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This medication comes with essential safety information regarding its potential risks and precautions. It is crucial to understand these warnings and consult your healthcare provider if you have any questions or concerns.

• Slow Heart Rate or Heart Block: The use of Diltiazem ER can lead to or exacerbate heart block, causing symptoms like weakness, lightheadedness, or fainting. Individuals taking digoxin (Lanoxin) or beta-blockers like propranolol (Inderal), or those with existing conditions that slow the heart rate, are at increased risk. It is important to inform your healthcare provider of your complete medical history before beginning treatment with Diltiazem ER.

• Worsening Heart Failure: Diltiazem ER may aggravate heart failure, especially in patients with pre-existing heart conditions that impair blood circulation. Contact your healthcare provider if you experience symptoms such as chest pain, breathing difficulties, dizziness, fatigue, swelling in the legs and feet, or bloating.

• Severely Low Blood Pressure: Diltiazem ER can cause a significant drop in blood pressure, resulting in dizziness, fatigue, or lightheadedness. This is more common when starting the medication or when the dosage is increased. If you experience extreme dizziness, sit down carefully and contact your healthcare provider to discuss potential dosage adjustments. Seek immediate medical assistance if you sustain a head injury from a fall.

• Liver Issues: Although uncommon, Diltiazem ER can elevate liver enzymes, potentially leading to liver problems. Your healthcare provider may conduct liver function tests before and during treatment to monitor any issues. Seek medical attention if you experience severe nausea, vomiting, right-sided stomach pain, fatigue, loss of appetite, or jaundice.

• Severe Skin Reactions (Extended-Release Tablets Only): Rarely, Diltiazem ER may cause severe skin reactions like Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If you notice symptoms such as a sore throat, fever, fatigue, rash, painful blisters, skin reddening, or peeling, or if you have facial swelling or breathing difficulties, stop taking the medication and seek medical help immediately.

Contraindications: This medication should not be used in the following conditions without consulting your healthcare provider due to serious health risks:

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

Ensure you discuss any of these conditions with your healthcare provider before starting this medication.

When taking this medication, you might experience some common side effects such as dizziness, lightheadedness, weakness, nausea, flushing, constipation, and headache. These are generally mild and tend to resolve on their own. To minimize dizziness and lightheadedness, try getting up slowly from sitting or lying positions. If any of these effects persist or become bothersome, it's a good idea to consult your healthcare provider for further advice.

It's important to be aware of more serious side effects, even though they are rare. Seek immediate medical attention if you encounter persistent nausea or vomiting, fainting, new or worsening symptoms of heart failure like shortness of breath or swelling in the ankles or feet, unusual tiredness, sudden weight gain, or changes in heart rhythm such as a slow, irregular, pounding, or fast heartbeat. Other serious symptoms that require urgent care include mental or mood changes, unusual dreams, severe stomach pain, severe constipation, dark urine, or yellowing of the eyes or skin.

An allergic reaction to this medication is very rare but can be serious. Watch for signs such as rash, itching, swelling, especially of the face, tongue, or throat, severe dizziness, or trouble breathing. If you notice any other unusual effects, even if they are not listed, contacting your doctor or pharmacist for guidance is recommended. Remember, these side effects vary among individuals, and many people experience no significant issues while using this medication.

When taking diltiazem, it's important to be aware of potential interactions with other medications. Some drugs that may interact with diltiazem include Digoxin, Fingolimod, and Labetalol. These interactions can change how diltiazem works or how it is removed from the body. Additionally, medications like azole antifungals (e.g., Ketoconazole), Cimetidine, macrolide antibiotics (e.g., Erythromycin), rifamycins (e.g., Rifabutin, Rifampin), and St. John's wort may also affect the elimination of diltiazem, potentially altering its effectiveness.

Conversely, diltiazem can slow the removal of other medications from the body, impacting their efficacy. This includes drugs such as Aprepitant, Buspirone, Colchicine, Flibanserin, Ivabradine, lomitapide, and certain benzodiazepines like Triazolam and Midazolam. It’s crucial to inform your doctor and pharmacist about all the medications and supplements you are taking, including over-the-counter drugs and herbal products.

Some products, particularly those containing ingredients that can elevate heart rate or blood pressure, should be used cautiously. This is especially true for cough-and-cold medications, diet aids, or NSAIDs like Ibuprofen and Naproxen. Always consult with your healthcare provider to ensure safe and effective use of all your medications.