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This document outlines essential safety and warning information regarding the use of diltiazem ER. It is crucial to read and understand these warnings thoroughly and discuss any concerns with your healthcare provider.

• Slow Heart Rate or Heart Block: Diltiazem ER can lead to a slower heart rate or worsen an existing heart block, causing symptoms like weakness, lightheadedness, or fainting. This risk is higher if you are on digoxin (Lanoxin), beta-blockers such as propranolol (Inderal), or have conditions that naturally slow your heart rate. Inform your healthcare provider about your complete medical history to ensure this medication is appropriate for you.

• Worsening Heart Failure: Individuals with existing heart issues affecting blood circulation may experience aggravated heart failure with diltiazem ER. Report symptoms like chest pain, breathlessness, dizziness, fatigue, or swelling in the legs and feet to your provider promptly.

• Severely Low Blood Pressure: This medication may cause a significant drop in blood pressure, leading to dizziness, fatigue, or lightheadedness, especially when starting the treatment or adjusting the dose. If you feel excessively dizzy, sit down slowly and securely. Contact your provider to discuss possible dose adjustments, especially if you fall or sustain a head injury.

• Liver Issues: Though rare, diltiazem ER may elevate liver enzymes, potentially leading to liver problems. Regular liver function tests may be necessary. Seek immediate medical help if you experience severe nausea, vomiting, right-side abdominal pain, fatigue, loss of appetite, or jaundice.

• Severe Skin Reactions (Extended-Release Tablets Only): Rare but severe skin reactions like Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) may occur. If you notice skin changes, such as rashes, painful blisters, or skin peeling, or if you have facial swelling or breathing difficulties, discontinue use and seek urgent medical attention.

Contraindications: Diltiazem ER is not recommended for individuals with the following conditions unless they have a ventricular pacemaker: sick sinus syndrome, second- or third-degree AV block, uncontrolled hypotension (systolic blood pressure under 90 mm Hg), or those experiencing an active heart attack with lung congestion. Always consult your healthcare provider if these conditions apply to you.

When taking this medication, some common side effects may occur, such as dizziness, lightheadedness, weakness, nausea, flushing, constipation, and headache. These are generally mild and often dissipate on their own. However, if they persist or worsen, it's advisable to consult with a healthcare professional. To minimize dizziness and lightheadedness, try to rise slowly from sitting or lying positions.

Occasionally, some individuals may experience more pronounced symptoms such as a low heart rate, swelling, sore throat, pain, shortness of breath, or indigestion. These symptoms are typically not serious, but monitoring them can be beneficial. If you notice an increase in their intensity, reaching out to a healthcare provider is recommended.

While serious side effects are rare, they should be taken seriously. Immediate medical attention is necessary if you experience persistent nausea or vomiting, fainting, new or worsening heart failure symptoms like shortness of breath or swelling in the ankles or feet, unusual tiredness, sudden weight gain, or any heart rhythm changes. Additionally, mental or mood changes, unusual dreams, severe stomach pain, dark urine, or yellowing of the eyes or skin should not be ignored.

In rare cases, a severe allergic reaction may occur, characterized by a rash, itching or swelling (especially of the face, tongue, or throat), severe dizziness, or trouble breathing. If these symptoms appear, seek emergency medical help without delay. Always report any side effects you experience to your healthcare provider to ensure your safety while using this medication.

When taking Diltiazem ER, it's important to be aware of potential interactions with other medications or supplements. Always inform your doctor and pharmacist about all the medications and supplements you are using, whether they are prescribed, over-the-counter, vitamins, or herbal products.

Certain drugs, such as cisapride, Colchicine, eliglustat, Flibanserin, and lomitapide, should generally not be combined with Diltiazem ER due to possible adverse interactions. In some cases, these medications may be necessary, but your doctor might adjust the dosage or frequency.

Other medications might require caution when combined with Diltiazem ER. Your doctor may need to modify the dose or usage schedule if these are used together. These include abametapir, acalabrutinib, Acebutolol, and many others, including Digoxin, Fingolimod, Labetalol, Erythromycin, rifamycins like Rifampin, and St. John's wort. These can influence how Diltiazem ER is processed in your body or its effectiveness.

Additionally, Diltiazem ER can interfere with the metabolism of certain medications, potentially increasing their levels and effects. Some affected drugs are Aprepitant, Buspirone, colchicine, Ivabradine, and certain benzodiazepines like Triazolam and Midazolam.

Lastly, be cautious with products that may increase your heart rate or blood pressure, like cough-and-cold medications, diet aids, or NSAIDs such as Ibuprofen and Naproxen. Always consult your pharmacist for safe usage guidelines.