Benazepril vs. Diltiazem

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

Key Takeaways

  • Benazepril is an ACE inhibitor approved only for high blood pressure, while diltiazem also treats angina, atrial fibrillation, and certain fast heart rhythms.

  • Diltiazem comes in oral and IV forms with several release types, offering more flexibility for urgent or long-term heart rhythm control than benazepril.

  • Benazepril carries a boxed pregnancy warning and a small angioedema risk, while diltiazem is contraindicated in people with certain heart block or sick sinus syndrome.

Benazepril vs. Diltiazem Drug Summary

Benazepril

Benazepril is an ACE inhibitor that relaxes blood vessels to lower blood pressure. It comes as an oral tablet taken once daily, with the dose increased gradually over several weeks. It is FDA-approved only for treating hypertension.

Diltiazem

Diltiazem is a calcium channel blocker that relaxes blood vessels and slows the heart to lower blood pressure and control certain rhythms. It comes as an oral tablet or capsule in several release forms, or as an IV infusion for acute care. It is FDA-approved for hypertension, angina, and certain fast heart rhythms.

Benazepril vs. Diltiazem Side Effects

Benazepril

Most common
headache (up to 6%)
dizziness (up to 4%)
somnolence (up to 2%)
postural dizziness (up to 2%)

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%)

Benazepril vs. Diltiazem Dosage

Benazepril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.2 mg/kg once daily At the start
Maximum dose 0.6 mg/kg once daily If needed
Dose changes 1 increase As tolerated

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

Benazepril vs. Diltiazem Indications

Benazepril

Benazepril is approved by the FDA solely for treating high blood pressure in adults and in children age 6 and older. It works by blocking an enzyme that narrows blood vessels, which helps blood pressure drop steadily over the day.

  • Lowering high blood pressure in adults

  • Lowering high blood pressure in children 6 and older

  • Often prescribed alone or alongside other blood pressure drugs

Diltiazem

Diltiazem is FDA-approved for several cardiovascular conditions beyond high blood pressure, including chronic and vasospastic angina, atrial fibrillation or flutter, and paroxysmal supraventricular tachycardia. It is also used off-label for migraine prevention, Raynaud's phenomenon, and pulmonary hypertension.

  • Lowering high blood pressure

  • Chronic stable and vasospastic (Prinzmetal's) angina

  • Rate control in atrial fibrillation or flutter

Benazepril vs. Diltiazem Pros and Cons

Benazepril

Benazepril has decades of use as a low-cost, once-daily option for blood pressure control. It is not appropriate during pregnancy and carries a small risk of angioedema, a rare but serious swelling reaction.

Pros

  • Roughly $9 to $30 per month without insurance, before savings programs

  • Once-daily oral dosing

  • Long track record since FDA approval in 1991

  • Fewer contraindications tied to heart rhythm problems

Cons

  • Boxed warning for fetal harm during pregnancy

  • Risk of angioedema, including rare fatal cases

  • Less effective as monotherapy in Black patients

  • Only approved for hypertension, no other uses

Diltiazem

Diltiazem's ability to treat angina, atrial fibrillation, and PSVT makes it useful when blood pressure control and heart rhythm management are both needed. It requires more caution around existing heart block or sick sinus syndrome, and its cost varies widely by formulation.

Pros

  • FDA-approved for angina, AFib/flutter, and PSVT, not just hypertension

  • Available in immediate, sustained, extended-release, and IV forms

  • IV form allows rapid control in urgent hospital settings

  • No boxed pregnancy warning

Cons

  • Contraindicated with sick sinus syndrome or certain AV block

  • Can cause slow heart rate and lower-limb swelling

  • Roughly $18 to $125 per month depending on formulation, without insurance

  • Not recommended with severe hypotension or cardiogenic shock

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