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

Most common
Dizziness (up to 4%)
Headache (up to 4%)
Cough (up to 3%)
Diarrhea (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%)

Lisinopril vs. Diltiazem Dosage

Lisinopril

Dosage
Dosage Table
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

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

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

Common Symptoms and Related Diseases You Can Explore

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