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Diltiazem Hydrochloride SR (diltiazem) Disease Interactions

There are 9 disease interactions with Diltiazem Hydrochloride SR (diltiazem):


Ccbs (Includes Diltiazem Hydrochloride SR) ↔ Aortic Stenosis

Severe Potential Hazard, High plausibility

Applies to: Aortic Stenosis

The use of some calcium channel blockers (CCBs) is contraindicated in patients with advanced aortic stenosis. CCBs whose pharmacologic effect is partially dependent on their ability to reduce afterload (e.g., diltiazem, nicardipine, nifedipine, verapamil) may be of less benefit in these patients due to a fixed impedance to flow across the aortic valve and may, in fact, worsen rather than improve myocardial oxygen balance. Rarely, heart failure has developed following the initiation of these CCBs, particularly in patients receiving concomitant beta-blocker therapy.


  1. "Product Information. Adalat (nifedipine)." Bayer, West Haven, CT.
  2. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc, Palo Alto, CA.
  3. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.

Ccbs (Includes Diltiazem Hydrochloride SR) ↔ Bradyarrhythmia/Av Block

Severe Potential Hazard, High plausibility

Applies to: Heart Block, Sinus Node Dysfunction

The use of some calcium channel blockers (CCBs) is contraindicated in patients with severe bradyarrhythmia, sick sinus syndrome (unless a functioning pacemaker is present), or heart block greater than the first degree (unless a functioning pacemaker is present). CCBs like bepridil, diltiazem and verapamil have a negative effect on AV conduction and the SA node and may exacerbate these conditions.


  1. Colombo G, Zucchella G, Planca E, Grieco A "Intravenous diltiazem in the treatment of unstable angina: a study of efficacy and tolerance." Clin Ther 9 (1987): 536-47
  2. Aromatorio GJ, Uretsky BF, Reddy PS "Hypotension and sinus arrest with nifedipine in pulmonary hypertension." Chest 87 (1985): 265-7
  3. Gobel EJAM, Hautvast RWM, Vangilst WH, Spanjaard JN, Hillege HL, Dejongste MJL, Molhoek GP, Lie KI "Randomised, double-blind trial of intravenous diltiazem versus glyceryl trinitrate for unstable angina pectoris." Lancet 346 (1995): 1653-7
View all 14 references

Ccbs (Includes Diltiazem Hydrochloride SR) ↔ Cardiogenic Shock/Hypotension

Severe Potential Hazard, High plausibility

Applies to: Cardiogenic Shock, Hypotension

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.


  1. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  2. Stehle G, Buss J, Eibach J, et al "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  3. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical, Raritan, NJ.
View all 6 references

Ccbs (Includes Diltiazem Hydrochloride SR) ↔ Coronary Artery Disease

Severe Potential Hazard, Low plausibility

Applies to: Ischemic Heart Disease

Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.


  1. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  2. Kloner RA "Nifedipine in ischemic heart disease." Circulation 92 (1995): 1074-8
  3. Thomassen AR, Bagger JP, Nielsen TT "Hemodynamic and cardiac metabolic changes during nicardipine-induced myocardial ischemia." Cathet Cardiovasc Diagn 14 (1988): 41-3
View all 15 references

Ccbs (Includes Diltiazem Hydrochloride SR) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, several patients have developed cholestasis or hepatocellular injury that was proven by rechallenge. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function and for excessive pharmacologic effects (e.g., abnormal prolongation of PR interval) is advised, and the dosage adjusted if necessary.


  1. Stern EH, Pitchon R, King BD, Wiener I "Possible hepatitis from verapamil." N Engl J Med 306 (1982): 612-3
  2. Giacomini KM, Massoud N, Wong FM, Giacomini JC "Decreased binding of verapamil to plasma proteins in patients with liver disease." J Cardiovasc Pharmacol 6 (1984): 924-8
  3. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
View all 53 references

Diltiazem (Includes Diltiazem Hydrochloride SR) ↔ Chf/Ami

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure, Myocardial Infarction

Diltiazem has demonstrated a negative inotropic effect in isolated animal tissue preparations but rarely in clinical situations. Hemodynamic studies in humans with normal ventricular function and in patients with a compromised myocardium have not shown a reduction in cardiac index nor consistent negative effects on contractility. However, worsening of congestive heart failure has been reported in patients with preexisting impairment of ventricular function. Therapy with diltiazem should be administered cautiously, if at all, in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, diltiazem should not be given to patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened. Mild symptoms of cardiac failure should be under control, if possible, prior to initiating diltiazem therapy.


  1. Sleight P "Calcium antagonists during and after myocardial infarction." Drugs 51 (1996): 216-25
  2. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.

Diltiazem Iv (Includes Diltiazem Hydrochloride SR) ↔ Accessory Av Tracts

Severe Potential Hazard, High plausibility

Applies to: Preexcitation Syndrome

The use of intravenous diltiazem is contraindicated for the management of atrial flutter or fibrillation in patients with an accessory AV tract (e.g., those with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome). Diltiazem can cause ventricular fibrillation and cardiac arrest in such patients, the mechanism of which is related to the drug's ability to shorten the refractory period and accelerate antegrade conduction within the accessory pathway.


  1. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  2. Jacob AS, Nielsen DH, Gianelly RE "Fatal ventricular fibrillation following verapamil in Wolff-Parkinson-White syndrome with atrial fibrillation." Ann Emerg Med 14 (1985): 159-60
  3. McGovern B, Garan H, Ruskin JN "Precipitation of cardiac arrest by verapamil in patients with Wolff-Parkinson-White syndrome." Ann Intern Med 104 (1986): 791-4
View all 7 references

Diltiazem/Verapamil Iv (Includes Diltiazem Hydrochloride SR) ↔ Ventricular Tachycardia

Severe Potential Hazard, High plausibility

Applies to: Ventricular Arrhythmia

The use of intravenous diltiazem or verapamil is contraindicated in patients with ventricular tachycardia. IV administration of a calcium channel blocker can precipitate cardiac arrest in such patients. Marked hemodynamic deterioration and ventricular fibrillation have occurred in patients with wide-complex ventricular tachycardia (QRS >= 0.12 seconds) treated with IV verapamil.


  1. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  2. Winters SL, Schweitzer P, Kupersmith J, Gomes JA "Verapamil-induced polymorphous ventricular tachycardia." J Am Coll Cardiol 6 (1985): 257-9
  3. Buxton AE, Marchlinski FE, Doherty JU, et al "Hazards of intravenous verapamil for sustained ventricular tachycardia." Am J Cardiol 59 (1987): 1107-10
View all 4 references

Diltiazem (Includes Diltiazem Hydrochloride SR) ↔ Renal Dysfunction

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Diltiazem is extensively metabolized by the liver and subsequently excreted in the urine, primarily as metabolites. Limited data suggest that the pharmacokinetic disposition of diltiazem is not altered in the presence of renal insufficiency or even end-stage renal disease. However, the effects of possible metabolite accumulation have not been studied. The manufacturers recommend that therapy with diltiazem be administered cautiously in patients with impaired renal function. Laboratory parameters of renal function should be monitored at regular intervals.


  1. Tawashi M, Marc-Aurelet J, Bichet D, et al "Pharmacokinetics of intravenous diltiazem and five of its metabolites in patients with chronic renal failure and in healthy volunteers." Biopharm Drug Dispos 12 (1991): 105-12
  2. Patel R, Lipper B, Schwartzbard A, Nelson C, Oconnor MA, Frishman W "Toxic effects of diltiazem in a patient with chronic renal failure." J Clin Pharmacol 34 (1994): 273-4
  3. Shallcross H, Padley SP, Glynn MJ, Gibbs DD "Fatal renal and hepatic toxicity after treatment with diltiazem." Br Med J 295 (1987): 1256-7
View all 8 references

Diltiazem Hydrochloride SR (diltiazem) drug Interactions

There are 894 drug interactions with Diltiazem Hydrochloride SR (diltiazem)

Diltiazem Hydrochloride SR (diltiazem) alcohol/food Interactions

There are 2 alcohol/food interactions with Diltiazem Hydrochloride SR (diltiazem)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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