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
Diltiazem
Benazepril vs. Diltiazem Dosage
Benazepril
Diltiazem
| 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 |
| 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
| 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
| 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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