Antianginal, antiarrythmic, antihypertensive, nondihydropyridine calcium channel blocker

CCP: Atrial fibrillation or atrial flutter

Hypersensitivity to diltiazem or any component

Sick sinus syndrome (except in patients with a functioning artificial pacemaker)

Second- or third-degree AV block (except in patients with a functioning artificial pacemaker)

Severe hypotension or cardiogenic shock

Atrial fibrillation or atrial flutter associated with accessory conduction pathway (e.g., Wolff-Parkinson-White)

Ventricular tachycardia

Severe bradycardia

Pregnancy

Concurrent use with intravenous dantrolene

Intravenous:

• Onset: 3 minutes
• Duration: 1-3 hours following bolus; 0.5-1 hour after discontinuation of infusion
• Metabolism: hepatic
• Half-life: 3-4 hours following bolus; 4-5 hours following infusion

Common: Peripheral edema

Less common: 

Cardiovascular: Bradycardia (3% to 4%), bundle branch block (<2%), cardiac arrhythmia (1%), cardiac failure (<2%), complete atrioventricular block (<2%), ECG abnormality (<2%), edema (2% to 3%), extrasystoles (2%), first-degree atrioventricular block (3% to 4%), hypotension (3% to 4%), lower extremity edema (5% to 8%), palpitations (1% to 2%), second degree atrioventricular block (<2%), syncope (<2%), vasodilation (2% to 3%)

Dermatologic: Pruritus (<2%), skin photosensitivity (<2%) (Ramirez 2007), skin rash (1% to 2%) (Tuchinda 2014)

Endocrine & metabolic: Albuminuria (<2%), gout (1% to 2%), gynecomastia (<2%), hyperglycemia (<2%), hyperuricemia (<2%), increased lactate dehydrogenase (<2%), increased thirst (<2%), weight gain (<2%)

Gastrointestinal: Abdominal swelling (2%), anorexia (<2%), constipation (<2%), diarrhea (1% to 2%), dysgeusia (<2%), dyspepsia (1% to 6%), nausea (2%), vomiting (<2%), xerostomia (<2%)

Genitourinary: Crystalluria (<2%), impotence (2%), nocturia (<2%), sexual difficulty (<2%)

Hematologic & oncologic: Petechia (<2%)

Hepatic: Increased serum alanine aminotransferase (<2%), increased serum alkaline phosphatase (<2%), increased serum aspartate transaminase (<2%)

Hypersensitivity: Hypersensitivity reaction (<2%)

Infection: Infection (1% to 6%)

Local: Burning sensation at injection site (≤4%), itching at injection site (≤4%)

Nervous system: Abnormal dreams (<2%), abnormal gait (<2%), amnesia (<2%), depression (<2%), dizziness (2% to 10%), drowsiness (<2%), fatigue (5%), hallucination (<2%), headache (2% to 8%), insomnia (<2%), nervousness (2%), pain (6%), paresthesia (<2%), personality changes (<2%)

Neuromuscular & skeletal: Asthenia (1% to 4%), increased creatine phosphokinase in blood specimen (<2%), muscle cramps (<2%), myalgia (2%), neck stiffness (<2%), osteoarthritis (<2%), tremor (<2%)

Ophthalmic: Amblyopia (<2%), conjunctivitis (2%), eye irritation (<2%)

Otic: Tinnitus (<2%)

Renal: Polyuria (<2%)

Respiratory: Bronchitis (1% to 4%), cough (1% to 2%), dyspnea (1% to 6%), epistaxis (<2%), flu-like symptoms (2%), paranasal sinus congestion (1% to 2%), pharyngitis (6%), rhinitis (<2%)

Source: Diltiazem. In: Lexicomp Online, UpToDate, Waltham, MA. (Accessed November 20, 2020.) 

May cause first-, second-, and third-degree AV block or sinus bradycardia.

Use with caution in patients with left ventricular dysfunction: due to negative inotropic effects, cardiac output may be adversely affected.

Avoid co-administration with beta blockers -- a significant decrease in myocardial contractility may develop, as well as significant bradycardia or AV block.