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Flibanserin: The concomitant use of flibanserin and moderate CYP3A4 inhibitors, such as diltiazem, is contraindicated. Moderate CYP3A4 inhibitors can increase flibanserin concentrations, which can cause severe hypotension and syncope. If initiating flibanserin following use of a moderate CYP3A4 inhibitor, start flibanserin at least 2 weeks after the last dose of the CYP3A4 inhibitor.

If initiating a moderate CYP3A4 inhibitor following flibanserin use, start the moderate CYP3A4 inhibitor at least 2 days after the last dose of flibanserin. Fluconazole: Fluconazole may decrease the clearance of calcium-channel blockers, including diltiazem, via inhibition of CYP3A4 metabolism. Fluoxetine: Fluoxetine may decrease the clearance of calcium-channel blockers via inhibition of CYP3A4 metabolism.

Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents. Flurazepam: Diltiazem could theoretically inhibit CYP3A4 metabolism of oxidized benzodiazepines, such as flurazepam.

If combination therapy is initiated or withdrawn in conjunction with propranolol, an adjustment in the propranolol dose may be warranted see WARNINGS. In nine healthy subjects, diltiazem significantly increased the mean buspirone AUC 5. Enhanced effects and increased toxicity of buspirone may be possible during concomitant administration with diltiazem.

Subsequent dose adjustments may be necessary during coadministration, and should be based on clinical assessment. Patients receiving these drugs concurrently should be monitored for a potential drug interaction. Ranitidine produced smaller, nonsignificant increases. Patients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine.

An adjustment in the diltiazem dose may be warranted. Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with the use of clonidine concurrently with diltiazem. Monitor heart rate in patients receiving concomitant diltiazem and clonidine.

A pharmacokinetic interaction between diltiazem and cyclosporine has been observed during studies involving renal and cardiac transplant patients. If these agents are to be administered concurrently, cyclosporine concentrations should be monitored, especially when diltiazem therapy is initiated, adjusted, or discontinued.

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Inhibition of methadone metabolism can lead to toxicity including CNS adverse effects and potential for QT prolongation and torsades de pointes when high doses of methadone are used e. Methamphetamine: Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, like calcium channel blockers. Methoxsalen: Preclinical data suggest that calcium-channel blockers could decrease the efficacy of photosensitizing agents used in photodynamic therapy.

Methylergonovine: Because of its potential to cause coronary vasospasm, methylergonovine could theoretically antagonize the therapeutic effects of calcium-channel blockers. In addition, calcium-channel blockers with CYP3A4 inhibitory properties, such as diltiazem, nicardipine, and verapamil, may also reduce the hepatic metabolism of methylergonovine and increase the risk of ergot toxicity. Methylphenidate: Methylphenidate reduces the hypotensive effect of antihypertensive agents.

Methylprednisolone: Diltiazem may decrease the metabolism of methylprednisolone via inhibition of the CYP3A4 isoenzyme, with the potential for increased corticosteroid effects.

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Nitrates: Nitroglycerin can cause hypotension. Nitroglycerin: Nitroglycerin can cause hypotension. Nitroprusside: Additive hypotensive effects may occur when nitroprusside is used concomitantly with other antihypertensive agents.

Dosages should be adjusted carefully, according to blood pressure. Nonsteroidal antiinflammatory drugs: If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.

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May make these conditions worse. Heart attack orHeart block type of abnormal heart rhythm, can use if have a pacemaker that works properly orHypotension low blood pressuresevere or Lung problem eg, pulmonary congestion orSick sinus syndrome type of abnormal heart rhythm, can use if have a pacemaker that works properly -Should not be used in patients with these conditions.

Kidney disease orLiver disease-Use with caution. The effects may be increased because of slower removal of the medicine from the body. PrecautionsTOP It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly.

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Common Order Cartia Xt ide effects may include:

  • After the first fingolimod dose, overnight monitoring with continuous ECG in a medical facility is advised for patients who cannot stop taking drugs that slow the heart rate or atrioventricular conduction.

  • He said it won't do any harm to give it a go, but he doesn't usually make it part of his patients' treatment because there are not enough studies to prove it has any benefit for AR patients.

  • Ergonovine: Because of its potential to cause coronary vasospasm, ergonovine could theoretically antagonize the therapeutic effects of anti-anginal agents including calcium-channel blockers.

  • Crizotinib: Use caution if coadministration of crizotinib with diltiazem is necessary, due to the risk of increased diltiazem- and crizotinib-related adverse reactions.

Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents, especially calcium-channel blockers.

Diltiazem is a substrate and moderate inhibitor of both CYP3A4 and P-glycoprotein P-gp. Coadministration of diltiazem and rifampin, a strong CYP3A inducer, resulted in undetectable diltiazem plasma concentrations.

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  • Concomitant administration of prazosin with other antihypertensive agents is not prohibited, however.

  • Cobicistat: Coadministration of cobicistat a CYP3A4 inhibitor with calcium-channel blockers metabolized by CYP3A4, such as diltiazem, may result in elevated calcium-channel blockers serum concentrations.