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This medication contains important safety information that must be carefully considered before use. If you have any questions or concerns, please consult your healthcare provider.

• Slow Heart Rate or Heart Block: Diltiazem ER may cause or worsen heart block, leading to a slowed heart rate. Symptoms such as weakness, lightheadedness, or fainting may occur. Those taking digoxin (Lanoxin), beta-blockers (e.g., propranolol (Inderal)), or with pre-existing conditions affecting heart rate should be cautious. Ensure your healthcare provider is aware of your complete medical history before initiating treatment.

• Worsening Heart Failure: Individuals with existing heart conditions that impair blood circulation may experience worsened heart failure. Be vigilant for symptoms like chest pain, breathing difficulties, dizziness, fatigue, swollen extremities, or bloating, and inform your healthcare provider if they arise.

• Severely Low Blood Pressure: Diltiazem ER can significantly reduce blood pressure, potentially causing dizziness, fatigue, or lightheadedness. This is particularly common at the start of treatment or following dose increases. If you experience these symptoms, sit down slowly and securely. Contact your provider for possible dose adjustment. Seek immediate medical help if you fall and sustain a head injury.

• Liver Problems: Although uncommon, diltiazem ER can elevate liver enzymes, potentially leading to liver issues. This typically occurs within the first 1 to 8 weeks of treatment. Regular liver function tests may be conducted by your provider. Seek medical attention if you notice severe nausea, vomiting, right-sided stomach pain, fatigue, loss of appetite, or yellowing of the skin or eyes.

• Severe Skin Reactions (Extended-Release Tablets Only): Rare but serious skin reactions such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) may occur. Be alert to skin changes (e.g., sore throat, fever, fatigue, rash, painful blisters, reddening, peeling) or facial swelling and breathing difficulties. Discontinue use and seek immediate medical attention if these symptoms develop.

Contraindications: This medication should not be used in the following conditions due to serious health risks. Consult your healthcare provider if any apply to you:

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

Always adhere to your healthcare provider's advice and report any adverse reactions promptly.

When taking this medication, you may experience some common side effects. These include dizziness, lightheadedness, weakness, nausea, flushing, constipation, and headache. These symptoms are generally mild, but if they persist or worsen, it is advisable to consult your healthcare provider. To help prevent dizziness and lightheadedness, try to rise slowly from sitting or lying positions.

Other side effects reported by some patients include sore throat, pain, indigestion, and low heart rate. Although these are less frequent, they should be monitored, especially if they become bothersome. Swelling and shortness of breath have also been noted in a small percentage of users, so keep an eye on these symptoms.

On a more serious note, there are rare side effects that need immediate medical attention. These include persistent nausea or vomiting, fainting, new or worsening heart failure symptoms such as shortness of breath and swelling of the ankles or feet, unusual tiredness, sudden weight gain, and irregular or rapid heartbeat. Mental or mood changes like depression or agitation, severe abdominal pain, dark urine, and yellowing of the eyes or skin are also critical signs to watch for.

An allergic reaction to this medication is very rare, but can be severe. Symptoms of an allergic reaction include rash, itching, swelling of the face, tongue, or throat, severe dizziness, and trouble breathing. If you experience any of these, seek medical help immediately. Always contact your healthcare provider if you notice any other side effects not listed here.

Diltiazem ER may interact with various medicines and supplements. It is crucial to inform your doctor and pharmacist about all medications and supplements you're taking, including prescription, over-the-counter, vitamins, and herbal products. Here are some important interactions to be aware of:

1. Medications to Avoid: Combining Diltiazem ER with medications such as cisapride, colchicine, eliglustat, flibanserin, and lomitapide is generally not advised. Your doctor might choose alternative treatments or adjust your medication regimen.

2. Potentially Risky Combinations: Some medicines might not be recommended with Diltiazem ER, but could be necessary in certain situations. If prescribed together, your doctor may alter the dosage or frequency. These include drugs like abametapir, acalabrutinib, acebutolol, amiodarone, aprepitant, digoxin, fingolimod, labetalol, and more.

3. Increased Side Effects: Using Diltiazem ER with certain medications could heighten side effects, although it might be the best treatment plan for you. Your doctor might need to adjust doses or schedules for drugs such as alfuzosin, apixaban, buspirone, cimetidine, and others.

Additionally, certain products containing ingredients that can raise heart rate or blood pressure, like some cough-and-cold products, diet aids, or NSAIDs (e.g., ibuprofen, naproxen), should be used cautiously. Always consult with your pharmacist to ensure safe use of all your medications.