Diltiazem alternatives: What can I take instead of diltiazem?

Compare diltiazem alternatives | Norvasc | Toprol XL | Zestril | Cozaar | Hydrochlorothiazide | Natural alternatives | How to switch meds

Diltiazem is a prescription drug used for hypertension (high blood pressure) or angina (chest pain). Diltiazem is a generic drug and is available in several formulations, including immediate-release tablets and extended-release tablets and capsules. It is also available as an injection, but this article will focus on diltiazem and alternatives as an oral medication. 

Diltiazem is also known by several brand names and branded generic names. A branded generic is a generic drug that is given a name other than its active ingredient. Some of the brand names/branded generic names of diltiazem include:

• Cardizem, Cardizem CD, Cardizem LA
• Cartia XT
• Dilacor XR
• Dilt-CD
• Diltia XT
• Tiazac

Diltiazem—also known as diltiazem hydrochloride—is part of a drug class called calcium channel blockers. Calcium channel blockers prevent calcium from entering the muscle cells of the heart and blood vessels, allowing the blood vessels to relax and widen. 

Sometimes, an individual may be looking for an alternative treatment to diltiazem. Some people may not see the desired results and may want to try a different medication to see if they have better results. Others may experience side effects that are bothersome or do not go away. Common side effects of diltiazem include:

• Swelling of the arms or legs
• Headache
• Nausea
• Constipation 
• Dizziness
• Orthostatic hypotension (a drop in blood pressure when standing up)
• Rash
• Slow heart rate

The extended-release form of diltiazem can cause the above side effects as well as tiredness, pain, and indigestion.

In rare cases, a serious side effect could occur, such as:

• Irregular heartbeat (arrhythmias), heart failure, or other heart problems 
• Severely low blood pressure
• Fainting
• Liver injury
• Severe allergic or skin reaction

A note about severe allergic or skin reactions: these can be life-threatening and may cause death. If you experience symptoms of a severe allergic or skin reaction, get emergency medical help. Symptoms of a severe allergic reaction may include hives, difficulty breathing, and swelling of the face, lips, tongue, or throat. Symptoms of a severe skin reaction may include fever, burning eyes, sore throat, red or purple rash, or blistering or peeling skin. 

Some people may not be able to take diltiazem because of drug interactions. Diltiazem has some notable drug interactions such as Lanoxin (digoxin), Zocor (simvastatin), and Tegretol (carbamazepine).

If you cannot take diltiazem, or wish to explore other options, there are other medications that you can discuss with your healthcare provider. 

What can I take in place of diltiazem?

There are other types of medications that can treat high blood pressure when diltiazem cannot be taken or tolerated—or sometimes, a combination of several medications may be needed to control blood pressure. 

The table below compares diltiazem (in bold), with common alternatives. All of the drugs listed are prescription medications approved by the United States Food and Drug Administration (FDA). 

Other alternatives to diltiazem

Some other popular alternatives are listed below. Because there are so many possible alternatives, this is not a full list. Consult your healthcare professional for more information about diltiazem alternatives. 

• Accupril (quinapril)
• Atacand (candesartan)
• Avapro (irbesartan)
• Benicar (olmesartan)
• Benicar HCT (olmesartan/hydrochlorothiazide)
• Bystolic (nebivolol)
• Coreg (carvedilol)
• Diovan (valsartan)
• Diovan HCT (valsartan/hydrochlorothiazide)
• Dyazide (triamterene/hydrochlorothiazide)
• Hyzaar (losartan/hydrochlorothiazide)
• Inderal (propranolol)
• Lopressor (metoprolol tartrate)
• Micardis (telmisartan)
• Tenormin (atenolol)
• Zebeta (bisoprolol)

Top 5 diltiazem alternatives

The following are some of the most common antihypertensive drugs that are alternatives to diltiazem.

1. Another calcium channel blocker such as Norvasc (amlodipine)

Diltiazem is a calcium channel blocker (CCB). There are two categories of CCBs. Diltiazem is classified as a nondihydropyridine CCB (as is verapamil). Norvasc (amlodipine), as well as other CCBs that end in -dipine such as felodipine and isradipine, are dihydropyridine CCBs. Side effects vary based on the type of CCB used. As a nondihydropyridine CCB, diltiazem may be more likely to cause headache and nausea, as well as cause the heart rate to slow too much. 

Norvasc can be used to treat high blood pressure and chest pain in patients with coronary artery disease. 

Common side effects may include swelling of the gums, swelling of the arms and legs, palpitations, tiredness, dizziness, flushing, and nausea. 

2. A beta-blocker such as Toprol XL (metoprolol succinate extended-release)

Beta blockers work by blocking the effects of the sympathetic nervous system. The sympathetic nervous system increases the heart rate and blood pressure. Beta-blockers lower blood pressure by decreasing how fast and forcefully the heart pumps blood. 

One commonly used beta-blocker is called Toprol XL. It contains the active ingredient metoprolol succinate extended-release. Toprol XL treats high blood pressure and/or chest pain. It is also used in heart failure patients to lower the risk of hospitalization and cardiovascular death. 

Common side effects of Toprol XL may include tiredness, dizziness, rash/itching, diarrhea, depression, shortness of breath, slow heart rate, sleep disturbances, and nightmares.

3. An ACE inhibitor such as Zestril (lisinopril)

Angiotensin-converting enzyme (ACE) inhibitors work by blocking an enzyme from producing a hormone called angiotensin II. Angiotensin II causes blood vessels to narrow and blood pressure to increase. By lowering the production of angiotensin II, ACE inhibitors widen blood vessels, lowering blood pressure.

Zestril (lisinopril) is an ACE inhibitor that can treat high blood pressure, treat heart failure with reduced ejection fraction, and reduce the chance of death after a heart attack. 

Lisinopril (or any ACE inhibitor) should never be used in pregnant women because it can cause harm or death to the unborn baby. 

Common side effects of lisinopril include low blood pressure, dizziness, headache, high potassium levels, fatigue, stomach pain, sun sensitivity, and upper respiratory infections. 

ACE inhibitors are well known for causing a dry cough as a side effect. Patients who experience a cough after starting an ACE inhibitor should consult their healthcare provider. 

A potential, but rare serious side effect of ACE inhibitors is angioedema. Angioedema is a swelling of the lips, tongue, or throat, which can cause problems breathing. These symptoms are a medical emergency and require immediate medical attention, as well as stopping the medication. 

4. An ARB such as Cozaar (losartan)

Angiotensin II receptor blockers (ARBs) block angiotensin II from increasing blood pressure. They widen blood vessels and lower blood pressure. ARBs are less likely to cause cough or angioedema than ACE inhibitors. Like ACE inhibitors, ARBs should not be used in pregnant women. 

Cozaar (losartan) is an ARB that can treat high blood pressure and prevent strokes. It can also be used to treat diabetic nephropathy (kidney problems) in patients with Type 2 diabetes and high blood pressure. 

Common side effects of losartan include weakness, dizziness, fatigue, muscle and joint pain, diarrhea, chest pain, cough, upper respiratory infection, low blood pressure, high potassium levels, and indigestion. 

5. A diuretic such as hydrochlorothiazide

Diuretics help the kidneys eliminate sodium and water, which helps to lower blood pressure. Hydrochlorothiazide can be found alone as a tablet or capsule, or in combination with many other medications. It treats high blood pressure or peripheral edema (swelling). 

Common side effects of hydrochlorothiazide include low levels of potassium, chloride, sodium, and magnesium—and increased levels of calcium, uric acid, and blood sugar. This medicine can also cause high cholesterol, orthostatic hypotension, dizziness, appetite loss, headache, weakness, muscle cramps, stomach pain, and diarrhea. 

Hydrochlorothiazide can increase the risk of skin cancer, so patients who take this drug should see a dermatologist regularly for skin screenings, and avoid tanning beds and the sun (but when the sun is unavoidable, wear protective clothing and frequently apply sunscreen of at least SPF 30). 

Natural alternatives to diltiazem

While not a substitute for diltiazem, there are some nonmedicinal ways to try to lower your blood pressure. Consult your physician to see if any of these tips may help in combination with your prescription medication. 

• Exercise more, as approved by your healthcare provider. Adults need a minimum of 30 minutes, five days a week, of moderate-intensity exercise like brisk walking. 
• Get to a healthy weight. Obesity increases the risk for high blood pressure and other medical conditions. You may want to consult a registered dietician about incorporating a healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH) diet. On the topic of diet, cut back on salt. The American Heart Association recommends a maximum of 2,300 mg (1 teaspoon) of salt a day and a limit of only 1,500 mg a day for those with high blood pressure. You can try to increase your dietary potassium intake by including more fruits, vegetables, dairy, and seafood. Just check with your physician first because some medications can increase potassium levels, and in these cases, extra potassium should be avoided. 
• Stop smoking for a multitude of health benefits, including lowering blood pressure and reducing your risk of heart attacks, strokes, and certain cancers. 
• Limit alcohol intake to no more than one daily drink for women or two daily drinks for men. And check serving sizes—one drink consists of 12 ounces of beer, four ounces of wine, or one ounce of 100-proof spirits.

Many patients ask about vitamins or supplements that can help lower blood pressure. There are no supplements approved to treat blood pressure (and supplement manufacturers are not allowed to make such claims), so most healthcare providers focus on prescription medication and lifestyle modifications to reduce blood pressure. 

How to switch to a diltiazem alternative

• Speak with your healthcare provider. Your provider will want to check your blood pressure and talk to you about your current medications. In some cases, you may need a higher dose of diltiazem and/or add another medicine from another drug class to your regimen rather than switching medications. However, if you experience an allergic reaction or certain side effects from diltiazem, your healthcare provider will likely change you to another drug or combination of drugs.
• Before switching medications, review your medical history with your doctor. Be sure to tell your doctor about any allergies or reactions to medications, and all the medicines you take, including Rx and OTC drugs, vitamins, and supplements. 
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