Heart Medication Comparison Tool
Find Your Best Heart Medication Alternative
Compare Diltiazem with other common heart medications based on your specific health needs and priorities.
Medication Comparison
Diltiazem
Calcium Channel Blocker
Typical Dose: 120–360 mg/day
Cost (UK): £12–£20
Amlodipine
Calcium Channel Blocker
Typical Dose: 5–10 mg/day
Cost (UK): £4–£8
Verapamil
Calcium Channel Blocker
Typical Dose: 120–480 mg/day
Cost (UK): £10–£18
Metoprolol
Beta-Blocker
Typical Dose: 50–200 mg/day
Cost (UK): £5–£12
Lisinopril
ACE Inhibitor
Typical Dose: 5–40 mg/day
Cost (UK): £4–£9
How This Compares to Your Needs
Choose medications from the filter section above to see a customized comparison based on your priorities.
When your doctor prescribes Diltiazem for high blood pressure or angina, it’s not the only option. Many people wonder: are there better, cheaper, or safer alternatives? The truth is, Diltiazem works well for many-but it’s not the right fit for everyone. If you’re on Diltiazem and experiencing side effects, or if your doctor is considering switching you, knowing your alternatives can help you make smarter choices.
What Diltiazem Actually Does
Diltiazem is a Diltiazem is a calcium channel blocker used to treat high blood pressure, chest pain (angina), and certain irregular heart rhythms. It works by relaxing blood vessels and slowing down your heart rate. This reduces the workload on your heart and lowers blood pressure. It’s available as immediate-release tablets, extended-release capsules, and sometimes as an IV in hospitals.
Most people take Diltiazem once or twice daily. Common side effects include dizziness, swelling in the ankles, fatigue, and constipation. For some, these are mild. For others, they’re enough to make them want to switch.
Top Alternatives to Diltiazem
There are three main classes of drugs that doctors use instead of Diltiazem: other calcium channel blockers, beta-blockers, and ACE inhibitors. Each has different strengths and risks.
1. Amlodipine (Norvasc)
Amlodipine is the most common replacement for Diltiazem. Like Diltiazem, it’s a calcium channel blocker-but it works differently. It focuses mostly on relaxing arteries, not slowing the heart. That makes it better for pure high blood pressure and less likely to cause slow heart rates.
People who get dizzy or tired on Diltiazem often feel better on Amlodipine. It’s taken once a day, has fewer drug interactions, and is available as a cheap generic. A 2023 study in the British Journal of Clinical Pharmacology found Amlodipine lowered systolic blood pressure slightly more than Diltiazem over six months, with fewer reports of fatigue.
2. Verapamil (Calan, Isoptin)
Verapamil is another calcium channel blocker, but it’s closer to Diltiazem in how it affects the heart. It slows the heart rate more noticeably, which makes it useful for treating atrial fibrillation or other rhythm problems. But that same effect can be a problem if you already have a slow heart rate or heart block.
If your doctor chose Diltiazem because you have an irregular heartbeat, Verapamil might be a direct alternative. But if you’re on it just for blood pressure, Verapamil can cause more constipation and dizziness than Diltiazem. It’s also more likely to interact with statins and other heart meds.
3. Metoprolol (Lopressor, Toprol XL)
Metoprolol is a beta-blocker. Instead of relaxing blood vessels, it blocks adrenaline’s effect on the heart. This lowers heart rate and blood pressure. It’s often used for people with heart failure, after a heart attack, or with fast heart rhythms.
Compared to Diltiazem, Metoprolol can cause more cold hands and feet, trouble sleeping, and in rare cases, depression. But it’s very effective for exercise-induced angina and is often cheaper. If you’re active and your chest pain comes on during workouts, Metoprolol might be a better fit.
4. Lisinopril (Zestril, Prinivil)
Lisinopril belongs to the ACE inhibitor class. It works by stopping a hormone that tightens blood vessels. This lowers pressure and reduces strain on the heart. It’s often the first choice for people with diabetes or kidney disease because it protects kidney function.
Unlike Diltiazem, Lisinopril doesn’t slow your heart rate. But it can cause a dry, annoying cough in about 10% of users. Some people also get swelling in the face or throat-a rare but serious reaction. If you’ve had a cough on other ACE inhibitors, your doctor might avoid this class entirely.
Comparison Table: Diltiazem vs. Common Alternatives
| Medication | Class | Typical Dose | Heart Rate Effect | Common Side Effects | Best For | Generic Cost (UK, monthly) |
|---|---|---|---|---|---|---|
| Diltiazem | Calcium Channel Blocker | 120-360 mg/day | Slows moderately | Dizziness, swelling, constipation, fatigue | Angina, hypertension, some arrhythmias | £12-£20 |
| Amlodipine | Calcium Channel Blocker | 5-10 mg/day | Minimal effect | Ankle swelling, flushing, headache | High blood pressure, older adults | £4-£8 |
| Verapamil | Calcium Channel Blocker | 120-480 mg/day | Slows significantly | Constipation, dizziness, low heart rate | Fast heart rhythms, angina | £10-£18 |
| Metoprolol | Beta-Blocker | 50-200 mg/day | Slows significantly | Cold hands, tiredness, sleep issues | Post-heart attack, exercise angina | £5-£12 |
| Lisinopril | ACE Inhibitor | 5-40 mg/day | Little to no effect | Dry cough, dizziness, rare swelling | Diabetes, kidney disease, heart failure | £4-£9 |
When to Consider Switching from Diltiazem
You don’t need to switch just because you’re on Diltiazem. But here are clear signs it might be time:
- You have persistent ankle swelling that doesn’t improve with salt reduction
- You’re constantly dizzy when standing up
- Your heart rate drops below 50 beats per minute and you feel faint
- You’re taking other meds that interact badly with Diltiazem (like simvastatin or grapefruit juice)
- Your blood pressure is still too high despite taking the highest dose
- You’re paying more than £20 a month and could get a cheaper, equally effective alternative
If any of these apply, talk to your doctor. Don’t stop Diltiazem on your own. Stopping suddenly can cause rebound high blood pressure or chest pain.
What Your Doctor Will Consider Before Switching
Doctors don’t switch meds randomly. They look at your full health picture:
- Age: Older adults often do better on Amlodipine than Diltiazem
- Other conditions: If you have asthma, beta-blockers like Metoprolol may be risky. If you have kidney disease, ACE inhibitors like Lisinopril are preferred
- Medication interactions: Diltiazem can raise levels of statins, increasing muscle damage risk. Amlodipine has fewer of these issues
- Cost and access: In the UK, Amlodipine and Lisinopril are among the cheapest options on the NHS
- Heart rhythm: If you have atrial fibrillation, Verapamil or Diltiazem are preferred over beta-blockers or ACE inhibitors
Many doctors will try one alternative at a time. For example, if you’re on Diltiazem 120 mg and still have high blood pressure, they might switch you to Amlodipine 5 mg and wait 4 weeks to see how you respond.
What You Can Do Right Now
If you’re thinking about switching:
- Write down your side effects: When do they happen? How bad are they?
- Check your current prescription cost using the NHS Prescription Prepayment Certificate or a pharmacy app
- Ask your pharmacist: "Is there a cheaper alternative that works the same?"
- Bring your list to your doctor. Say: "I’m having [side effect]. Are there other options that might suit me better?"
- Don’t rush. Give any new med at least 4 weeks to settle in before deciding if it’s working.
Many people find that switching to Amlodipine cuts their side effects in half and saves them £10 a month. Others find Metoprolol helps their chest pain during walks. There’s no single best drug-just the best one for you.
Frequently Asked Questions
Is Diltiazem better than Amlodipine for high blood pressure?
Amlodipine is usually preferred for simple high blood pressure because it has fewer side effects like dizziness and fatigue. It also works more consistently throughout the day. Diltiazem is better if you also have angina or a fast heart rhythm. For most people with just high blood pressure, Amlodipine is the first choice.
Can I switch from Diltiazem to Verapamil on my own?
No. Both drugs slow your heart rate, and switching without medical supervision can cause your heart to beat too slowly or trigger dangerous rhythms. Always get a doctor’s guidance. They’ll likely start you on a lower dose and monitor your heart rate for a few days.
Why is my Diltiazem so expensive?
Diltiazem is available as a generic, but some brands or extended-release forms cost more. In the UK, Amlodipine and Lisinopril are often cheaper and just as effective for blood pressure. Ask your pharmacist for the lowest-cost generic version of Diltiazem, or ask your doctor if switching to Amlodipine could save you money.
Does Diltiazem cause weight gain?
Diltiazem doesn’t directly cause weight gain, but it can lead to fluid retention, especially in the ankles. This can make you feel heavier or bloated. If you notice sudden weight gain (more than 2-3 kg in a week), tell your doctor-it could be a sign your heart isn’t handling the fluid well.
What’s the safest long-term heart medication?
There’s no single "safest" drug-it depends on your health. For most people without other conditions, Amlodipine is considered one of the safest long-term options because it has minimal side effects and few interactions. For those with diabetes or kidney disease, Lisinopril is often preferred. Your doctor will pick based on your risks, not a one-size-fits-all rule.
Next Steps If You’re Considering a Change
Don’t wait until your next appointment to think about alternatives. Start by:
- Checking your current prescription cost on the NHS app or with your pharmacist
- Writing down every side effect you’ve noticed since starting Diltiazem
- Asking your doctor: "What would you recommend if I were starting this today?"
- Noticing how you feel after meals or during exercise-these are clues your doctor needs
Many people find that switching to Amlodipine or Lisinopril makes them feel more energetic and less bloated. Others discover Verapamil helps their chest pain better. The key is not to stay stuck on one drug just because it was prescribed first. Your body changes. Your needs change. Your medication should too.
