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This medication comes with several important safety warnings and contraindications. It is crucial to review these points and discuss any concerns with your healthcare provider to ensure the safe use of this medication.

• Slow Heart Rate or Heart Block: Use of Diltiazem ER may result in or exacerbate heart block, causing a slow heart rate. Symptoms can include weakness, lightheadedness, or fainting. The risk increases if you are taking medications such as digoxin or beta-blockers, or have conditions that already slow your heart rate. Inform your healthcare provider of your complete medical history before starting this medication.

• Worsening Heart Failure: Individuals with existing heart problems may experience aggravated heart failure with Diltiazem ER. Notify your provider if you notice any symptoms like chest pain, breathing difficulties, dizziness, fatigue, swelling in the legs and feet, or bloating. This risk is heightened for those with heart failure or on beta-blockers.

• Severely Low Blood Pressure: This medication can cause a significant drop in blood pressure, leading to dizziness, fatigue, or lightheadedness. Such effects are more common when beginning treatment or increasing dosage. If you experience severe dizziness, sit down slowly and seek medical advice, especially if a fall occurs.

• Liver Problems: Though rare, Diltiazem ER might elevate liver enzyme levels, potentially causing liver issues. Regular liver function tests may be advisable during treatment. Seek immediate medical attention if you experience severe nausea, vomiting, right-sided abdominal pain, fatigue, appetite loss, or jaundice.

• Severe Skin Reactions: In rare instances, Diltiazem ER can lead to serious skin conditions like Stevens-Johnson syndrome or toxic epidermal necrolysis. If you develop symptoms such as a sore throat, fever, fatigue, rash, painful blisters, skin reddening, or peeling, or if you have facial swelling or breathing difficulty, discontinue use and seek urgent medical care.

Contraindications indicate conditions under which this medication should not be used, as it may pose serious health risks. Consult a healthcare provider if any of the following apply to you:

• Sick sinus syndrome without a ventricular pacemaker
• Second- or third-degree AV block without a ventricular pacemaker
• Uncontrolled low blood pressure (systolic below 90 mm Hg)
• Active heart attack with lung congestion

Always consult your healthcare provider to ensure this medication is safe for you, particularly if you have any pre-existing health conditions or are taking other medications.

When taking this medication, it's important to be aware of its potential side effects. Common side effects include headache, dizziness, low heart rate, and swelling. These typically occur in a small percentage of individuals and are usually mild. However, if they persist or worsen, it is advisable to speak with your healthcare provider.

Other side effects that have been reported include sore throat, general pain, shortness of breath, indigestion, and weakness. Although these effects are less common, they should still be monitored. If you experience any of these symptoms, especially if they are bothersome, contacting your healthcare provider is recommended for further guidance.

There are also serious side effects associated with this medication, albeit rare, that necessitate immediate medical attention. Significant swelling, for instance, though uncommon, is a serious condition that requires urgent care. Always be vigilant about any unusual symptoms and seek prompt medical assistance when necessary.