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Details

Stereochemistry ABSOLUTE
Molecular Formula C22H26N2O4S
Molecular Weight 414.518
Optical Activity ( + )
Defined Stereocenters 2 / 2
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of DILTIAZEM

SMILES

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

InChI

InChIKey=HSUGRBWQSSZJOP-RTWAWAEBSA-N
InChI=1S/C22H26N2O4S/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/h5-12,20-21H,13-14H2,1-4H3/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
Statins and peripheral neuropathy.
1999 Jan
[Sinoatrial block induced by therapeutic doses of diltiazem. Report of 3 cases].
2000 Dec
[Unexpected formation of spiro(benzofuran-2,2'-(1,4)benzothiazines) from aurones].
2001 Apr
Atrial fibrillation: is rate stabilization a valid clinical strategy?
2001 Apr
Effects of chlorthalidone and diltiazem on myocardial ischemia in elderly patients with hypertension and coronary artery disease.
2001 Apr
Ionic mechanisms of aglycemic axon injury in mammalian central white matter.
2001 Apr
Pharmacokinetics of cyclosporine in heart transplant recipients receiving metabolic inhibitors.
2001 Apr
Voltage-dependent calcium channels in the rat retina: involvement in NMDA-stimulated influx of calcium.
2001 Apr
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
Acute ventricular rate control in atrial fibrillation: IV combination of diltiazem and digoxin vs. IV diltiazem alone.
2001 Feb
Calcium antagonists as inhibitors of in vitro low density lipoprotein oxidation and glycation.
2001 Feb 1
Pharmacological interventions of cyanide-induced cytotoxicity and DNA damage in isolated rat thymocytes and their protective efficacy in vivo.
2001 Feb 3
Diltiazem downregulates IL-12 production by human dendritic cells.
2001 Feb-Mar
Diltiazem for nocturnal leg cramps.
2001 Jan
Calculation of the dimensions of dosage forms with release controlled by diffusion for in vivo use.
2001 Jan
Prehospital management of rapid atrial fibrillation: recommendations for treatment protocols.
2001 Jan
The use of diltiazem for treating rapid atrial fibrillation in the out-of-hospital setting.
2001 Jan
Calcium channel antagonists enhance retention of passive avoidance and maze learning in mice.
2001 Jan
Electrophysiological characteristics of rat gustatory cyclic nucleotide--gated channel expressed in Xenopus oocytes.
2001 Jun
Analysis of multicomponent formulations containing phenylpropanolamine hydrochloride, caffeine and diazepam by using LC.
2001 Jun
Calcium signaling pathways utilized by P2X receptors in freshly isolated preglomerular MVSMC.
2001 Jun
Effect of angiotensin II on venodilator response to nitroglycerin.
2001 Mar
Ca2+-dependent exocytosis of L-glutamate by alphaTC6, clonal mouse pancreatic alpha-cells.
2001 May
Left ventricular diastolic heart failure with normal left ventricular systolic function in older persons.
2001 May
Calcium-dependent effects of melatonin inhibition of glutamatergic response in rat striatum.
2001 May
The effects of diltiazem on hemodynamics and seizure duration during electroconvulsive therapy.
2001 May
Nifedipine-activated Ca(2+) permeability in newborn rat cortical collecting duct cells in primary culture.
2001 May
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
SURAZEM
Preferred Name English
DILTIAZEM
HSDB   INN   MI   VANDF   WHO-DD  
INN  
Official Name English
Diltiazem [WHO-DD]
Common Name English
DILTIAZEM [HSDB]
Common Name English
DILTIAZEM EXTENDED RELEASE
Common Name English
DILTIAZEM [VANDF]
Common Name English
DILTIAZEM [MI]
Common Name English
1,5-BENZOTHIAZEPIN-4(5H)-ONE, 3-(ACETYLOXY)-5-(U2-(DIMETHYLAMINO)ETHYL)-2,3-DIHYDRO-2-(4-METHOXYPHENYL)-, (+)-CIS-
Common Name English
diltiazem [INN]
Common Name English
(+)-5-(2-(DIMETHYLAMINO)ETHYL)-CIS-2,3-DIHYDRO-3-HYDROXY-2-(P-METHOXYPHENYL)-1,5-BENZOTHIAZEPIN-4(5H)-ONE ACETATE (ESTER)
Common Name English
DITIAZ [VANDF]
Common Name English
Classification Tree Code System Code
WHO-VATC QC08DB01
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
WHO-ATC C08DB01
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
NDF-RT N0000000069
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
LIVERTOX NBK547898
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
WHO-ATC C05AE03
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
NDF-RT N0000175566
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
NCI_THESAURUS C333
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
Code System Code Type Description
FDA UNII
EE92BBP03H
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
CAS
42399-41-7
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
IUPHAR
2298
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
PUBCHEM
39186
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
ECHA (EC/EINECS)
255-796-4
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
DAILYMED
EE92BBP03H
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
ChEMBL
CHEMBL23
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
DRUG BANK
DB00343
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
HSDB
6528
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
INN
3433
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
MERCK INDEX
m4494
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY Merck Index
EVMPD
SUB07148MIG
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
LACTMED
Diltiazem
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
EPA CompTox
DTXSID9022940
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
MESH
D004110
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
DRUG CENTRAL
897
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
CHEBI
101278
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
RXCUI
3443
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY RxNorm
WIKIPEDIA
DILTIAZEM
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
NCI_THESAURUS
C61725
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY
SMS_ID
100000082630
Created by admin on Wed Apr 02 07:52:35 GMT 2025 , Edited by admin on Wed Apr 02 07:52:35 GMT 2025
PRIMARY