Drug interactions
Diltiazem + Nisoldipine
Severity: Major
Diltiazem and Nisoldipine: major interaction.
Last updated Sources: US FDA label
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 markedly increases nisoldipine exposure, which has low oral bioavailability due to extensive first-pass CYP3A4 metabolism. Excessive vasodilation can cause hypotension, flushing, headache and peripheral edema, in addition to additive antihypertensive effects.
What this interaction means in plain words
Diltiazem and Nisoldipine 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; Nisoldipine belongs to Cardiovascular.
Why it happens
Diltiazem inhibits intestinal and hepatic CYP3A4, and both drugs are calcium channel blockers with additive vasodilatory effects.
What to do
Start nisoldipine at a low dose and titrate cautiously according to blood pressure, or choose another agent. Monitor for hypotension and edema.
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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References
Other interactions of Diltiazem
- Diltiazem + Flibanserin Contraindicated
- Diltiazem + Ivabradine Contraindicated
- Diltiazem + Lomitapide Contraindicated
- Diltiazem + Lonafarnib Contraindicated
- Acebutolol + Diltiazem Major
- Alfentanil + Diltiazem Major
Other interactions of Nisoldipine
- Itraconazole + Nisoldipine Contraindicated
- Ketoconazole + Nisoldipine Contraindicated
- Apalutamide + Nisoldipine Major
- Carbamazepine + Nisoldipine Major
- Chloramphenicol + Nisoldipine Major
- Clarithromycin + Nisoldipine Major
Frequently asked questions
Can I take Diltiazem with Nisoldipine?
MediHelp rates the interaction as major. Diltiazem and Nisoldipine 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 markedly increases nisoldipine exposure, which has low oral bioavailability due to extensive first-pass CYP3A4 metabolism. Excessive vasodilation can cause hypotension, flushing, headache and peripheral edema, in addition to additive antihypertensive effects.
How serious is the interaction between Diltiazem and Nisoldipine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Start nisoldipine at a low dose and titrate cautiously according to blood pressure, or choose another agent. Monitor for hypotension and edema.
What other medicines interact with Diltiazem?
MediHelp also lists interactions of Diltiazem with, for example, Flibanserin, Ivabradine, Lomitapide. The full list is on the Diltiazem page.
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