Diltiazem increases digoxin serum levels by 20-35% and both have additive AV nodal depression
Management: Reduce digoxin dose by 25-50% when adding diltiazem. Monitor digoxin levels and ECG.
Both suppress AV conduction and myocardial contractility; combined use risks severe bradycardia and heart block
Management: Use combination with extreme caution. Monitor ECG. May be intentional for rate control in refractory cases.
Additive negative chronotropy and dromotropy: risk of severe bradycardia, AV block, and cardiac arrest.
Management: Use with extreme caution under cardiologist supervision. Do not give both IV. Monitor ECG continuously if combined.
Amiodarone + diltiazem: additive negative chronotropic and dromotropic effects. Risk of severe bradycardia and AV block.
Management: Avoid combination. If used, continuous ECG monitoring essential.
Non-selective beta-blocker + non-DHP calcium channel blocker: additive negative inotropy, chronotropy, dromotropy. Risk of severe bradycardia and heart failure decompensation.
Management: Avoid concurrent use or use under cardiologist supervision with ECG monitoring.
Additive AV nodal depression and negative inotropy. Risk of severe bradycardia and heart failure.
Management: Avoid concurrent IV use. If both needed for SVT, use under cardiologist supervision with continuous ECG and have pacing available.
Beta-blocker + non-DHP calcium channel blocker: additive negative chronotropy and dromotropy. Risk of severe bradycardia and AV block.
Management: Avoid concurrent use or use under cardiologist supervision with ECG monitoring.