Chaffman M, Brogden R N
Drugs. 1985 May;29(5):387-454. doi: 10.2165/00003495-198529050-00001.
Diltiazem is an orally and intravenously active calcium channel blocking agent shown to be an effective and well-tolerated treatment for stable angina and angina due to coronary artery spasm. Its efficacy in these diseases has generally been similar to that of nifedipine or verapamil - alternative calcium channel blockers with which diltiazem has many electrophysiological, haemodynamic, and antiarrhythmic similarities. The antianginal mechanism of diltiazem cannot be precisely described; however, it appears to increase myocardial oxygen supply and decrease myocardial oxygen demand, mainly by coronary artery dilatation and/or via both direct and indirect haemodynamic alterations. Diltiazem has also shown substantial efficacy in the treatment of unstable angina, hypertension, and supraventricular tachyarrhythmias, but further study is necessary before its place in the treatment of these diseases may be clearly established. Although headache due to peripheral vasodilatation and depression of atrioventricular nodal conduction may be troublesome, side effects occur in only 2 to 10% of patients receiving diltiazem and are generally minor in nature. Thus, diltiazem offers a worthwhile alternative to other agents currently available for the treatment of angina pectoris. Although the infrequency of serious side effects may offer an advantage, its relative place in therapy compared with that of other calcium channel blockers remains to be clarified.
地尔硫䓬是一种口服和静脉给药均有效的钙通道阻滞剂，已被证明是治疗稳定型心绞痛和冠状动脉痉挛所致心绞痛的有效且耐受性良好的药物。它在这些疾病中的疗效通常与硝苯地平或维拉帕米相似，硝苯地平和维拉帕米是其他钙通道阻滞剂，地尔硫䓬与它们在许多电生理、血流动力学和抗心律失常方面具有相似性。地尔硫䓬的抗心绞痛机制尚不能精确描述；然而，它似乎主要通过冠状动脉扩张和/或直接和间接的血流动力学改变来增加心肌氧供并降低心肌氧需求。地尔硫䓬在治疗不稳定型心绞痛、高血压和室上性快速心律失常方面也显示出显著疗效，但在明确其在这些疾病治疗中的地位之前，还需要进一步研究。虽然外周血管扩张引起的头痛和房室结传导抑制可能会带来麻烦，但接受地尔硫䓬治疗的患者中只有2%至10%会出现副作用，且一般性质轻微。因此，地尔硫䓬为目前可用于治疗心绞痛的其他药物提供了一种有价值的替代选择。虽然严重副作用发生率低可能是一个优势，但其与其他钙通道阻滞剂相比在治疗中的相对地位仍有待明确。
