Diltiazem alternatives: What can I take instead of diltiazem?

In this article:

• Diltiazem alternatives
• Other calcium channel blockers
• Beta blockers
• ACE inhibitors
• ARBs
• Diuretics
• Natural alternatives
• How to switch

In this article

• Diltiazem alternatives
• Other calcium channel blockers
• Beta blockers
• ACE inhibitors
• ARBs
• Diuretics
• Natural alternatives
• How to switch

Diltiazem is a generic prescription drug used to reduce high blood pressure (hypertension) or control angina (chest pain). Sometimes, however, diltiazem doesn’t produce the desired results, or side effects or drug interactions become a problem. If you cannot take diltiazem or wish to explore other options, there are other blood pressure medications that you can discuss with your healthcare provider. 

RELATED: Hypertension resources & financial assistance

What can I take instead of diltiazem?

Many other types of medications can treat high blood pressure when diltiazem cannot be taken or tolerated. In some cases, another drug may be added to diltiazem treatment to better control blood pressure. Diltiazem is also used to control chest pain. Only some diltiazem alternatives are suitable to treat both hypertension and chest pain. 

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing in ZIP code 23666 as of 03/06/26. Click the link under “See our lowest price” to see the latest drug prices.

Top 5 diltiazem alternatives

The following are some of the most common alternatives to diltiazem for treating hypertension.

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

Diltiazem is a calcium channel blocker (CCB). There are two categories of CCBs. One type treats hypertension primarily by slowing the heart and making heart contractions less forceful. Diltiazem and verapamil are common examples. A second type reduces blood pressure by relaxing and widening blood vessels. These drugs typically end in “-dipine,” like “amlodipine.” Side effects of CCBs like diltiazem are headache, nausea, and slowing down the heart too much. Norvasc (amlodipine) can be used to treat high blood pressure without these problems. It can also be used to treat chest pain in patients with coronary artery disease. Common side effects of amlodipine may include swelling of the gums, swelling of the arms and legs, palpitations, tiredness, dizziness, flushing, and nausea. 

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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 part of the nervous system that causes our “fight-or-flight” response. One major effect of the sympathetic nervous system is to increase heart rate and raise blood pressure. This helps get more blood to the muscles. By blocking the sympathetic nervous system, beta blockers lower blood pressure by slowing the heart rate and reducing the force of heart contraction. 

Toprol XL (extended-release metoprolol succinate) is a beta blocker used for high blood pressure or chest pain. It is also used in heart failure patients because research shows it lowers the risk of subsequent hospitalization and death from a cardiovascular event. 

Common side effects of Toprol XL 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 that produces angiotensin II, a hormone that causes blood vessels to narrow, leading to a subsequent increase in blood pressure. By inhibiting the production of angiotensin II, ACE inhibitors relax and dilate blood vessels, lowering blood pressure. They are often the first-line treatment for hypertension because they only affect blood vessels (not heart rate), and adverse side effects are uncommon and comparatively mild.

Zestril (lisinopril) is an ACE inhibitor that treats high blood pressure, heart failure, and reduces the chance of death after a heart attack. It is not used to treat chest pain, called angina. 

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

A potential, and rare, serious side effect of ACE inhibitors is angioedema, a swelling of the lips, tongue, or throat, which can cause difficulty breathing. These symptoms are a medical emergency and require emergent medical attention, as well as stopping the medication. Patients are urged to call 911 if needed.

4. An ARB such as Cozaar (losartan)

Angiotensin II receptor blockers (ARBs) block angiotensin II from constricting blood vessels and increasing blood pressure. Like ACE inhibitors, 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 used to 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. It is not a chest pain maintenance treatment like diltiazem.

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 lowers blood pressure by reducing blood volume. Hydrochlorothiazide is a medication that is available alone as a tablet or capsule, or in combination with many other antihypertensive medications. It treats high blood pressure and peripheral edema (swelling of the legs). 

Hydrochlorothiazide is commonly prescribed with a blood pressure medication to treat high blood pressure. If diltiazem isn’t working well, a healthcare provider may add hydrochlorothiazide to the daily diltiazem dose, but won’t replace diltiazem with it. 

Common side effects of hydrochlorothiazide include low levels of potassium, chloride, sodium, and magnesium, and increased levels of calcium, uric acid, and blood sugar. Because of these side effects, routine lab work may be obtained after starting hydrochlorothiazide. This medicine can also cause high cholesterol, orthostatic hypotension (low blood pressure when first standing up), 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 cancer screenings, avoid tanning beds, and avoid excessive sun exposure without adequate sunscreen. However, when the sun is unavoidable, wear protective clothing and apply sunscreen with at least SPF 30 frequently. 

Natural alternatives to diltiazem

While not a substitute for diltiazem, there are some nonmedicinal ways to help lower your blood pressure. All of these tips will help in combination with your prescription medication. 

• Exercise, as approved by your healthcare provider. Adults benefit from at least 30 minutes of moderate-intensity exercise, such as brisk walking, five days a week. 
• Get to a healthy weight. Obesity increases the risk of high blood pressure and other debilitating medical conditions. Consulting with a registered dietitian about incorporating a healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH) diet, may help. 
• Cut back on salt. The American Heart Association recommends a maximum of 2,300 mg (one teaspoon) of salt a day for everyone, and a limit of 1,500 mg a day for those with high blood pressure. 
• 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 many cancers. 
• Limit alcohol intake to no more than one daily drink for women, or two daily drinks for men. Check serving sizes, as one drink is defined as 12 ounces of beer, 4 ounces of wine, or 1 ounce of 100-proof spirits.

Many patients ask about vitamins or supplements that help lower blood pressure. There are no supplements approved to treat high blood pressure (and supplement manufacturers are not allowed to make such claims), so most healthcare providers focus on prescription medications and lifestyle modifications to lower blood pressure. In fact, some supplements can make the body work harder, as they may need to be metabolized and may interact with other helpful medications you are taking. 

How to switch to a diltiazem alternative

• Speak with your healthcare provider. Your provider will want to check your blood pressure and discuss 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 healthcare provider. Be sure to tell your doctor about any allergies or reactions to medications, as well as all the medicines you take, including prescription and over-the-counter drugs, vitamins, and supplements. 
• Be proactive and check your blood pressure twice a week at different times of day after being seated (and calm) for 3 minutes. The level of the blood pressure cuff should be at your heart level. Rest your arm. Write down these blood pressure readings and bring them to your office visit. This will give your provider ample information to decide if your current medication regimen is right for you.