Diltiazem 90mg Tablets

Diltiazem is a non-dihydropyridine calcium channel blocker. It inhibits the influx of extracellular calcium ions across the myocardial and vascular smooth muscle cell membranes through voltage-gated L-type calcium channels. This leads to relaxation of vascular smooth muscle, resulting in peripheral and coronary vasodilation, which reduces systemic vascular resistance and blood pressure. In the heart, it decreases sinoatrial (SA) and atrioventricular (AV) nodal conduction, prolongs AV nodal refractory period, and reduces myocardial contractility, leading to a decrease in heart rate and myocardial oxygen demand.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Severe dizziness or fainting
Slow heartbeat
New or worsening abnormal heartbeat
Worsening heart failure (if you have a history of heart failure, consult your doctor). Be aware of symptoms such as:
+ Shortness of breath
+ Significant weight gain
+ Swelling in the arms or legs
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other severe skin reactions (sometimes fatal). Seek help if you experience:
- Red, swollen, blistered, or peeling skin
- Skin irritation (with or without fever)
- Red or irritated eyes
- Sores in your mouth, throat, nose, or eyes

Other Possible Side Effects

Like all medications, this drug can cause side effects. Many people may not experience any side effects or only mild ones. If you are bothered by any of the following side effects or if they persist, contact your doctor or seek medical help:

Headache
* Feeling dizzy, tired, or weak

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following conditions to ensure safe treatment:

Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced, including any symptoms.
Certain types of abnormal heart rhythms, as this medication may not be suitable for you. If you are unsure, consult your doctor or pharmacist for guidance.
Specific health conditions, such as:
+ Fluid accumulation in the lungs
+ Low blood pressure
+ Recent heart attack
Concurrent use of certain medications, including:
+ Ivabradine
+ Rifampin

Please note that this is not an exhaustive list of potential interactions. To guarantee your safety, it is crucial to disclose all of your:

Prescription and over-the-counter medications
Natural products
Vitamins
Health problems

Your doctor and pharmacist need this information to assess the safety of taking this medication with your existing treatments and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying position, and be cautious when climbing stairs.

Follow your doctor's instructions for monitoring your blood pressure and heart rate. You may need to undergo an electrocardiogram (ECG) before initiating this medication and during treatment. Discuss any concerns or questions with your doctor.

If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.

If you regularly consume grapefruit juice or eat grapefruit, discuss this with your doctor. Additionally, talk to your doctor before consuming alcohol while taking this medication.

If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.

If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. You will need to discuss the potential benefits and risks of this medication to both you and your baby.

• Ivabradine (risk of severe bradycardia)
• Dantrolene (IV) (risk of cardiovascular collapse)

• Beta-blockers (e.g., metoprolol, propranolol): Increased risk of bradycardia, AV block, and myocardial depression/heart failure.
• Digoxin: Increased digoxin serum concentrations (monitor digoxin levels).
• Amiodarone: Increased risk of bradycardia, sinus arrest, and AV block.
• Statins (e.g., simvastatin, lovastatin, atorvastatin): Increased statin concentrations due to CYP3A4 inhibition, leading to increased risk of myopathy/rhabdomyolysis.
• Fentanyl: Increased fentanyl exposure (CYP3A4 inhibition).
• Midazolam/Triazolam: Increased benzodiazepine exposure (CYP3A4 inhibition).
• Cyclosporine/Tacrolimus/Sirolimus: Increased immunosuppressant levels (CYP3A4 inhibition).
• Quinidine: Increased quinidine levels and risk of adverse cardiac effects.
• Rifampin/Phenytoin/Carbamazepine: Decreased diltiazem levels (CYP3A4 induction).

• Alpha-blockers (e.g., prazosin, tamsulosin): Additive hypotensive effects.
• Other antihypertensives: Additive hypotensive effects.
• Grapefruit juice: May increase diltiazem levels (CYP3A4 inhibition).
• Cimetidine: May increase diltiazem levels.
• Theophylline: May increase theophylline levels.
• Buspirone: Increased buspirone levels.
• Alfentanil: Increased alfentanil exposure.

• Acetaminophen: Minor effect on diltiazem metabolism.
• NSAIDs: May reduce the antihypertensive effect of diltiazem.

• Dizziness
• Lightheadedness
• Fatigue
• Headache
• Constipation
• Swelling in ankles/feet (peripheral edema)
• Shortness of breath
• Chest pain (angina control)
• Palpitations (rate control)

Diltiazem is Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects on the fetus.

Diltiazem is excreted into breast milk. While the amount is generally small, caution is advised. Monitor the infant for bradycardia, hypotension, or sedation. The American Academy of Pediatrics considers diltiazem to be compatible with breastfeeding, but individual risk-benefit should be assessed.

Safety and efficacy have not been established for routine use in pediatric patients for hypertension or angina. Use in children is generally limited to specific cardiac arrhythmias (e.g., SVT) under specialist supervision, often via IV route, with highly individualized dosing and close monitoring.

Elderly patients may be more sensitive to the hypotensive and bradycardic effects of diltiazem due to age-related decreases in renal and hepatic function. Start with lower doses and titrate slowly, monitoring closely for adverse effects.

• Diltiazem IR (immediate-release) is typically dosed multiple times a day (e.g., QID) due to its short half-life. Ensure patients understand the dosing frequency.
• Peripheral edema is a common side effect, particularly in the ankles. It's often dose-dependent and can be managed by dose reduction or adding a diuretic.
• Always check heart rate and blood pressure before administering diltiazem, especially in patients prone to bradycardia or hypotension.
• Be cautious when combining diltiazem with other medications that slow AV nodal conduction (e.g., beta-blockers, digoxin, amiodarone) due to increased risk of severe bradycardia or AV block.
• Diltiazem is a potent CYP3A4 inhibitor; significant drug interactions can occur with substrates of this enzyme (e.g., statins, immunosuppressants).
• For patients with adherence issues or those preferring once-daily dosing, consider switching to an extended-release formulation of diltiazem (e.g., Cardizem CD, Tiazac, Cartia XT) if appropriate for their condition.

• Other non-dihydropyridine calcium channel blockers (e.g., Verapamil)
• Dihydropyridine calcium channel blockers (e.g., Amlodipine, Nifedipine)
• Beta-blockers (e.g., Metoprolol, Atenolol)
• ACE inhibitors (e.g., Lisinopril, Enalapril)
• Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan, Losartan)
• Diuretics (e.g., Hydrochlorothiazide, Furosemide)
• Nitrates (for angina) (e.g., Isosorbide mononitrate, Nitroglycerin)
• Ranolazine (for chronic angina)

If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.