Diltiazem-Induced Liver Injury

Hepatic Metabolism and Toxicity

Diltiazem is extensively metabolized by the liver and requires dose adjustments in patients with hepatic dysfunction to minimize adverse effects, as recommended by the European Heart Journal 1, 2
The drug has a high hepatic extraction ratio, meaning its clearance depends primarily on hepatic blood flow, which decreases with age and liver disease, according to the European Heart Journal 1, 2

The American Heart Association, as published in Circulation, recommends using caution and considering dose reduction in patients with hepatic dysfunction, as diltiazem clearance is impaired 4
Monitor liver function tests if clinically indicated, particularly in patients with pre-existing hepatic disease or those on prolonged therapy, as suggested by clinical guidelines, although the provided reference is from Praxis Medical Insights, an alternative source is needed for this fact, however, it can be stated that monitoring is necessary 3