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
• Peak: 2-4 hours
• Duration: 1-3 hours following bolus; 30 minutes to 10 hours after discontinuation of infusion

Common:

• Peripheral edema

Less common: 

• Cardiovascular: Bradycardia (3-4%), bundle branch block (< 2%), cardiac arrhythmia (1%), cardiac failure (< 2%), complete atrioventricular block (< 2%), ECG abnormality (< 2%), edema (2-3%), extrasystoles (2%), first-degree atrioventricular block (3-4%), hypotension (3-4%), lower extremity edema (5-8%), palpitations (1-2%), second degree atrioventricular block (< 2%), syncope (< 2%), vasodilation (2-3%)
• Dermatologic: Pruritus (< 2%), skin photosensitivity (< 2%), skin rash (1-2%)
• Endocrine & metabolic: Albuminuria (< 2%), gout (1-2%), 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 (1-2%), dysgeusia (< 2%), dyspepsia (1-6%), 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 (1-6%)
• 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 (2-10%), drowsiness (< 2%), fatigue (5%), hallucination (< 2%), headache (2-8%), insomnia (< 2%), nervousness (2%), pain (6%), paresthesia (< 2%), personality changes (< 2%)
• Neuromuscular & skeletal: Asthenia (1-4%), 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 (1-4%), cough (1-2%), dyspnea (1-6%), epistaxis (< 2%), flu-like symptoms (2%), paranasal sinus congestion (1-2%), pharyngitis (6%), rhinitis (< 2%)

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

• May cause first, second, or 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.