardol CD, Dilzem)

Usual Dose & Max

PO 180-240 mg CD/XR OD. Titrate up to Max 360 mg/day.

Key Indication Doses

Angina / Hypertension: PO 180-240 mg CD/XR OD. Titrate up to Max 360 mg/day. AF Rate Control: PO 180-360 mg CD/XR OD. Elderly / Frail: Start at PO 120 mg CD OD.

Best Uses

Diltiazem is a versatile non-DHP CCB for rate control and angina with fewer GI side effects than Verapamil, but must not be combined with beta-blockers and inhibits CYP3A4.

Avoid / Cautions

Left ventricular failure (HFrEF), 2nd/3rd degree heart block, sick sinus syndrome. Pregnancy Category C.

Key Risks

Key Interactions

Monitoring

Baseline and routine ECG to assess PR interval. Monitor HR and BP. Check LFTs periodically. No specific U&E shifts expected.

Clinical Pearl

Like Verapamil, Diltiazem reduces cardiac contractility. It must be avoided in patients with heart failure with reduced ejection fraction (HFrEF).

Access

Cardizem CD, Vasocardol CD, Dilzem120 mg

Brand: Cardizem CD, Vasocardol CD, Dilzem
Formulation: Controlled Delivery (CD) capsules (120 mg, 180 mg, 240 mg, 360 mg)