Drug interactions
Diltiazem + Esmolol
Severity: Major
Diltiazem and Esmolol: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Diltiazem depresses sinus and AV nodal function and myocardial contractility, and esmolol adds beta-blockade. Together they can cause profound bradycardia, AV block, hypotension and heart failure, particularly when given intravenously or in left ventricular dysfunction.
What this interaction means in plain words
Diltiazem and Esmolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Diltiazem belongs to Cardiovascular; Esmolol belongs to Cardiovascular.
Why it happens
Additive negative chronotropic, dromotropic and inotropic effects from beta-blockade and non-dihydropyridine calcium channel blockade.
What to do
Avoid giving IV esmolol with IV diltiazem, or use only with continuous ECG and blood pressure monitoring and staggered, reduced dosing. Avoid in patients with heart failure, conduction disease or hypotension.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Esmolol
- Acebutolol + Esmolol Major
- Amifostine + Esmolol Major
- Amiodarone + Esmolol Major
- Celiprolol + Esmolol Major
- Epinephrine racemic + Esmolol Major
- Epinephrine + Esmolol Major
Other interactions of Diltiazem
- Diltiazem + Flibanserin Contraindicated
- Diltiazem + Ivabradine Contraindicated
- Diltiazem + Lomitapide Contraindicated
- Diltiazem + Lonafarnib Contraindicated
- Acebutolol + Diltiazem Major
- Alfentanil + Diltiazem Major
Frequently asked questions
Can I take Diltiazem with Esmolol?
MediHelp rates the interaction as major. Diltiazem and Esmolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Diltiazem depresses sinus and AV nodal function and myocardial contractility, and esmolol adds beta-blockade. Together they can cause profound bradycardia, AV block, hypotension and heart failure, particularly when given intravenously or in left ventricular dysfunction.
How serious is the interaction between Diltiazem and Esmolol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid giving IV esmolol with IV diltiazem, or use only with continuous ECG and blood pressure monitoring and staggered, reduced dosing. Avoid in patients with heart failure, conduction disease or hypotension.
What other medicines interact with Esmolol?
MediHelp also lists interactions of Esmolol with, for example, Acebutolol, Amifostine, Amiodarone. The full list is on the Esmolol page.
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