Side Effects of diltiazem: A Synthesis of Findings from 27 Studies

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This analysis is based on research papers included in PubMed, but medical research is constantly evolving and may not fully reflect the latest findings. There may also be biases towards certain research areas.

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Original Abstract of the Article

Main Research Findings

Diltiazem is a calcium channel blocker that is commonly used to treat hypertension and cardiac arrhythmias. Studies have shown that diltiazem can have various side effects, and these can range from mild to severe. For instance, the study in 9 reported a case of a patient who developed BRASH syndrome after taking diltiazem and metoprolol, a beta-blocker. BRASH syndrome is a rare but serious condition that involves bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia. In addition, the study in 12 found that calcium channel blocker poisoning, a severe consequence of diltiazem overdose, can occur.

Diltiazem has also been investigated for its potential therapeutic applications, such as its ability to reduce thromboinflammatory responses associated with ponatinib, a tyrosine kinase inhibitor used for leukemia treatment, as highlighted in the study in 5 . Another study, found in 16 , showed that diltiazem, when used topically, can be an effective alternative to nitroglycerin for the treatment of chronic anal fissures.

Reasons for Side Effects

Diltiazem's side effects arise from its mechanism of action. It functions by blocking calcium channels in the heart and blood vessels, leading to a decrease in heart muscle contractility and relaxation of blood vessels. While this mechanism effectively lowers blood pressure and regulates heart rate, excessive blocking of calcium channels can lead to adverse effects such as bradycardia, hypotension, and digestive issues.

Common Side Effects

Bradycardia

The study in 9 reported a case where diltiazem contributed to BRASH syndrome, which includes bradycardia as a symptom. Furthermore, 1 highlighted that diltiazem can lower heart rate.

Hypotension

The study in 9 reported a case where diltiazem contributed to BRASH syndrome, which includes hypotension as a symptom. Also, the study in 6 discussed diltiazem's use in hypertension treatment, emphasizing its effect on lowering blood pressure.

Gastrointestinal Issues

Diltiazem can affect the gastrointestinal system. For example, the study in 10 mentioned pedal edema as a potential side effect of diltiazem. Additionally, 17 cautioned against combining diltiazem with beta-blockers due to the risk of AV block and bradycardia.

Countermeasures for Side Effects

Countermeasures for Bradycardia

If bradycardia occurs due to diltiazem, immediately discontinue the medication and consult a doctor. In severe cases, a pacemaker may be required.

Countermeasures for Hypotension

If hypotension occurs due to diltiazem, immediately discontinue the medication and consult a doctor. Medication to increase blood pressure may be necessary.

Countermeasures for Gastrointestinal Issues

If gastrointestinal issues occur due to diltiazem, immediately discontinue the medication and consult a doctor. Medications to manage gastrointestinal symptoms may be required.

Comparison between Studies

Common Points of Studies

Most studies agree that diltiazem works by blocking calcium channels, leading to a decrease in heart contractility and relaxation of blood vessels. They also share the observation that diltiazem can cause side effects such as bradycardia, hypotension, and gastrointestinal issues.

Differences between Studies

The severity and frequency of diltiazem's side effects can vary based on the study. While the study in 9 reported a case of BRASH syndrome, other studies have indicated a lower incidence of this condition.

Points to Note for Applying to Real Life

Diltiazem is a valuable medication for treating hypertension and cardiac arrhythmias, but it's crucial to be aware of its potential side effects. Always follow your doctor's instructions and be vigilant for any adverse reactions. If you have pre-existing conditions like heart disease or kidney disease, it is essential to consult your doctor before taking diltiazem.

Limitations of Current Research

Research on the side effects of diltiazem is still ongoing and limited. There is a lack of extensive data on long-term side effects. Further research is necessary to fully evaluate diltiazem's long-term safety.

Future Research Directions

Future research on diltiazem should prioritize assessing its long-term safety, uncovering the underlying mechanisms responsible for its side effects, and developing preventive and treatment strategies to manage those side effects.

Conclusion

Diltiazem is an effective medication for hypertension and cardiac arrhythmias, but potential side effects should be acknowledged. Always follow your doctor's instructions, be watchful for any adverse reactions, and don't hesitate to seek medical advice if you have concerns or experience any side effects.

Literature analysis of 27 papers
Positive Content
19
Neutral Content
1
Negative Content
7
Article Type
3
1
3
11
26
2.

Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure.

Author: KocherH M, StewardM, LeatherA J M, CullenP T

Anal fissure healing
Headache

Diltiazem hydrochloride (DTZ) cream was more effective than glyceryl trinitrate (GTN) ointment in treating chronic anal fissure with fewer headaches as a side effect. The healing rate was similar in both treatments.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

3.

Hydrochlorothizide-induced acute generalised exanthematous pustulosis presenting with bilateral periorbital impetigo.

Author: ReapLeo E, RoddCassandra, LariosJose, MarshallMichael

AGEP

Hydrochlorothiazide, a diuretic, has been reported to induce acute generalised exanthematous pustulosis (AGEP) in two cases, highlighting the need for caution when using this drug.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

7.

Calcium channel blockers for neuroleptic-induced tardive dyskinesia.

Author: EssaliAdib, DeirawanHany, Soares-WeiserKarla, AdamsClive E

Tardive dyskinesia

This study reviewed the use of calcium channel blockers to treat tardive dyskinesia, a movement disorder associated with antipsychotic medications.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

[Significant Prolongation of the International Normalized Ratio Associated with COVID-19 Treatment: Possible Drug Interaction with Remdesivir].

Author: IshiiHidetoshi, YokotaNorio, BandoYuki, OtoriKatsuya

Treats COVID-19
INR prolongation

This case report discussed the potential for drug interactions between remdesivir (RDV), dexamethasone (DXM), and warfarin (WF) in a patient with COVID-19 and hypertrophic cardiomyopathy. It highlighted the importance of close monitoring of INR levels when co-administering these medications.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Japanese

10.

Author: SkovbjergBirgit K, HelgestadOle Kl, OxlundChristina S, ChristensenBo, HenriksenJakob N

Pedal edema management
Amlodipine side effects

This review provides an overview of management strategies for pedal edema, a common side effect of amlodipine, a calcium channel blocker. The review prioritizes strategies to minimize side effects, including reducing dosage, switching to alternative calcium channel blockers, adding ACE inhibitors or angiotensin II-receptor blockers, and administering the drug at night.

ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Danish

11.

[Management of side effects of targeted therapies in renal cancer: nephrological side effects].

Author: IzzedineHassan, NégrierSylvie, NeuzilletYann, ZiniLaurent

High blood pressure
Kidney failure
Proteinuria
Thrombotic microangiopathy

Screening and treatment for high blood pressure, proteinuria and kidney failure are recommended during treatment with molecular targeted therapy.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : French

12.

Treatment for calcium channel blocker poisoning: a systematic review.

Author: St-OngeM, DubéP-A, GosselinS, GuimontC, GodwinJ, ArchambaultP M, ChaunyJ-M, FrenetteA J, DarveauM, Le SageN, PoitrasJ, ProvencherJ, JuurlinkD N, BlaisR

Hemodynamic improvement
Mortality reduction
Hypoglycemia
Hypokalemia

High-dose insulin and extracorporeal life support were the interventions supported by the strongest evidence for calcium channel blocker poisoning, although the evidence is of low quality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

Drug hypersensitivity syndrome.

Author: KumariRashmi, TimshinaDependra K, ThappaDevinder Mohan

Drug hypersensitivity

Drug hypersensitivity syndrome (DHS) is a serious adverse drug reaction that is often associated with aromatic antiepileptic drugs. It is characterized by fever, rash, lymphadenopathy, and internal organ involvement. The syndrome is managed by immediate withdrawal of the culprit drug, symptomatic treatment, and systemic steroids or immunoglobulins.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

15.

Treatment of chronic anal fissure: a feasibility study on Levorag® Emulgel versus Diltiazem gel 2.

Author: Nordholm-CarstensenAndreas, PerregaardHelene, WahlstrømKirsten Lykke, HagenKikke Bartholin, HougaardHelene Tarri, KrarupPeter-Martin

Anal fissure treatment
Perianal exanthema

The study compared the effectiveness of diltiazem gel 2% and Levorag® Emulgel for chronic anal fissures. Levorag® Emulgel was found to be non-inferior to diltiazem in terms of complete fissure healing after 12 weeks. Although diltiazem provided faster pain relief, it also caused a significant number of local allergic reactions. Levorag® Emulgel may be a suitable alternative for patients who experience allergic reactions to diltiazem.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

16.

[Local treatment of a chronic anal fissure with diltiazem vs. nitroglycerin. A comparative study].

Author: PucheJosé J, García-CoretM José, VillalbaFrancisco L, Ali-MahmoudIsmail, RoigJosé V

Avoid surgery
More symptomatic relief
Recurrence
Side effects (nitroglycerin)

Smooth muscle relaxant drugs, like diltiazem and nitroglycerin, offered more symptomatic relief than traditional measures for chronic anal fissure (CAF) but did not achieve a higher cure rate. Topical diltiazem was better tolerated than nitroglycerin.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Spanish

17.

Combining other antihypertensive drugs with β-blockers in hypertension: a focus on safety and tolerability.

Author: RichardsTiffany R, TobeSheldon W

Blood pressure control
Atrioventricular block
Bradycardia

Combining multiple classes of antihypertensive drugs is often essential for blood pressure control in patients with hypertension. This review discusses the benefits of combination therapy and provides recommendations for effective drug combinations based on their efficacy and potential side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

19.

[Prophylaxis and therapy for atrial fibrillation after general thoracic surgery].

Author: KaragiannidisC, MeissnerA, KoryllosA, WindischW, StrassmannS

Postoperative AF prevention
Postoperative AF treatment

This review article discusses the evidence for medical therapy and treatment strategies for atrial fibrillation (AF) after thoracic surgery. The article highlights the importance of prophylactic treatment to prevent AF, as well as the options for rate and rhythm control in those who develop AF.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : German

20.

Oral triazolam sedation in implant dentistry.

Author: FlanaganDennis

Dental sedation
Drug interactions
Seizure risk

Triazolam is a medication used to sedate patients. This study reviewed the use of triazolam in dental implant patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

21.

Assessment of the efficacy, optimal dosage, and safety of diltiazem in early treatment of unstable angina pectoris.

Author: BaiRong,

Angina relief
Hemodynamic stability
Bradyarrhythmias

Continuous intravenous infusion of diltiazem effectively relieved symptoms in 94% of patients with unstable angina pectoris (UAP), with the majority treated at a low dosage of 1 microg/kg/min.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.

Language : English

22.

Beyond anxiety and agitation: A clinical approach to akathisia.

Author: TachereRichardson Oghoteru, ModirroustaMandana

Akathisia

This article discusses the importance of considering akathisia, a subjectively distressing condition characterized by restlessness and an inability to sit or stand still, as a differential diagnosis in patients presenting with sudden restlessness in general medical settings.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

23.

Calcium antagonists, diltiazem and nifedipine, protect broilers against low temperature-induced pulmonary hypertension and pulmonary vascular remodeling.

Author: YangYing, GaoMingyu, GuoYuming, QiaoJian

Pulmonary hypertension prevention

Diltiazem, a calcium antagonist, effectively prevented low temperature-induced pulmonary hypertension in broilers, while nifedipine showed limited efficacy.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

25.

Effect of Topical Calcium Channel Blockers on Intraocular Pressure in Steroid-induced Glaucoma.

Author: GanekalSunil, DorairajSyril, JhanjiVishal, KudluKrishnaprasad

Reduced IOP

Topical calcium channel blockers, verapamil and diltiazem, significantly reduced intraocular pressure (IOP) in rabbit eyes with steroid-induced glaucoma. The reduction of IOP by both drugs was comparable to timolol.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

26.

Intravenous lipid emulsion to reverse acute drug toxicity in pediatric patients.

Author: PresleyJoseph D, ChykaPeter A

Drug toxicity reversal
Hypertriglyceridemia
Pancreatitis

Intravenous lipid emulsion has been used to treat life-threatening toxicity from several lipophilic drugs in neonates and adolescents, with generally positive outcomes.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

27.

A systematic review and meta-analysis of the efficacy of topical sphincterotomy treatments for anal fissure.

Author: JinJames Z, HardyMolly-Olivia, UnasaHanson, Mauiliu-WallisMelbourne, WestonMaree, ConnollyAndrew, SinghPrimal Parry, HillAndrew G

Anal fissure healing
Pain reduction
Headache
Side effects

Topical nitrates (glyceryl trinitrate [GTN]) were more effective than placebo in healing anal fissures, with a relative risk (RR) of 1.96 (95% CI 1.35-2.84). GTN also reduced pain but was associated with a higher risk of headache. More evidence is needed to determine the effectiveness of topical diltiazem.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

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