Enalapril and Diltiazem (Systemic)
Before Using This MedicineIn deciding to use a medicine,
the risks of taking the medicine must be weighed against the good it will
do. This is a decision you and your doctor will make. For enalapril and diltiazem
combination, the following should be considered:
Allergies - Tell your doctor if you have ever had any unusual or
allergic reaction to enalapril or diltiazem, as well as to any other ACE inhibitor
(benazepril, captopril, fosinopril, lisinopril, moexipril, quinapril, ramipril,
or trandolapril). Also tell your health care professional if you are allergic
to any other substances, such as foods, preservatives, or dyes.
Pregnancy - Studies with this combination medicine have not been
done in pregnant women. However, use of ACE inhibitors during pregnancy, especially
in the second and third trimesters (after the first 3 months) can cause low
blood pressure, kidney failure, an underdeveloped skull, or even death in
newborns. Diltiazem has caused problems in animals, including birth defects,
pregnancy that continues too long, poor bone development, and stillbirth.
Therefore, it is important that you check with your doctor
immediately if you think that you may be pregnant
. Be sure that you
have discussed this with your doctor before taking this combination medicine.
Breast-feeding - Diltiazem and enalapril pass into breast milk.
Breast-feeding is not recommended in women who are taking this medicine.
Children - Studies on this medicine have been done only in adult
patients, and there is no specific information comparing use of enalapril
and diltiazem in children with use in other age groups.
Older adults - Although this medicine has not been shown to cause
different side effects or problems in older people than it does in younger
adults, blood levels of the diltiazem component may be increased in the elderly
and elderly people may be more sensitive to the effects of this combination
medicine.
Racial differences - Black patients may be less sensitive to the blood pressure-lowering
effects of this medicine. In addition, the risk of a serious allergic reaction
involving swelling of the face, mouth, hands, or feet may be increased in
black patients.
Other medicines - Although certain medicines should not be used
together at all, in other cases two different medicines may be used together
even if an interaction might occur. In these cases, your doctor may want to
change the dose, or other precautions may be necessary. When you are taking
this medicine, it is especially important that your health care professional
know if you are taking any of the following:
-
Beta-blockers (acebutolol [e.g., Sectral], atenolol [e.g., Tenormin],
betaxolol [e.g., Kerlone], bisoprolol [e.g., Zebeta], carteolol [e.g., Cartrol],
carvedilol [e.g., Coreg], labetalol [e.g., Normodyne], metoprolol [e.g., Lopressor],
nadolol [e.g., Corgard], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol],
pindolol [e.g., Visken], propranolol [e.g., Inderal], sotalol [e.g., Sotacor],
timolol [e.g., Blocadren]) - Effects of these medicines and diltiazem
on the heart may be increased
-
Digitalis glycosides (heart medicine [e.g., Lanoxin]) - Effects
of these medicines may be increased
-
Diuretics (water pills) - Blood pressure lowering effect may
be increased
-
Potassium-containing medicines or supplements or
-
Salt substitutes that contain potassium - Use of these substances
with ACE inhibitors may result in an unusually high potassium level in the
blood, which can lead to irregular heart rhythm and other problems
Also, tell your health care professional if you are using any of the following
medicines in the eye:
-
Betaxolol (e.g., Betoptic) or
-
Carteolol (e.g., Ocupress) or
-
Levobunolol (e.g., Betagan) or
-
Metipranolol (e.g., OptiPranolol) or
-
Timolol (e.g., Timoptic) - Effects on heart and blood pressure
may be increased
Other medical problems - The presence of other medical
problems may affect the use of this medicine. Make sure you tell your doctor
if you have any other medical problems, especially:
-
Bee-sting allergy treatments or
-
Dialysis - Increased risk of serious allergic reaction occurring
-
Dehydration - Lowering effects on blood pressure may be increased
-
Diabetes mellitus (sugar diabetes) - Increased risk of potassium
levels in the body becoming too high
-
Heart attack or stroke or
-
Heart or blood vessel disease or
-
Hypotension (low blood pressure) - Further lowering of blood
pressure may make problems resulting from these conditions worse
-
Heart rate or rhythm problems - Diltiazem may make these problems
worse
-
Kidney disease - Effects may be increased because of slower removal
of the medicine from the body
-
Liver disease - Diltiazem has been reported to cause liver problems
in animals
-
Scleroderma or
-
Systemic lupus erythematosus (SLE) - Increased risk of blood
problems caused by ACE inhibitors
-
Previous reaction to an ACE inhibitor involving hoarseness; swelling
of face, mouth, hands, or feet; or sudden trouble in breathing - Reaction
is more likely to occur with this medicine
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