Lisinopril vs. Diltiazem
See how Lisinopril and Diltiazem compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Lisinopril, an ACE inhibitor, and diltiazem, a calcium channel blocker, both lower blood pressure but work through completely different mechanisms in the body.
Lisinopril's most common side effects are cough and dizziness, while diltiazem more often causes leg swelling and a slowed heart rate.
Diltiazem also treats angina and abnormal heart rhythms, while lisinopril is specifically used after heart attacks and in heart failure.
Lisinopril vs. Diltiazem Drug Summary
Lisinopril
Lisinopril is an ACE inhibitor that treats high blood pressure and heart failure, and it improves survival after a heart attack. It comes as a tablet taken once a day, with the dose raised gradually based on blood pressure readings.
Diltiazem
Diltiazem is a calcium channel blocker used to lower blood pressure, relieve angina chest pain, and control heart rate in certain fast rhythms. It is taken once daily as an oral tablet or capsule, or given by IV in hospitals for urgent rate control.
Lisinopril vs. Diltiazem Side Effects
Lisinopril
Diltiazem
Lisinopril vs. Diltiazem Dosage
Lisinopril
Diltiazem
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | Up to 80 mg once daily | If needed |
| Dose changes | 3 increases | 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 |
Lisinopril
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | Up to 80 mg once daily | If needed |
| Dose changes | 3 increases | 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 |
Lisinopril vs. Diltiazem Indications
Lisinopril
Lisinopril lowers blood pressure by blocking an enzyme that narrows blood vessels, and it also helps the heart work more efficiently after damage from a heart attack or heart failure.
Essential hypertension in adults and children 6 and older
Heart failure, as add-on therapy with diuretics
To improve survival after a heart attack
Off-label: migraine prevention, diabetic kidney protection
Diltiazem
Diltiazem relaxes and widens blood vessels while also slowing the heart's electrical signals, which lowers blood pressure and eases the workload on the heart in several related conditions.
Hypertension
Chronic stable angina
Vasospastic (Prinzmetal's) angina
Atrial fibrillation and flutter (rate control)
Lisinopril vs. Diltiazem Pros and Cons
Lisinopril
Lisinopril has decades of outcomes data showing fewer deaths and hospitalizations in heart failure and after heart attacks, and it is one of the least expensive blood pressure medicines available. It does not slow the heart rate, but its dry cough side effect is a common reason people stop taking it.
Pros
Reduced death and hospitalizations in heart failure trials
Roughly $4 to $15 per month generic, before insurance
Does not slow heart rate, safer with slow rhythms
Also protects kidneys in diabetic patients (off-label)
Cons
Dry cough affects some users enough to switch drugs
Contraindicated during pregnancy
Can raise potassium levels
Risk of angioedema (facial or throat swelling)
Diltiazem
Diltiazem doubles as a rate-control drug for atrial fibrillation and a treatment for angina, giving it uses beyond blood pressure that lisinopril does not cover. It carries a higher list price and needs caution in anyone with a slow heart rate or conduction problems.
Pros
Also controls heart rate in atrial fibrillation and flutter
Also treats chronic and vasospastic angina
Does not cause cough or raise potassium
Available as IV for urgent rate control in hospitals
Cons
Roughly $18 to $125 per month, before insurance
Contraindicated with sick sinus syndrome or AV block
Can cause bradycardia and leg swelling
Interacts with many drugs processed by CYP3A4
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