Well-controlled hypertensive patients receiving decongestant sympathomimetics at recommended doses do not appear to be at high risk for significant elevations in blood pressure; however, increased blood pressure especially systolic hypertension has been reported in some patients. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Monitor blood pressure and heart rate.
Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Acetaminophen; Codeine: Moderate Concomitant use of codeine with diltiazem may increase codeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased morphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Acetaminophen; Dextromethorphan; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Acetaminophen; Dextromethorphan; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers.
Acetaminophen; Dichloralphenazone; Isometheptene: Major Isometheptene has sympathomimetic properties. Patients taking antihypertensive agents may need to have their therapy modified.
Careful blood pressure monitoring is recommended. Acetaminophen; Guaifenesin; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Acetaminophen; Hydrocodone: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
It is recommended to avoid this combination when hydrocodone is being used for cough. If coadministration is necessary, monitor patients closely at frequent intervals and consider a dosage reduction of hydrocodone until stable drug effects are achieved.
Discontinuation of diltiazem could decrease hydrocodone plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to hydrocodone.
Hydrocodone is a substrate for CYP3A4. Acetaminophen; Oxycodone: Moderate Consider a reduced dose of oxycodone with frequent monitoring for respiratory depression and sedation if concurrent use of diltiazem is necessary.
If diltiazem is discontinued, consider increasing the oxycodone dose until stable drug effects are achieved and monitor for evidence of opioid withdrawal. Oxycodone is a CYP3A4 substrate, and coadministration with a moderate inhibitor like diltiazem can increase oxycodone exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of oxycodone.
If diltiazem is discontinued, oxycodone plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to oxycodone. Acetaminophen; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Acrivastine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers.
Alemtuzumab: Moderate Alemtuzumab may cause hypotension. Careful monitoring of blood pressure and hypotensive symptoms is recommended especially in patients with ischemic heart disease and in patients on antihypertensive agents.
Alfentanil: Moderate Consider a reduced dose of alfentanil with frequent monitoring for respiratory depression and sedation if concurrent use of diltiazem is necessary. If diltiazem is discontinued, consider increasing the alfentanil dose until stable drug effects are achieved and monitor for evidence of opioid withdrawal. Alfentanil is a sensitive CYP3A4 substrate, and coadministration with CYP3A4 inhibitors like diltiazem can increase alfentanil exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of alfentanil.
If diltiazem is discontinued, alfentanil plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to alfentanil. Alfuzosin: Major Alfuzosin and diltiazem may have additive vasodilatory actions; concurrent use of these agents can result in hypotension. Alfuzosin is primarily metabolized by the CYP3A4 hepatic enzyme. This effect might lead to hypotension or edema in some individuals.
Caution should be used when diltiazem is coadministered with amlodipine; therapeutic response should be monitored. Alprazolam: Moderate Consider a reduced dose of alprazolam is concurrent use of diltiazem is necessary.
Alprostadil: Minor The concomitant use of systemic alprostadil injection and antihypertensive agents, like calcium channel blockers, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository MUSE or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration.
In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction ED and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil.
However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil. Amifostine: Major Patients receiving calcium-channel blockers should be closely monitored during amifostine infusions due to additive effects. Patients receiving amifostine at doses recommended for chemotherapy should have antihypertensive therapy interrupted 24 hours preceding administration of amifostine. If the antihypertensive cannot be stopped for 24 hours before chemotherapy doses of amifostine, patients should not receive amifostine.
Aminolevulinic Acid: Minor Preclinical data suggest that calcium-channel blockers could decrease the efficacy of photosensitizing agents used in photodynamic therapy.
Concurrent use of amiodarone and diltiazem may result in bradycardia and depressed cardiac output; monitor clinical response. In addition, amiodarone is both a substrate and inhibitor of CYP3A4 metabolism, and may potentially interact with diltiazem via CYP3A4 metabolic pathways. Amitriptyline; Chlordiazepoxide: Moderate Diltiazem could theoretically inhibit CYP3A4 metabolism of oxidized benzodiazepines, including chlordiazepoxide.
Otherwise, consider dosage adjustments for both drugs along with close monitoring for signs and symptoms of myopathy and rhabdomyolysis. Coadministration of diltiazem, a moderate CYP3A4 inhibitor, with atorvastatin, a CYP3A4 substrate, may increase atorvastatin exposure resulting in atorvastatin-related toxicity; the risk may be increased with higher statin doses. Amoxicillin; Clarithromycin; Lansoprazole: Major Avoid coadministration of clarithromycin and diltiazem, particularly in geriatric patients, due to an increased risk of hypotension and acute kidney injury.
If the use of a macrolide antibiotic is necessary in a patient receiving diltiazem therapy, azithromycin is the preferred agent. If coadministration is unavoidable, monitor blood pressure and heart rate. A retrospective, case crossover study, found the risk of hospitalization due to hypotension or shock to be significantly increased in geriatric patients exposed to clarithromycin during concurrent calcium-channel blocker therapy OR 3.
Concurrent use of azithromycin was not associated with an increased risk of hypotension OR 1. Amoxicillin; Clarithromycin; Omeprazole: Major Avoid coadministration of clarithromycin and diltiazem, particularly in geriatric patients, due to an increased risk of hypotension and acute kidney injury. Amphetamine; Dextroamphetamine Salts: Minor Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, like calcium-channel blockers.
Close monitoring of blood pressure is advised. Amprenavir: Moderate Amprenavir may inhibit the metabolism of other medications that are metabolized via cytochrome P 3A4. Although drug interaction studies have not been conducted, the serum concentration of diltiazem may be increased with concomitant administration of amprenavir. Amyl Nitrite: Moderate Nitroglycerin can cause hypotension.
This action may be additive with other agents that can cause hypotension such as calcium-channel blockers. Patients should be monitored more closely for hypotension if nitroglycerin, including nitroglycerin rectal ointment, is used concurrently with a calcium-channel blocker. Apalutamide: Major Avoid coadministration of diltiazem and apalutamide due to decreased plasma concentrations of diltiazem.
Coadministration with another strong CYP3A4 inducer lowered diltiazem plasma concentrations to undetectable levels. Apixaban: Moderate Use apixaban and diltiazem together with caution in patients with significant renal dysfunction as risk of bleeding may be increased. Although serum concentrations of non-vitamin K oral anticoagulants have been increased in the presence of moderate inhibitors, one cohort study found that the risk of bleeding was not increased.
Apomorphine: Moderate Use of calcium-channel blockers and apomorphine together can increase the hypotensive effects of apomorphine. Monitor blood pressure regularly during use of this combination.
Apraclonidine: Minor Apraclonidine had minimal effects on heart rate and blood pressure during clinical studies in patients with glaucoma. However, it is theoretically possible that additive blood pressure reductions could occur when apraclonidine is combined with the use of antihypertensive agents.
Use caution during concurrent use, especially in patients with severe, uncontrolled cardiovascular disease, including hypertension. Aprepitant, Fosaprepitant: Moderate Avoid the concomitant use of diltiazem with aprepitant, fosaprepitant due to substantially increased exposure of aprepitant; increased diltiazem exposure may also occur.
If coadministration cannot be avoided, use caution and monitor for an increase in diltiazem- and aprepitant-related adverse effects for several days after administration of a multi-day aprepitant regimen. Coadministration of daily oral aprepitant mg, or 1. Diltiazem is also a CYP3A4 substrate.
As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions. However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction. Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1.
Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Aripiprazole: Moderate Because aripiprazole is partially metabolized by CYP3A4, increased aripiprazole blood levels may occur when the drug is coadministered with inhibitors of CYP3A4 such as diltiazem.
If these agents are used in combination, the patient should be carefully monitored for aripiprazole-related adverse reactions. Due to aripiprazole's antagonism at alpha 1-adrenergic receptors, the drug may enhance the hypotensive effects of alpha-blockers and other antihypertensive agents. Concomitant use warrants caution due to the potential for increased side effects. Concomitant use warrants caution due to the potential for increased side effects, including increased potentiation of QT prolongation.
Asenapine: Moderate Secondary to alpha-blockade, asenapine can produce vasodilation that may result in additive effects during concurrent use of antihypertensive agents. The potential reduction in blood pressure can precipitate orthostatic hypotension and associated dizziness, tachycardia, and syncope. If concurrent use of asenapine and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position.
Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known. Aspirin, ASA; Butalbital; Caffeine; Codeine: Moderate Concomitant use of codeine with diltiazem may increase codeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased morphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Aspirin, ASA; Caffeine; Dihydrocodeine: Moderate Concomitant use of dihydrocodeine with diltiazem may increase dihydrocodeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased dihydromorphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Aspirin, ASA; Carisoprodol; Codeine: Moderate Concomitant use of codeine with diltiazem may increase codeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased morphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. Aspirin, ASA; Oxycodone: Moderate Consider a reduced dose of oxycodone with frequent monitoring for respiratory depression and sedation if concurrent use of diltiazem is necessary.
Atazanavir: Major Coadministration of atazanavir with diltiazem may result in increased plasma concentrations of either drug. Concurrent atazanavir use led to a 2-fold increase in the AUC of diltiazem. Additionally, atazanavir can prolong the PR interval, especially with high serum concentrations.
Greater lengthening of the PR interval with the combined use of diltiazem and atazanavir as compared to either alone has been documented. Atazanavir; Cobicistat: Major Coadministration of atazanavir with diltiazem may result in increased plasma concentrations of either drug.
Moderate Monitor blood pressure and heart rate if coadministration of diltiazem with cobicistat is necessary. Atenolol: Moderate The combination of diltiazem and a beta-blocker, like atenolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance.
Atenolol; Chlorthalidone: Moderate The combination of diltiazem and a beta-blocker, like atenolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance. Atracurium: Moderate Prolongation of the effects of neuromuscular blockers is possible when they are given in combination with calcium-channel blockers, particularly diltiazem.
Studies have shown that drugs that inhibit CYP3A4 can increase avanafil exposure. Particular caution should be used when prescribing avanafil to patients receiving concomitant moderate CYP3A4 inhibitors such as diltiazem. For example, erythromycin increased avanafil Cmax and AUC equal to approximately 2-fold and 3-fold, respectively, and prolonged the half-life of avanafil to approximately 8 hours. Therefore, during coadministration, the maximum recommended adult dose of avanafil is 50 mg, not to exceed once every 24 hours.
Baclofen: Moderate Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required. Coadministration of diltiazem with known CYP3A4 inducers, such as barbiturates, may significantly decrease the bioavailability of diltiazem.
When possible, avoid coadministration of these drugs and consider alternative therapy. When an alternative therapy is not possible, patients should be monitored for the desired cardiovascular effects on heart rate, chest pain, or blood pressure. Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Be alert for symptoms of ergot toxicity if using ergotamine and diltiazem together is medically necessary. An ergot alkaloid dose reduction may be necessary if these drugs are used together.
Concomitant use of diltiazem, a CYP3A4 inhibitor, and ergotamine, a CYP3A4 substrate with a narrow therapeutic range, may result in increased ergot alkaloid levels. Bendroflumethiazide; Nadolol: Moderate The combination of diltiazem and a beta-blocker, like nadolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance.
Benzhydrocodone; Acetaminophen: Moderate Concurrent use of benzhydrocodone with diltiazem may increase the risk of increased opioid-related adverse reactions, such as fatal respiratory depression.
Consider a dose reduction of benzhydrocodone until stable drug effects are achieved. Monitor patients for respiratory depression and sedation at frequent intervals. Discontinuation of diltiazem in a patient taking benzhydrocodone may decrease hydrocodone plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to opioid agonists.
Benzhydrocodone is a prodrug for hydrocodone. Diltiazem is an inhibitor of CYP3A4. Benzonatate: Moderate Local anesthetics may cause additive hypotension in combination with antihypertensive agents. Benzphetamine: Minor Benzphetamine might increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, like calcium-channel blockers.
Bepridil: Moderate Calcium-channel blockers, including bepridil, can have additive hypotensive effects with other antihypertensive agents.
Betaxolol: Moderate The combination of diltiazem and a beta-blocker, like betaxolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance.
Bisoprolol: Moderate The combination of diltiazem and a beta-blocker, like bisoprolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance.
Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate The combination of diltiazem and a beta-blocker, like bisoprolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance. Bortezomib: Moderate Patients on antihypertensive agents receiving bortezomib treatment may require close monitoring of their blood pressure and dosage adjustment of their medication.
During clinical trials of bortezomib, hypotension was reported in roughly 12 percent of patients. Bosentan: Major Avoid coadministration of diltiazem and bosentan if possible due to decreased plasma concentrations of diltiazem; additionally, increased plasma concentrations of bosentan may occur. If coadministration unavoidable, monitor blood pressure and heart rate and adjust the diltiazem and bosentan dose based on clinical response.
Bosutinib: Major Avoid concomitant use of bosutinib and diltiazem as bosutinib plasma exposure may be significantly increased resulting in an increased risk of bosutinib adverse events e.
In a cross-over trial in 18 healthy volunteers, the Cmax and AUC values of bosutinib were increased 1. Bretylium: Major Concomitant use of bretylium with other antiarrhythmis, such as diltiazem, can have additive, antagonistic, or synergistic electrophysiologic, pharmacodynamic, or toxic effects, including hypotension. Combined antiarrhythmic therapy may necessitate a reduction in antiarrhythmic drug dosages, to decrease the potential for toxicity. If diltiazem is used in combination with brexpiprazole and a moderate to strong CYP2D6 inhibitor, the brexpiprazole dose should be adjusted and the patient should be carefully monitored for brexpiprazole-related adverse reactions.
Brigatinib: Major Avoid coadministration of brigatinib with diltiazem if possible due to increased plasma exposure of brigatinib; an increase in brigatinib-related adverse reactions may occur. Brimonidine; Timolol: Moderate The combination of diltiazem and a beta-blocker, like timolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance.
Bromocriptine: Major When bromocriptine is used for diabetes, do not exceed a dose of 1. Use this combination with caution in patients receiving bromocriptine for other indications.
Concurrent use may increase bromocriptine concentrations. Brompheniramine; Carbetapentane; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Brompheniramine; Guaifenesin; Hydrocodone: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Brompheniramine; Hydrocodone; Pseudoephedrine: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Brompheniramine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers.
Budesonide: Minor Diltiazem may increase plasma concentrations of oral budesonide due to inhibition of the CYP3A4 isoenzymet, and can enhance the cortisol suppression associated with budesonide administered via inhalation. Budesonide; Formoterol: Minor Diltiazem may increase plasma concentrations of oral budesonide due to inhibition of the CYP3A4 isoenzymet, and can enhance the cortisol suppression associated with budesonide administered via inhalation.
Use caution when administering these drugs concomitantly. Bupivacaine; Lidocaine: Moderate Concomitant use of systemic lidocaine and diltiazem may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Monitor for lidocaine toxicity if used together. Co-administration with diltiazem may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as buprenorphine.
Buspirone: Moderate 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. Co-administration with diltiazem may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as cabergoline.
Caffeine; Ergotamine: Moderate Be alert for symptoms of ergot toxicity if using ergotamine and diltiazem together is medically necessary. Cannabidiol: Moderate Consider a dose reduction of cannabidiol if coadministered with diltiazem. Coadministration may increase cannabidiol plasma concentrations increasing the risk of adverse reactions. Carbamazepine: Major Avoid coadministration of diltiazem and carbamazepine due to decreased plasma concentrations of diltiazem. Monitor patients receiving these drugs concurrently for altered clinical response to therapy.
Coadministration with another strong CYP3A4 inducer lowered diltiazem plasma concentrations to undetectable. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Carbetapentane; Diphenhydramine; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers.
Carbetapentane; Guaifenesin; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Carbetapentane; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Carbetapentane; Phenylephrine; Pyrilamine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers.
Carbetapentane; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Carbidopa; Levodopa: Moderate Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Carbidopa; Levodopa; Entacapone: Moderate Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects.
Carbinoxamine; Dextromethorphan; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Carbinoxamine; Hydrocodone; Phenylephrine: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Carbinoxamine; Hydrocodone; Pseudoephedrine: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. Carbinoxamine; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers.
Carbinoxamine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers.
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.
Atypical antipsychotics may cause orthostatic hypotension and syncope, most commonly during treatment initiation and dosage increases. Patients should be informed about measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning, or rising slowly from a seated position.
Consider a cariprazine dose reduction if hypotension occurs. Carteolol: Moderate The combination of diltiazem and a beta-blocker, like carteolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance.
Carvedilol: Moderate The combination of diltiazem and a beta-blocker, like carvedilol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance. Celecoxib: Moderate 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. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
Ceritinib: Major Avoid coadministration of ceritinib with diltiazem if possible due to the risk of additive bradycardia; plasma concentrations of diltiazem may also increase. An interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if bradycardia occurs. Bradycardia has been reported with ceritinib treatment; diltiazem also causes bradycardia. Cetirizine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers.
In theory, concurrent administration of inhibitors of CYP3A4, such as diltiazem, may lead to increased cevimeline plasma concentrations. Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers.
Chlophedianol; Guaifenesin; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers.
Chlordiazepoxide: Moderate Diltiazem could theoretically inhibit CYP3A4 metabolism of oxidized benzodiazepines, including chlordiazepoxide. Chlordiazepoxide; Clidinium: Moderate Diltiazem could theoretically inhibit CYP3A4 metabolism of oxidized benzodiazepines, including chlordiazepoxide.
Chloroprocaine: Moderate Local anesthetics may cause additive hypotension in combination with antihypertensive agents. Chlorpheniramine; Codeine: Moderate Concomitant use of codeine with diltiazem may increase codeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased morphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate Concomitant use of dihydrocodeine with diltiazem may increase dihydrocodeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased dihydromorphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: Moderate Concomitant use of dihydrocodeine with diltiazem may increase dihydrocodeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased dihydromorphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Chlorpheniramine; Hydrocodone: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Chlorpheniramine; Hydrocodone; Phenylephrine: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Chlorpheniramine; Hydrocodone; Pseudoephedrine: Moderate Concomitant use of hydrocodone with diltiazem may increase hydrocodone plasma concentrations and prolong opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death.
Chlorpheniramine; Phenylephrine: Moderate Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Chlorpheniramine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Chlorthalidone; Clonidine: Moderate Monitor heart rate in patients receiving concomitant clonidine and agents known to affect sinus node function or AV nodal conduction e.
Complete AV block resulting in a nodal rhythm and sinus bradycardia resulting in hospitalization and pacemaker insertion have been reported during combination therapy of clonidine with diltiazem or verapamil. Cimetidine: Moderate Cimetidine can increase the plasma levels of diltiazem, possibly via inhibition of cytochrome P metabolism. Concurrent cimetidine and diltiazem therapy may require a reduction in diltiazem dosage in some patients; monitor clinical response.
Subjects being treated with mg ketoconazole twice daily for 7 days received a single 90 mg cinacalcet dose on day 5 of therapy. The AUC and Cmax for cinacalcet increased 2. Therefore, caution is recommended when co-administering cinacalcet with other CYP3A4 enzyme inhibitors. These agents may include diltiazem. If a patient initiates or discontinues therapy with a strong CYP3A4 inhibitor during cinacalcet therapy, the manufacturer recommends that dosage adjustment may be needed with close monitoring of PTH and serum calcium concentrations.
Ciprofloxacin: Moderate Caution and monitoring is warranted with the use of ciprofloxacin and diltiazem. Monitor for adverse events such as a decrease in blood pressure or heart rate. Cisapride: Severe Caution should be taken when cisapride CYP3A4 substrate is prescribed with diltiazem CYP3A4 inhibitor ; the manufacturer of cisapride considers concurrent use contraindicated.
A possible drug interaction occurred in a year-old woman taking cisapride with diltiazem who had near syncopal effects and QT-interval prolongation.
After discontinuing cisapride, the QT interval returned to normal without recurrence of symptoms. Prolongation of QT interval, torsades de pointes, and sudden cardiac death have been reported after concomitant administration of cisapride a CYP3A4 substrate with other CYP3A4 inhibitors.
Cisatracurium: Moderate Prolongation of the effects of neuromuscular blockers is possible when they are given in combination with calcium-channel blockers, particularly diltiazem. Citalopram: Moderate During concurrent use of citalopram and diltiazem, clinicians should monitor patients for a potential increase in side effects or toxicity.
In theory, diltiazem may inhibit the metabolism of citalopram through inhibition of CYP3A4. It should be noted that because citalopram is metabolized by multiple enzyme systems, inhibition of one pathway may not appreciably decrease citalopram clearance. Clarithromycin: Major Avoid coadministration of clarithromycin and diltiazem, particularly in geriatric patients, due to an increased risk of hypotension and acute kidney injury.
Clindamycin: Moderate Concomitant use of clindamycin and diltiazem may decrease clindamycin clearance and increase the risk of adverse reactions. Although dosages may vary based on physician orders, protocols and age, a standard initial dose is 0. Treatment of hemodynamically unstable patients in narrow QRS complex AF with RVR requires synchronized cardioversion at J initially, and should not be delayed for administration of an anti-arrhythmic agent.
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Please review our refund policy. Simply email us through the contact us link displayed on every page of this website any time within 60 days of purchase. For general information, Learn About Clinical Studies. Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information. Search for terms. Save this study. Warning You have reached the maximum number of saved studies Bolus vs IVP Intravenous Push Diltiazem for Atrial Fibrillation or Flutter The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Listing a study does not mean it has been evaluated by the U. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Last Update Posted : October 28, See Contacts and Locations. Study Description. MedlinePlus related topics: Atrial Fibrillation. Drug Information available for: Diltiazem hydrochloride Diltiazem Diltiazem malate.
FDA Resources. Arms and Interventions. Randomization to one of to active comparator groups. Other Names: diltiazem immediate release oral tablet 0. In the slow infusion group, 50 mg of diltiazem will be diluted in 50 mL of 0. Outcome Measures. Secondary Outcome Measures : Use of additional medications to achieve rate control [ Time Frame: within 30 minutes of diltiazem administration ] Percentage of patients who require medications other than diltiazem to achieve rate control.
Incidence of electrical cardioversion to achieve rate control. Percentage of enrolled patients who require hospital admission to achieve and maintain rate control. Eligibility Criteria.
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