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The following safety information is crucial for understanding the potential risks and necessary precautions when using Diltiazem ER. If you have any concerns or questions, please discuss them with your healthcare provider.

• Slow Heart Rate or Heart Block: Diltiazem ER may slow your heart rate or worsen existing heart block conditions, increasing the risk of feeling weak, lightheaded, or fainting. The risk is higher if you are also taking digoxin (Lanoxin) or beta-blockers such as propranolol (Inderal). Ensure your healthcare provider is fully aware of your medical history before starting this medication.

• Worsening Heart Failure: This medication can exacerbate heart failure, particularly in individuals with pre-existing heart conditions. Notify your healthcare provider immediately if you experience symptoms like chest pain, breathing difficulties, dizziness, fatigue, swollen extremities, or bloating.

• Severely Low Blood Pressure: Diltiazem ER may significantly lower blood pressure, leading to dizziness, fatigue, or lightheadedness, particularly when initiating treatment or increasing the dose. If you experience severe dizziness, sit down gradually, and contact your provider for possible dose adjustments. Seek immediate medical attention if you fall and injure your head.

• Liver Problems: Rarely, Diltiazem ER can increase liver enzyme levels, potentially causing liver issues within 1 to 8 weeks of starting treatment. Regular liver function tests may be conducted by your healthcare provider. Seek medical assistance immediately if you experience severe nausea, vomiting, abdominal pain, fatigue, loss of appetite, or jaundice.

• Severe Skin Reactions (Extended-Release Tablets Only): In rare cases, serious skin reactions such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) may occur. Discontinue use and seek immediate medical attention if you notice skin changes like rash, blisters, redness, peeling, or if you have a sore throat, fever, facial swelling, or difficulty breathing.

Contraindications for Diltiazem ER include certain conditions where its use could be harmful. Consult your healthcare provider if you have:

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

This information aims to ensure the safe use of Diltiazem ER by highlighting potential risks and necessary precautions. Always follow your healthcare provider's guidance when using this medication.

When taking this medication, you might experience some common side effects, including dizziness, lightheadedness, headache, weakness, nausea, flushing, and constipation. These effects are generally mild and often temporary. To minimize dizziness or lightheadedness, try to rise slowly from sitting or lying down.

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 such as shortness of breath, swelling in the ankles or feet, unusual tiredness, or unexpected weight gain. Additionally, be alert for changes in heartbeat, mental or mood changes like depression or agitation, severe stomach pain, dark urine, or yellowing of the eyes or skin.

Severe allergic reactions to this medication are uncommon but require urgent care. Watch for symptoms such as rash, itching or swelling particularly of the face, tongue, or throat, severe dizziness, or trouble breathing. If you notice any other unexpected effects, consult your healthcare provider promptly. Always ensure you monitor your body's reactions and report any concerns to your healthcare provider for guidance.

Diltiazem ER can interact with a range of medications and supplements, so it is important to inform your doctor and pharmacist about all the substances you are currently taking, including prescriptions, over-the-counter drugs, vitamins, and herbal supplements. Here's a summary of potential interactions:

1. Medications to Avoid with Diltiazem ER:

   • Certain drugs, such as Cisapride, Colchicine, Eliglustat, Flibanserin, and Lomitapide, should generally not be used with Diltiazem ER. Your doctor might decide against using Diltiazem ER or alter your other medications.

2. Medications That May Require Caution:

   • Some medications might not be recommended alongside Diltiazem ER, but exceptions can occur. If necessary, your doctor might adjust dosages or frequency. These include, but are not limited to, Abametapir, Acalabrutinib, Acebutolol, Amiodarone, and Atorvastatin.

3. Increased Side Effect Risk:

   • Combining Diltiazem ER with certain drugs could increase side effects. Your doctor may adjust your treatment plan accordingly. Drugs in this category include Alfuzosin, Apixaban, Buspirone, Cimetidine, and Rifampin.

Additionally, certain other medications can impact how Diltiazem ER is eliminated from your body, potentially affecting its efficacy. Examples include azole antifungals like ketoconazole, macrolide antibiotics such as erythromycin, rifamycins like rifampin, and even herbal supplements like St. John's wort.

Diltiazem ER can also slow down the removal of other medications from your body, affecting their performance. Some of these include aprepitant, buspirone, colchicine, and certain benzodiazepines like triazolam and midazolam.

Lastly, some over-the-counter products, particularly those for coughs and colds, diet, or pain relief (like ibuprofen and naproxen), may increase your heart rate or blood pressure. It’s crucial to discuss all products you use with your pharmacist to ensure safe usage.