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Details

Stereochemistry ABSOLUTE
Molecular Formula C22H26N2O4S.C4H4O4
Molecular Weight 530.59
Optical Activity ( + )
Defined Stereocenters 2 / 2
E/Z Centers 1
Charge 0

SHOW SMILES / InChI
Structure of DILTIAZEM MALEATE

SMILES

OC(=O)\C=C/C(O)=O.COC1=CC=C(C=C1)[C@@H]2SC3=CC=CC=C3N(CCN(C)C)C(=O)[C@@H]2OC(C)=O

InChI

InChIKey=WHBXLOWLFLTDMD-WECFPGDBSA-N
InChI=1S/C22H26N2O4S.C4H4O4/c1-15(25)28-20-21(16-9-11-17(27-4)12-10-16)29-19-8-6-5-7-18(19)24(22(20)26)14-13-23(2)3;5-3(6)1-2-4(7)8/h5-12,20-21H,13-14H2,1-4H3;1-2H,(H,5,6)(H,7,8)/b;2-1-/t20-,21+;/m1./s1

HIDE SMILES / InChI
Diltiazem is a nondihydropyridines calcium channel blocker used in the treatment of hypertension, angina pectoris, and some types of arrhythmia. Diltiazem produces its antihypertensive effect primarily by relaxation of vascular smooth muscle and the resultant decrease in peripheral vascular resistance.

Approval Year

Targets

Targets

Primary TargetPharmacologyConditionPotency
21.0 nM [Ki]
Conditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
CARDIZEM

Approved Use

Diltiazem produces its antihypertensive effect primarily by relaxation of vascular smooth muscle and the resultant decrease in peripheral vascular resistance. The magnitude of blood pressure reduction is related to the degree of hypertension; thus hypertensive individuals experience an antihypertensive effect, whereas there is only a modest fall in blood pressure in normotensives.

Launch Date

1982
Primary
CARDIZEM

Approved Use

Diltiazem has been shown to produce increases in exercise tolerance, probably due to its ability to reduce myocardial oxygen demand. This is accomplished via reductions in heart rate and systemic blood pressure at submaximal and maximal work loads. Diltiazem has been shown to be a potent dilator of coronary arteries, both epicardial and subendocardial. Spontaneous and ergonovine-induced coronary artery spasm are inhibited by diltiazem.

Launch Date

1982
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
166.4 ng/mL
240 mg 1 times / day steady-state, oral
dose: 240 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
DILTIAZEM plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: UNKNOWN
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
2410 ng × h/mL
240 mg 1 times / day steady-state, oral
dose: 240 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
DILTIAZEM plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: MALE
food status: UNKNOWN
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
7.5 h
360 mg single, oral
dose: 360 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
DILTIAZEM plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: FASTED
Funbound

Funbound

ValueDoseCo-administeredAnalytePopulation
25%
360 mg single, oral
dose: 360 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
DILTIAZEM plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: FASTED
Overview

OverviewOther

Other InhibitorOther SubstrateOther Inducer






Drug as perpetrator​

Drug as perpetrator​

TargetModalityActivityMetaboliteClinical evidence
weak
yes [IC50 0.6 uM]
yes [IC50 11 uM]
yes [IC50 120 uM]
yes (co-administration study)
Comment: Diltiazem is an inhibitor of CYP3A4 and has been shown to increase significantly the AUC of some statins.
yes [Ki 117 uM]
yes [Ki 12.5 uM]
yes [Ki 77.7 uM]
Drug as victim

Drug as victim

TargetModalityActivityMetaboliteClinical evidence
major
no
no (pharmacogenomic study)
Comment: results suggest that CYP3A5*3 has only a minor effect on the pharmacokinetics and metabolism of diltiazem
yes
yes
yes
weak (pharmacogenomic study)
Comment: Two of the most frequent alleles, CYP3A5 3 and CYP2D6 10, among Chinese do not have major impacts on the disposition of diltiazem and N-desmethyl diltiazem. However, the desacetyl diltiazem showed 2-fold accumulation in individuals with CYP2D6 10/10 genotype
Tox targets

Tox targets

TargetModalityActivityMetaboliteClinical evidence
PubMed

PubMed

TitleDatePubMed
Improved efficacy and safety of controlled-release diltiazem compared to nifedipine may be related to its negative chronotropic effect.
2000 Jan
Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation.
2000 Jan
Diltiazem-mediated inhibition of sildenafil metabolism may promote nitrate-induced hypotension.
2000 Oct
Physiology in medicine: importance of hypoxic pulmonary vasoconstriction in maintaining arterial oxygenation during acute respiratory failure.
2001
Influence of diltiazem on the pharmacokinetics of amlodipine in elderly hypertensive patients.
2001 Apr
Atrial fibrillation: is rate stabilization a valid clinical strategy?
2001 Apr
An extremely severe case of cutaneous calcinosis with juvenile dermatomyositis, and successful treatment with diltiazem.
2001 Apr
Effects of verapamil on atrial fibrillation and its electrophysiological determinants in dogs.
2001 Apr
Contribution of amiloride-insensitive pathways to alveolar fluid clearance in adult rats.
2001 Apr
Drug release from and mechanical properties of press-coated tablets with hydroxypropylmethylcellulose acetate succinate and plasticizers in the outer shell.
2001 Apr 17
Involvement of calcium signaling in the fibronectin-stimulated macrophage recognition of oxidatively damaged erythrocytes.
2001 Apr 23
Susac's syndrome: beneficial effects of corticosteroid therapy in a Japanese case.
2001 Feb
Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia.
2001 Feb
Diltiazem-associated photodistributed hyperpigmentation: a review of 4 cases.
2001 Feb
Acute ventricular rate control in atrial fibrillation: IV combination of diltiazem and digoxin vs. IV diltiazem alone.
2001 Feb
Mechanical stress stimulates phospholipase C activity and intracellular calcium ion levels in neonatal rat cardiomyocytes.
2001 Feb
Characterization of a novel cationic drug transporter in human retinal pigment epithelial cells.
2001 Feb
Calcium antagonists as inhibitors of in vitro low density lipoprotein oxidation and glycation.
2001 Feb 1
Diltiazem downregulates IL-12 production by human dendritic cells.
2001 Feb-Mar
Diltiazem affects human dendritic cell maturation.
2001 Feb-Mar
Muscarinic activation of transient inward current and contraction in canine colon circular smooth muscle cells.
2001 Jan
Heart rate-lowering and -regulating effects of once-daily sustained-release diltiazem.
2001 Jan
Prehospital management of rapid atrial fibrillation: recommendations for treatment protocols.
2001 Jan
Protein kinase C activates store-operated Ca(2+) channels in human glomerular mesangial cells.
2001 Jul 13
Na+ effects on mitochondrial respiration and oxidative phosphorylation in diabetic hearts.
2001 Jun
Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias.
2001 Jun
Electrophysiological characteristics of rat gustatory cyclic nucleotide--gated channel expressed in Xenopus oocytes.
2001 Jun
Photostability and phototoxicity studies on diltiazem.
2001 Jun
Analysis of multicomponent formulations containing phenylpropanolamine hydrochloride, caffeine and diazepam by using LC.
2001 Jun
Adsorptive stripping voltammetric determination of antihypertensive agent: diltiazem.
2001 Jun
cAMP modulates the excitability of immortalized H=hypothalamic (GT1) neurons via a cyclic nucleotide gated channel.
2001 Jun
Smooth muscle relaxation and local hydraulic impedance properties of the aorta.
2001 Jun
Calcium signaling pathways utilized by P2X receptors in freshly isolated preglomerular MVSMC.
2001 Jun
Contraction of human colonic circular smooth muscle cells is inhibited by the calcium channel blocker pinaverium bromide.
2001 Jun
An alternative method to the evaluation of similarity factor in dissolution testing.
2001 Jun 4
Clinical outcomes of aneurysmal subarachnoid hemorrhage patients treated with oral diltiazem and limited intensive care management.
2001 Mar
Positive and negative contractile effects of somatostatin-14 on rat ventricular cardiomyocytes.
2001 Mar
Effect of magnesium stearate or calcium stearate as additives on dissolution profiles of diltiazem hydrochloride from press-coated tablets with hydroxypropylmethylcellulose acetate succinate in the outer shell.
2001 Mar 23
Inhibition by nifedipine of adherence- and activated macrophage-induced death of human gingival fibroblasts.
2001 Mar 9
Heart rate-lowering calcium antagonists in hypertensive post-myocardial infarction patients.
2001 May
Inhibitory effects of TA-993 and its metabolite MB3 on platelet activation induced by collagen and U-46619 in human platelets.
2001 May
Dilitiazem reduces nitric oxide production by human immune cells.
2001 May
Randomized trial of rhythm or rate control in atrial fibrillation: the Pharmacological Intervention in Atrial Fibrillation Trial (PIAF).
2001 May
Diltiazem treatment does not alter renal function after thoracic surgery.
2001 May
Calcium-channel antagonists and nitrates in coronary artery bypass patients receiving radial artery grafts.
2001 May
Left ventricular diastolic heart failure with normal left ventricular systolic function in older persons.
2001 May
[Attempted suicide with sustained release diltiazem].
2001 May 12
Patents

Sample Use Guides

In Vivo Use Guide
When used as monotherapy, reasonable starting doses are 180 to 240 mg once daily, although some patients may respond to lower doses. Maximum antihypertensive effect is usually observed by 14 days of chronic therapy; therefore, dosage adjustments should be scheduled accordingly. The usual dosage range studied in clinical trials was 240 to 360 mg once daily. Individual patients may respond to higher doses of up to 480 mg once daily. Dosages for the treatment of angina should be adjusted to each patient's needs, starting with a dose of 120 or 180 mg once daily. Individual patients may respond to higher doses of up to 480 mg once daily. When necessary, titration may be carried out over a 7- to 14-day period.
Route of Administration: Oral
In Vitro Use Guide
Tissue homogenate of cerebral cortext and heart containing calcium channel receptors was used in a radioligand-binding assays. Cerebral cortices of male SD rats were homogenized. Hearts were also removed, perfused through aorta with ice-cold saline solution, and homogenized. Subsequently, the cardiac homogenates were filtered through four layers of cloth. Both cortical and cardiac homogenates were washed 5 times by centrifugation for 10 min at 48000 g. The final pelle was resuspended to a conc. of 50 mg of original wet tissue wt/mL of buffer and stored at -70°C. Tissue homogenate (200 uL) was incubated for 90 min in a dark room at 0°C with 100 uL of [3H]nitreddipine (3x10^-10M, 87 Ci/mmol) and 100 uL of the test compound dissolved in DMSO in 50 mM of Na-Hepes buffer, pH 7.4. The incubations were stopped by adding 4 mL of cold buffer followed by rapid filtratoin through glass fiber filter disks. The samples were subsequently washed 3 times with 4.5 mL of the same buffer and placed into scintill. vials. Diltiazem inhibited binding of [3H]nitrendipine with Ki of 21 nM.
Name Type Language
DILTIAZEM MALEATE
VANDF  
Common Name English
DILTIAZEM MALEATE [VANDF]
Common Name English
1,5-BENZOTHIAZEPIN-4(5H)-ONE, 3-(ACETYLOXY)-5-(2-(DIMETHYLAMINO)ETHYL)-2,3-DIHYDRO-2-(4-METHOXYPHENYL)-, (2S,3S)-, (2Z)-2-BUTENEDIOATE (1:1)
Systematic Name English
Code System Code Type Description
PUBCHEM
67938926
Created by admin on Fri Dec 15 19:00:55 GMT 2023 , Edited by admin on Fri Dec 15 19:00:55 GMT 2023
PRIMARY
CAS
139492-78-7
Created by admin on Fri Dec 15 19:00:55 GMT 2023 , Edited by admin on Fri Dec 15 19:00:55 GMT 2023
PRIMARY
DRUG BANK
DBSALT002322
Created by admin on Fri Dec 15 19:00:55 GMT 2023 , Edited by admin on Fri Dec 15 19:00:55 GMT 2023
PRIMARY
FDA UNII
896626Q8XW
Created by admin on Fri Dec 15 19:00:55 GMT 2023 , Edited by admin on Fri Dec 15 19:00:55 GMT 2023
PRIMARY
RXCUI
314592
Created by admin on Fri Dec 15 19:00:55 GMT 2023 , Edited by admin on Fri Dec 15 19:00:55 GMT 2023
PRIMARY RxNorm