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The safety information below outlines crucial warnings and precautions related to the use of Diltiazem ER. It is important to review these details and discuss any concerns with your healthcare provider.

• Slow Heart Rate or Heart Block: Diltiazem ER may cause or exacerbate heart block, leading to a slowed heart rate. Symptoms can include weakness, lightheadedness, or fainting. The risk increases if you are taking digoxin (Lanoxin), beta-blockers like propranolol (Inderal), or have existing conditions that reduce heart rate. Ensure your healthcare provider is aware of your complete medical history before starting treatment.

• Worsening Heart Failure: This medication can aggravate heart failure, especially in those with pre-existing heart conditions affecting blood circulation. Notify your healthcare provider if you experience chest pain, difficulty breathing, dizziness, fatigue, swelling in legs and feet, or bloating.

• Severely Low Blood Pressure: Diltiazem ER can significantly lower blood pressure, causing dizziness, fatigue, or lightheadedness, particularly at the start of treatment or with dosage increases. If you experience severe dizziness, sit down slowly and seek medical advice. Immediate medical attention is required if a head injury occurs from a fall.

• Liver Problems: Rarely, Diltiazem ER may elevate liver enzymes, potentially leading to liver issues. Liver function tests might be conducted before and throughout treatment. Seek immediate medical attention if you experience severe nausea, vomiting, right-sided abdominal pain, fatigue, loss of appetite, or yellowing of the skin or eyes.

• Severe Skin Reactions: Although infrequent, extended-release tablets of Diltiazem ER can cause serious skin reactions like Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Discontinue use and seek emergency medical care if you experience skin changes, such as rash, painful blisters, skin redness, or peeling, as well as facial swelling or breathing difficulties.

Contraindications: Diltiazem ER should not be used if you have any of the following conditions, unless you have a ventricular pacemaker:

• Sick sinus syndrome
• Second- or third-degree AV block
• Uncontrolled low blood pressure (systolic pressure under 90 mm Hg)
• Active heart attack with lung congestion

Always consult your healthcare provider if any of these conditions apply to you before taking Diltiazem ER.

When taking this medication, some common side effects you might experience include dizziness, headache, weakness, nausea, flushing, constipation, and lightheadedness. These effects are generally mild and manageable. For instance, to minimize dizziness and lightheadedness, it is advisable to rise slowly from sitting or lying positions. These side effects are usually not serious and may diminish over time. However, if they persist or become bothersome, consider contacting your healthcare provider for advice.

More severe side effects, though less common, do occur and require prompt medical attention. These include persistent nausea or vomiting, fainting, symptoms of heart failure such as shortness of breath, swelling in the ankles or feet, unusual tiredness, or unexpected weight gain. Additionally, any irregularities in heartbeat, significant mental or mood changes, severe abdominal pain, dark urine, or yellowing of the eyes or skin should be reported to a healthcare professional immediately.

In rare cases, an allergic reaction may occur, characterized by a rash, itching, swelling of the face, tongue, or throat, severe dizziness, or trouble breathing. Immediate medical help is crucial in these instances. Although this list covers many side effects, it may not be exhaustive. If you notice any other unusual symptoms, consult with your healthcare provider for further guidance.

Diltiazem ER can interact with various medications and supplements, so it's vital to inform your doctor and pharmacist about everything you're currently taking, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements. Here are some key points regarding potential interactions:

1. Medications to Avoid: Certain drugs should not be combined with Diltiazem ER, as they could lead to serious complications. These include cisapride, Colchicine, eliglustat, Flibanserin, and lomitapide. Your healthcare provider might choose alternative treatments if you're using any of these medications.

2. Use with Caution: Some medications might be prescribed alongside Diltiazem ER, but require careful monitoring or dose adjustments. These include abametapir, acalabrutinib, Acebutolol, Alprazolam, Amiodarone, Aprepitant, Atorvastatin, Clarithromycin, Digoxin, Erythromycin, Fingolimod, and Labetalol among others. If both medications are necessary, your healthcare provider will guide you on how to use them safely.

3. Potential Side Effects: Using Diltiazem ER with certain other drugs could increase the risk of side effects. These include alfuzosin, apixaban, Buspirone, Cimetidine, digitoxin, Midazolam, and Triazolam among others. Your doctor may adjust your doses or monitor you more closely if you're taking any of these.

4. Impact on Medication Removal: Diltiazem ER can affect the metabolism and removal of other drugs from your body, potentially altering their effectiveness. This includes medications like aprepitant, buspirone, colchicine, flibanserin, Ivabradine, and certain benzodiazepines.

5. Products Affecting Heart Rate or Blood Pressure: Some over-the-counter products, particularly those for coughs and colds, diet aids, or nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Naproxen, might increase your heart rate or blood pressure. Always consult your pharmacist on how to use these products safely.

By understanding these interactions, you can help ensure that your treatment with Diltiazem ER is safe and effective. Always follow your healthcare provider's advice and report any unusual symptoms promptly.