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
Diltiazem
Amlodipine vs. Diltiazem Dosage
Amlodipine
Diltiazem
| 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 |
| 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
| 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
| 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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