Amlodipine vs. Diltiazem

See how Amlodipine and Diltiazem compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Amlodipine and diltiazem are both calcium channel blockers for high blood pressure, but they belong to different subclasses with different effects on the heart.

  • Diltiazem also slows heart rate and is used for atrial fibrillation and PSVT, while amlodipine does not affect heart rhythm.

  • Both drugs commonly cause swelling and dizziness, but diltiazem carries a higher risk of slow heart rate and heart block.

Amlodipine vs. Diltiazem Drug Summary

Amlodipine

Amlodipine is a dihydropyridine calcium channel blocker used to treat high blood pressure, chronic stable angina, and vasospastic angina. It relaxes blood vessels without slowing the heart rate and is taken as a single oral tablet once a day.

Diltiazem

Diltiazem is a non-dihydropyridine calcium channel blocker used for high blood pressure, angina, and heart rhythm conditions like atrial fibrillation and PSVT. It relaxes blood vessels and slows heart rate, and comes as oral tablets, extended-release capsules, or an IV infusion.

Amlodipine vs. Diltiazem Side Effects

Amlodipine

Most common
edema (up to 10.8%)
palpitations (up to 4.5%)
dizziness (up to 3.4%)
flushing (up to 2.6%)

Diltiazem

Most common
edema lower-limb (up to 6.8%)
dizziness (up to 6.4%)
fatigue (up to 4.8%)
bradycardia (up to 3.6%)

Amlodipine vs. Diltiazem Dosage

Amlodipine

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2.5 mg once daily At the start
Maximum dose 2.5 mg once daily Same as starting
Dose changes None Fixed dose

Diltiazem

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 120-240 mg once daily Weeks 1-2
Maximum dose 120-240 mg once daily Same as starting
Dose changes None Fixed dose

Amlodipine vs. Diltiazem Indications

Amlodipine

Amlodipine is FDA-approved for high blood pressure, chronic stable angina, and vasospastic (Prinzmetal's) angina, and it is also used in coronary artery disease. It works by relaxing the smooth muscle in blood vessel walls, which lowers blood pressure and reduces the heart's workload.

  • Hypertension

  • Chronic stable angina

  • Vasospastic (Prinzmetal's) angina

  • Coronary artery disease

Diltiazem

Diltiazem is FDA-approved for high blood pressure, angina, and for controlling heart rate in atrial fibrillation, atrial flutter, and PSVT. Doctors also prescribe it off-label for migraine prevention, Raynaud's phenomenon, and pulmonary hypertension.

  • Hypertension

  • Chronic stable angina

  • Vasospastic (Prinzmetal's) angina

  • Atrial fibrillation/flutter (rate control)

Amlodipine vs. Diltiazem Pros and Cons

Amlodipine

Amlodipine's long half-life allows once-daily dosing with steady blood pressure control and a low risk of rebound effects. It has a well-established safety profile in heart failure and does not require dose adjustment for kidney function, though swelling is a common trade-off.

Pros

  • Simple once-daily dosing due to long half-life

  • No dose adjustment needed for kidney disease

  • Generally well tolerated in patients with heart failure

  • Typically costs less: about $5 to $30 per month

Cons

  • Swelling (edema) is the most common side effect

  • Not used to treat arrhythmias or heart rate problems

  • Can occasionally worsen angina when dose is increased

Diltiazem

Diltiazem's ability to slow heart rate makes it useful beyond blood pressure control, including for certain arrhythmias, but that same effect means it must be avoided in patients with conduction problems. It comes in more formulations, including IV, giving doctors flexibility in acute settings.

Pros

  • Also treats atrial fibrillation, flutter, and PSVT

  • Available in IV form for use in hospitals

  • Multiple oral formulations offer flexible dosing

  • Used off-label for migraine prevention and Raynaud's

Cons

  • Can cause bradycardia or heart block

  • Contraindicated in sick sinus syndrome and AV block

  • Costs more: about $18 to $125 per month

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