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diltiazem (diltiazam, Aptalis / diltiazem, SURECAPS)

✓ Approved

Adare Pharma Solutions · CACNA1C · 小分子

什么是 diltiazem？

diltiazem 是一种小分子，由Adare Pharma Solutions研发。该药已获批，用于治疗相关适应症，给药途径：Oral (PO)。

药物档案

商品名diltiazam, Aptalis, diltiazem, SURECAPS
公司Adare Pharma Solutions
药物类别小分子
分子靶点CACNA1C
给药途径Oral (PO)
状态Approved
来源： ClinicalTrials.gov, Adare Pharma Solutions

作用机制

分子靶点

diltiazem 作用于 1 个分子靶点：

CACNA1Ccalcium voltage-gated channel subunit alpha1 C (CACNL1A1, CACNA1C-IT2)
需要更深入的分析？Noah AI 可解释复杂机制并与同类药物比较。

治疗适应症

diltiazem 针对 1 个适应症，涉及 1 个治疗领域。

治疗领域疾病/病症分期
Cardiac disordersAngina pectoris✓ Approved

相关研究文献

PubMedCritical care explorations2026-08-01

Severe Diltiazem Poisoning Managed With CytoSorb Hemoadsorption and Supportive Therapies: A Case Report.

Cox Juul M JM, Verwaaijen Julia A M JAM, Hendriks Ruben M F RMF, Smeets Dorien D et al.

Severe intoxication with nondihydropyridine calcium channel blockers, such as diltiazem, is associated with high morbidity and mortality. Evidence supporting extracorporeal treatment strategies remains limited. This case integrates serial toxicokinetic measurements with adjunctive hemoadsorption in sustained-release diltiazem poisoning. A 73-year-old man presented with coma, complete atrioventricular block, refractory hypotension, and severe lactic acidosis. Despite optimized supportive therapy including vasopressors, calcium supplementation, hyperinsulinemic-euglycemic therapy, and continuous renal replacement therapy, he remained hemodynamically unstable. CytoSorb hemoadsorption was initiated 6 hours after ICU admission. Shortly thereafter, sinus rhythm was restored, serum lactate rapidly declined, and vasopressor and insulin requirements were progressively reduced, allowing discontinuation of extracorporeal support. The patient recovered and was discharged home. Retrospective analysis demonstrated elevated diltiazem concentrations with delayed, capacity-limited elimination. This case supports considering hemoadsorption in unstable patients with severe diltiazem poisoning despite conventional measures and highlights the need for systematic pharmacokinetic evaluation in future studies.

PMID 42538738
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PubMedJACC. Case reports2026-07-30

AVNRT With Intermittent Aberrancy-Mimicking Ventricular Tachycardia: One Tachycardia, Two QRS Morphologies.

Madishetty Vineet V, Sojitra Badal B, Sachs Vincent V, Xiang Kun K

Regular wide-complex tachycardia often prompts concern for ventricular tachycardia, yet supraventricular tachycardia with aberrancy is a frequent mimic. A 36-year-old male presented with palpitations, dizziness, and presyncope after ambulatory monitoring documented tachycardia >200 beats/min. Telemetry showed recurrent regular tachycardia with alternating narrow and wide QRS morphologies at a similar cycle length. Vagal maneuvers, adenosine, and diltiazem transiently slowed/terminated the rhythm, but it recurred, necessitating cardioversion. Electrophysiology study induced typical atrioventricular nodal re-entrant tachycardia with rate-dependent aberrancy; slow-pathway ablation rendered the tachycardia noninducible. Unchanged cycle length during narrow-to-wide transitions supports a single supraventricular tachycardia mechanism with a functional bundle branch block. When QRS morphology alternates without cycle-length change, suspect supraventricular tachycardia with aberrancy and confirm with electrophysiology testing.

PMID 42530209
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PubMedJACC. Case reports2026-07-30

The Many ECG Faces of Wolff-Parkinson-White Syndrome.

Cao Jenny Jia JJ, Saha Bibek B, Deshmukh Abhishek J AJ

Wolff-Parkinson-White (WPW) syndrome is rare and can predispose to tachyarrhythmias. This case illustrates the heterogeneous electrocardiographic (ECG) features of WPW syndrome. A 57-year-old woman was admitted with pneumonia and atrial fibrillation with rapid ventricular response (174 beats/min). Atrial fibrillation terminated after diltiazem infusion, and repeat ECG showed sinus rhythm with pre-excitation (delta waves and a short PR interval). Subsequently, she developed an irregular wide complex tachycardia consistent with atrial fibrillation with pre-excitation (WPW syndrome). Catheter ablation of the accessory pathway was successfully performed. Varying degrees of pre-excitation in WPW can occur depending on accessory pathway properties and location, which can confound the diagnosis of WPW. WPW can present without classic features of pre-excitation on initial ECG; comprehensive serial ECG analysis is crucial to accurately diagnose WPW. Ventricular tachycardia should be considered in the differential diagnosis of WPW, as ECG cannot reliably differentiate between antidromic WPW and ventricular tachycardia.

PMID 42530198
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PubMedJournal of forensic sciences2026-07-22

Forensic investigation of unexpected multi-drug overdoses: A case series suggesting potential homicidal poisoning.

Dinçer Bekir B, İğde Emre Nuri EN, Erkman Fatma Tuğba FT, Güler Fatih F et al.

Homicidal poisoning involving multiple prescription medications presents significant diagnostic challenges, particularly in determining intent. We present a case series of two unexpected deaths within the same social community, both linked to the same suspect. In Case 1, a 49-year-old woman found unresponsive was referred for forensic autopsy as a suspicious death. Although initial findings were non-specific, postmortem toxicological analysis revealed fatal multi-drug poisoning involving tramadol, diltiazem, and metoprolol. The investigation of Case 1 subsequently raised suspicion regarding Case 2, a 50-year-old woman originally certified as a natural death and buried without an autopsy. Following exhumation, toxicological evaluation of decomposed samples demonstrated exposure to tramadol, diltiazem, and metoprolol. Postmortem toxicological analysis was conducted at the Chemistry Specialization Department's ISO/IEC 17025-accredited laboratory, using advanced analytical techniques such as LC-MS/MS, liquid chromatography-time-of-flight mass spectrometry (LC-TOF-MS), and GC-MS. Review of both victims' medical histories revealed no records of prescriptions for tramadol, diltiazem, or metoprolol. The presence of a common suspect, absence of relevant medical prescriptions for either victim, and associated investigative findings supported third-party involvement, making homicidal poisoning highly probable, although the possibility of voluntary ingestion within a socially influenced context was also considered. This case series highlights the critical role of comprehensive toxicological analysis and multidisciplinary forensic evaluation in the reclassification of unexpected deaths. It underscores the importance of meticulous investigation to identify potential homicidal poisonings that may otherwise be misclassified as natural or undetermined.

PMID 42482427
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PubMedJACC. Case reports2026-07-22

Exertional Syncope Caused by Hemodynamically Significant Myocardial Bridging With Coronary Vasospasm.

Toya Takumi T, Miyazaki Yoshichika Y, Sekine Otoya O, Aoyama Masayuki M et al.

Myocardial bridging (MB) may cause myocardial ischemia through impaired diastolic coronary perfusion and coronary vasomotor dysfunction, occasionally presenting as exertional presyncope or syncope. We report 2 patients with exertional presyncope/syncope caused by hemodynamically significant MB and concomitant epicardial coronary spasm. Coronary angiography showed no obstructive disease. Acetylcholine provocation induced diffuse spasm in the mid- to distal left anterior descending artery, whereas intracoronary nitroglycerine unmasked systolic compression of a mid-left anterior descending artery MB. Dobutamine stress with resting full-cycle ratio demonstrated functionally significant ischemia and reproduced symptoms, accompanied by marked reductions in distal coronary and systemic blood pressure. Treatment with diltiazem resulted in complete symptom resolution. MB may cause exertional syncope through stress-induced impairment of diastolic coronary perfusion, exacerbated by tachycardia and concomitant vasospasm. Comprehensive invasive vasomotor and physiological assessment is valuable for identifying clinically significant MB and concomitant coronary vasospasm in patients presenting with exertional presyncope or syncope.

PMID 42484566
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PubMedClinical cardiology2026-07-21

Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study.

Sikulu Josephine J, Kubini Ralf R, Turkman Muath M, Immohr Moritz Benjamin MB et al.

Coronary vasomotor disorders are frequently underdiagnosed in women with angina and non-obstructive coronary arteries. We investigated clinical presentation, diagnostic delay, spasm subtype, and patient-reported treatment response in women with acetylcholine-confirmed coronary spasm. This single-center observational study included women with a positive intracoronary acetylcholine provocation test who completed a locally developed questionnaire on symptoms, triggers, comorbidities, medication tolerance, and treatment response. Epicardial spasm was defined as ≥ 90% epicardial diameter reduction with symptom reproduction and ischemic ECG changes; microvascular spasm as symptoms and ischemic ECG changes with < 90% epicardial vasoconstriction. Diltiazem was initiated as first-line therapy, with amlodipine as an alternative. Regression analyses exploring therapeutic failure were considered exploratory because of the low event count. A total of 194 women were included (median age 60 years [IQR 52-67]). Chest pain/tightness was reported by 163/190 (85.8%), dyspnea by 70/135 (51.9%), and palpitations by 74/136 (54.1%). Epicardial/microvascular spasm was present in 110/187 (58.8%) and 77/187 (41.2%). Median symptom-to-diagnosis time was 24 months [IQR 8-90]. Diltiazem was prescribed in 162/194 (83.5%). Among respondents with follow-up data, symptom frequency decreased in 103/128 (80.5%), episode duration decreased in 91/118 (77.1%), and pain intensity decreased/resolved in 92/115 (80.0%). Therapeutic failure occurred in 8/106 (7.5%). Residual symptom burden remained common, with CCS class > II at follow-up in 65/124 (52.4%) and persistent complaints in 53/107 (49.5%). In women with acetylcholine-confirmed coronary spasm, symptom burden and diagnostic delay were substantial. Calcium-channel blocker therapy was associated with patient-reported symptom improvement among respondents with available follow-up data.

PMID 42478585
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