In our latest question and answer, the pharmacist discusses taking two blood pressure medications at the same time, Cardizem (diltiazem) and Altace (ramipril).
My brother had a stroke last year. He is simultaneously prescribed Cardizem CD (diltiazem) and Altace (ramipril). Why would these be prescribed at the same time? Are there any contraindications to take both? What are the side effects of these medications?
There are no drug interactions between Cardizem CD (diltiazem) and Altace (ramipril). These two medications are used for separate indications—both could be related to the reason why your brother had a stroke. We will help you understand these medications better below.
Cardizem is a medication known as a calcium channel blocker. Calcium channel blockers reduce the flow of calcium into cardiac and smooth muscle cells which blocks contraction of these cells. In particular, Cardizem and verapamil are calcium channel blockers known as non-dihydropyridines, which have a more pronounced effect on reducing heart rate instead of lowering blood pressure.
Cardizem has been FDA approved to treat angina, atrial fibrillation, atrial flutter, hypertension, and paroxysmal supraventricular tachycardia. These conditions can increase the risk for stroke. For example, atrial fibrillation is a common type of arrhythmia that causes an unorganized, rapid heart rate. This can increase the risk of a blood clot that can become lodged in the brain, causing a stroke. Cardizem helps to slow this unorganized heart rate, reducing the risk of another stroke.
Cardizem can sometimes can swelling of the feet, headache, low blood pressure, and flushing. Cardizem can also occasionally cause gastrointestinal side effects like constipation, nausea, and vomiting.
Altace and other ACE inhibitors are one of the most common blood pressure medications used in the United States. Blood pressure is a significant risk factor for having a stroke. ACE inhibitors are effective in reducing blood pressure and are usually well tolerated. Additionally, ACE inhibitors have cardiac protective effects outside of the impact on blood pressure. The FDA has also approved Altace for prevention of stroke and heart attack in adults over 55 years of age at high risk of cardiovascular events. Altace has been shown to reduce the risk of stroke by 32%.
Two common side effects to look out for with Altace include dry cough and angioedema. Dry cough can be an irritating side effect that can occur in some patients. Sometimes this can be persistent, but other times it can resolve over time. A more rare, but dangerous side effect is angioedema. This is more likely when beginning treatment, but can cause swelling of the lips and throat.
Cardizem and Altace are commonly used medications that make sense in being prescribed after a stroke. Since both of these medications reduce blood pressure, it is important to report any signs of dizziness or fatigue. While there are potential side effects, the benefit of these medications can help significantly reduce the risk of having a future stroke.