Atenolol vs. Diltiazem
See how Atenolol and Diltiazem compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Atenolol is a beta-blocker and diltiazem is a calcium channel blocker, so they lower blood pressure through different mechanisms and are sometimes combined.
Diltiazem also treats atrial fibrillation and PSVT, uses atenolol does not have, while atenolol has a stronger track record after heart attacks.
Both are taken once daily for chronic use, but diltiazem also comes as an IV formulation for urgent rhythm control in hospitals.
Atenolol vs. Diltiazem Drug Summary
Atenolol
Atenolol is a beta-1 selective beta-blocker used to treat high blood pressure, angina, and to stabilize heart rhythm after a heart attack. It works by slowing the heart rate and reducing the force of each heartbeat, and it is taken as an oral tablet once daily.
Diltiazem
Diltiazem is a non-dihydropyridine calcium channel blocker used to treat high blood pressure, angina, and to control heart rate in atrial fibrillation and certain fast rhythms. It relaxes blood vessels and slows the heart, and it comes as an oral tablet, extended-release capsule, or IV injection.
Atenolol vs. Diltiazem Side Effects
Atenolol
Diltiazem
Atenolol vs. Diltiazem Dosage
Atenolol
Diltiazem
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | At the start |
| Maximum dose | 200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 120-240 mg once daily | Weeks 1-2 |
| Maximum dose | 540 mg once daily | If needed |
| Dose changes | 5 increases | As tolerated |
Atenolol
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | At the start |
| Maximum dose | 200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Diltiazem
| STAGE | DOSE | WHEN |
| Starting dose | 120-240 mg once daily | Weeks 1-2 |
| Maximum dose | 540 mg once daily | If needed |
| Dose changes | 5 increases | As tolerated |
Atenolol vs. Diltiazem Indications
Atenolol
Atenolol is FDA-approved for high blood pressure, chronic angina, and to improve survival after a heart attack in stable patients. Doctors also prescribe it off-label for migraine prevention and tremor.
Hypertension
Angina pectoris
Stabilization after a heart attack
Off-label: migraine prevention
Off-label: essential tremor
Diltiazem
Diltiazem is FDA-approved for high blood pressure, chronic and vasospastic angina, and for controlling heart rate in atrial fibrillation, atrial flutter, and PSVT. Doctors also prescribe it off-label for migraine prevention and Raynaud's phenomenon.
Hypertension
Chronic stable and vasospastic angina
Atrial fibrillation and flutter (rate control)
Paroxysmal supraventricular tachycardia
Off-label: migraine prevention, Raynaud's
Atenolol vs. Diltiazem Pros and Cons
Atenolol
Atenolol has decades of outcome data supporting its use after a heart attack and is one of the least expensive blood pressure medications available. It is not a good fit for people with asthma, COPD, or certain heart rhythm problems.
Pros
One of the least expensive beta-blockers, roughly $6 to $37 a month without insurance
Strong evidence for improving survival after a heart attack
Simple once-daily oral dosing with one tablet strength progression
Long-standing safety record since 1981
Cons
Not recommended for people with asthma or COPD due to bronchospasm risk
Can mask warning signs of low blood sugar and hyperthyroidism
Requires dose adjustment in kidney impairment
Stopping suddenly can worsen angina or trigger a heart attack
Diltiazem
Diltiazem covers a wider range of heart rhythm problems than atenolol and comes in an IV form for urgent hospital use. It costs more on average and carries its own restrictions around slow heart rhythms and heart failure.
Pros
Also treats atrial fibrillation, atrial flutter, and PSVT
Available as IV injection for urgent rate control in the hospital
Does not mask low blood sugar symptoms the way beta-blockers can
Multiple release formulations (immediate, sustained, extended)
Cons
Roughly $18 to $125 a month without insurance, often costing more than atenolol
Contraindicated with sick sinus syndrome unless a pacemaker is in place
Can worsen symptoms in patients with reduced heart pump function
More titration steps to reach an effective maintenance dose
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