Guanfacine is primarily metabolized by CYP3A4, and diltiazem is a moderate CYP3A4 inhibitor. Pimozide: (Contraindicated) Concurrent use of pimozide and diltiazem should be avoided. Medications that possess negative inotropic effects and/or slow AV conduction, such as quinidine, should be administered with caution to patients receiving concomitant therapy with diltiazem due to the risk of additive effects. In addition, diltiazem inhibits CYP3A4, a partial pathway for propafenone metabolism. 180 to 240 mg PO once daily, initially. Diltiazem is a moderate inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of dihydrocodeine. It's not approved for sexual dysfunction in women yet, though some may use it. Consideration should be given to reducing the clozapine dose if necessary. Cobicistat: (Moderate) Monitor blood pressure and heart rate if coadministration of diltiazem with cobicistat is necessary. In addition, ritonavir and diltiazem both prolong the PR interval and caution for increased risk is recommended with coadministration. Cenobamate: (Moderate) Avoid coadministration of diltiazem and cenobamate if possible due to decreased plasma concentrations of diltiazem; if unavoidable, monitor blood pressure and heart rate and adjust the diltiazem dose based on clinical response. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Nebivolol; Valsartan: (Moderate) Monitor blood pressure and heart rate during concomitant diltiazem and nebivolol use; dosage adjustments may be needed. Diltiazem is a CYP3A4 substrate and fosphenytoin is a strong CYP3A4 inducer. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Use caution and careful monitoring when coadministering efavirenz with calcium-channel blockers; efavirenz induces CYP3A4, potentially altering serum concentrations of drugs metabolized by this enzyme such as some calcium-channel blockers. Vinblastine is a CYP3A4 substrate and diltiazem is a moderate CYP3A4 inhibitor. Concurrent use of diltiazem and quinidine in some patients may cause additive hypotension. Neratinib: (Major) Avoid concomitant use of diltiazem with neratinib due to an increased risk of neratinib-related toxicity. If diltiazem is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. Triazolam: (Moderate) Monitor for signs of triazolam toxicity during coadministration with diltiazem; consider appropriate dose reduction of triazolam if clinically indicated. Mavacamten: (Major) Avoid coadministration of diltiazem and mavacamten if possible due to decreased plasma concentrations of diltiazem; if unavoidable, monitor blood pressure and heart rate and adjust the diltiazem dose based on clinical response. Piroxicam: (Moderate) 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. Monitor blood pressure and heart rate. This medication is used to cure male sexual dysfunction. Bendroflumethiazide; Nadolol: (Moderate) Use diltiazem and nadolol with caution due to risk for additive negative effects on heart rate, AV conduction, and/or cardiac contractility. Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Pentoxifylline: (Moderate) Pentoxifylline has been used concurrently with antihypertensive drugs (beta blockers, diuretics) without observed problems. Vardenafil is primarily metabolized by CYP3A and diltiazem is a moderate CYP3A inhibitor. We do not record any personal information entered above. Coadministration increases mitapivat concentrations. Label: CARTIA XT- diltiazem hydrochloride capsule, extended release NDC Code (s): 62037-597-05, 62037-597-90, 62037-598-05, 62037-598-90, view more Packager: Actavis Pharma, Inc. Category: HUMAN PRESCRIPTION DRUG LABEL DEA Schedule: None Marketing Status: Abbreviated New Drug Application Drug Label Information Updated October 26, 2020 Intravenous administration of procainamide is more likely to cause hypotensive effects. Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known. Drugs that inhibit CYP3A4 may increase plasma concentrations of repaglinide. Elacestrant: (Major) Avoid concomitant use of elacestrant and diltiazem due to the risk of increased elacestrant exposure which may increase the risk for adverse effects. Voxelotor: (Moderate) Monitor blood pressure and heart rate if coadministration of diltiazem with voxelotor is necessary. Several trials have evaluated the use of diltiazem sustained-release in patients with proteinuria and diabetic nephropathy. But your out-of-pocket cost for Levitra may depend on a few different factors that can drop . Elevated plasma concentrations of clozapine occurring through CYP inhibition may potentially increase the risk of life-threatening arrhythmias, sedation, anticholinergic effects, seizures, orthostasis, or other adverse effects. Cut dose in half again, JUST RIGHT! Disopyramide: (Major) Due to the potential for additive effects, caution and careful titration are warranted in patients receiving diltiazem concomitantly with other agents known to affect cardiac contractility and/or conduction such as disopyramide. Elexacaftor; tezacaftor; ivacaftor: (Major) Adjust the elexacaftor; tezacaftor; ivacaftor dosing schedule when coadministered with diltiazem; coadministration may increase elexacaftor; tezacaftor; ivacaftor exposure and adverse reactions. Diltiazem is a CYP3A4 substrate and mifepristone is a strong CYP3A4 inhibitor. Oxymetazoline: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by calcium-channel blockers. A decreased diltiazem dose may be warranted. Monitor patient for respiratory depression and sedation at frequent intervals. Carbinoxamine; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Rifabutin is a CYP3A4 substrate and inducer. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. Ramelteon: (Moderate) Coadministration of ramelteon with inhibitors of CYP3A4, such as diltiazem, may lead to increases in the serum concentrations of ramelteon. If diltiazem is discontinued, consider increasing the oxycodone dose until stable drug effects are achieved and monitor for evidence of opioid withdrawal. Coadministration of a moderate CYP3A4 inhibitor is predicted to increase the AUC of entrectinib by 3-fold. This additive effect can be desirable, but the patient should be monitored carefully and the dosage should be adjusted based on clinical response. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. In a double-blind, multicenter study, 186 patients with idiopathic dilated cardiomyopathy were randomized to either diltiazem or placebo. The interaction is presumed due to increased simvastatin bioavailability via inhibition of CYP3A metabolism by diltiazem. Pemigatinib: (Major) Avoid coadministration of pemigatinib and diltiazem due to the risk of increased pemigatinib exposure which may increase the risk of adverse reactions. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Example: My Doc gave me a few 20mg Levitra to try out. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. Although this interaction has not been studied, predictions can be made based on metabolic pathways. Procaine: (Moderate) Local anesthetics may cause additive hypotension in combination with antihypertensive agents. Pexidartinib: (Major) Avoid concomitant use of pexidartinib and diltiazem due to the risk of increased pexidartinib exposure which may increase the risk for adverse effects; concomitant use may also decrease diltiazem plasma concentrations and reduce its efficacy. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. When an alternative therapy is not possible, patients should be monitored for the desired cardiovascular effects on heart rate, chest pain, or blood pressure, as well as associated rifabutin side effects. Concomitant use may increase the risk of neurologic adverse reactions, such as ataxia, tremors, nausea, vomiting, diarrhea, and/or tinnitus. Buspirone is a sensitive CYP3A substrate and diltiazem is a moderate CYP3A inhibitor. Carbinoxamine; Phenylephrine: (Moderate) Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Max: 15 mg/hour. Acebutolol: (Moderate) Use diltiazem and acebutolol with caution due to risk for additive negative effects on heart rate, AV conduction, and/or cardiac contractility. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. General anesthetics: (Major) The depression of cardiac contractility, conductivity, and automaticity as well as the vascular dilation associated with general anesthetics may be potentiated by calcium-channel blockers. Neratinib is a CYP3A4 substrate and diltiazem is a moderate CYP3A4 inhibitor. Initially, 30 mg PO 4 times per day administered before meals and at bedtime, gradually increasing the dosage at 1- or 2-day intervals until angina is optimally controlled. Diltiazem is a CYP3A substrate and ciprofloxacin is a moderate CYP3A inhibitor. Ibrutinib: (Major) If ibrutinib is coadministered with diltiazem, reduce the ibrutinib dosage to 280 mg/day PO in patients receiving ibrutinib for B-cell malignancy. Tolmetin: (Moderate) 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. Take on an empty stomach. Diltiazem is a CYP3A4 substrate and fedratinib is a moderate CYP3A4 inhibitor. Carvedilol: (Moderate) Use diltiazem and carvedilol with caution due to risk for additive negative effects on heart rate, AV conduction, and/or cardiac contractility. Aldesleukin, IL-2: (Moderate) Calcium channel blockers may potentiate the hypotension seen with aldesleukin, IL 2. Geriatric patients may need lower maximal dosage and slower titration. Coadministration may result in increased rilpivirine plasma concentrations. Diltiazem is an inhibitor of this enzyme and may decrease the clearance of mefloquine and increase mefloquine systemic exposure. If diltiazem is discontinued, hydrocodone plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to hydrocodone. Zafirlukast: (Minor) Zafirlukast and zileuton are respiratory antiinflammatory agents which can theoretically inhibit CYP3A4 metabolism of calcium-channel blockers, CYP3A4 substrates. Nirmatrelvir; Ritonavir: (Moderate) Ritonavir is expected to decrease the hepatic CYP metabolism of diltiazem, resulting in increased diltiazem concentrations. Rimegepant: (Major) Avoid a second dose of rimegepant within 48 hours if coadministered with diltiazem; concurrent use may increase rimegepant exposure. A change in your diet, medicine, or dosage may be necessary. Acetaminophen; Guaifenesin; Phenylephrine: (Moderate) Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Emtricitabine; Rilpivirine; Tenofovir Disoproxil Fumarate: (Moderate) Close clinical monitoring is advised when administering diltiazem with rilpivirine due to an increased potential for rilpivirine-related adverse events. Monitor plasma PTH and serum calcium and phosphorous concentrations if a patient initiates or discontinues therapy with this combination. [64020]Storage: Refrigerate and use within 24 hours. Geriatric patients may need lower maximal dosage and slower titration. Antiarrhythmic agents can have serious adverse effects (e.g., changes in mental function, appetite, behavior, heart function, or increased risk for falls) in older individuals. Roessler, G., Vobig, M. & Walter, P. & Mazinani, B.A. Methylphenidate Derivatives: (Moderate) Periodic evaluation of blood pressure is advisable during concurrent use of methylphenidate derivatives and antihypertensive agents, particularly during initial coadministration and after dosage increases of methylphenidate derivatives. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. Diphenhydramine; Ibuprofen: (Moderate) 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. Skip to content. Consider a reduced dose of sufentanil injection with frequent monitoring for respiratory depression and sedation if concurrent use of diltiazem is necessary. If diltiazem is discontinued, hydrocodone plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to hydrocodone. You will be able to enjoy the benefits of this medication. Carbidopa; Levodopa: (Moderate) Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Guaifenesin; Hydrocodone: (Moderate) Consider a reduced dose of hydrocodone with frequent monitoring for respiratory depression and sedation if concurrent use of diltiazem is necessary. Diltiazem is a moderate inhibitor of CYP3A4. If coadministration of these drugs is warranted, do so with caution and careful monitoring. Concurrent use may result in elevated diltiazem concentrations. Methoxsalen: (Minor) Preclinical data suggest that calcium-channel blockers could decrease the efficacy of photosensitizing agents used in photodynamic therapy. 1. Cariprazine: (Moderate) Cariprazine and its active metabolites are extensively metabolized by CYP3A4. Guidelines recommend a nondihydropyridine calcium channel blocker to control ventricular heart rate in persons with paroxysmal, persistent, or permanent atrial fibrillation in the absence of pre-excitation, significant heart failure, or left ventricular systolic dysfunction. Well-controlled hypertensive patients receiving decongestant sympathomimetics at recommended doses do not appear to be at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. Discontinuation of diltiazem could decrease dihydrocodeine plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to dihydrocodeine. Close monitoring of blood pressure is advised. There is limited clinical experience with doses greater than 360 mg/day. Both ceritinib and diltiazem can cause bradycardia. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. Complex interactions can be expected with coadministered with diltiazem or verapamil, as both are substrates and inhibitors of CYP3A4. LEVITRA is taken as needed: For most patients, the starting dose is 10 mg, up to once daily. CoQ10 use in combination with antihypertensive agents may lead to additional reductions in blood pressure in some individuals. When possible, avoid coadministration of these drugs and consider alternative therapy. Estradiol; Norethindrone: (Minor) As diltiazem inhibits CYP3A4 activity, serum estrogen concentrations and estrogenic-related side effects (e.g., nausea, breast tenderness) may potentially increase when coadministered with either estrogens or combined hormonal contraceptives. When combined, dose 1 tezacaftor; ivacaftor combination tablet every other day in the morning and 1 ivacaftor tablet every other day in the morning on alternate days (i.e., tezacaftor/ivacaftor tablet on Day 1 and ivacaftor tablet on Day 2). Cialis is a medication approved by the Food and Drug Administration (FDA) often used to treat erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) in those assigned male at birth . Caution and close monitoring are advised if these drugs are used together. This interaction may increase the potential for dofetilide-induced proarrhythmias. Dutasteride: (Moderate) Dutasteride is metabolized by CYP3A4 enzyme and the clearance of dutasteride may be reduced when co-administered with the CYP3A4 inhibitor diltiazem. Midazolam: (Moderate) Diltiazem may enhance and prolong the sedative effects of midazolam, and dosage reduction of midazolam and close monitoring is recommended during concurrent administration. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Ritonavir is expected to decrease the hepatic CYP metabolism of diltiazem, resulting in increased diltiazem concentrations. Coadministration may increase triazolam exposure. Close observation and monitoring of blood glucose is necessary to maintain adequate glycemic control. Coadministration with another strong CYP3A4 inducer lowered diltiazem plasma concentrations to undetectable. Hydrocodone; Pseudoephedrine: (Moderate) Consider a reduced dose of hydrocodone with frequent monitoring for respiratory depression and sedation if concurrent use of diltiazem is necessary. Etodolac: (Moderate) 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. Closely monitor patients who are also taking drugs associated with bradycardia such as calcium-channel blockers. Patients controlled on diltiazem alone or in combination with other medications may be switched to diltiazem hydrochloride extended-release capsules (once-a-day dosage) at the nearest equivalent total daily dose. Coadministration of lemborexant with another moderate CYP3A4 inhibitor increased the lemborexant AUC by up to 4.5-fold. Amlodipine is a CYP3A substrate and diltiazem is a moderate CYP3A inhibitor. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. When ibrutinib was administered with multiple doses of another moderate CYP3A4 inhibitor, the AUC value of ibrutinib was increased by 3-fold. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. The dose may be increased to a maximum recommended dose of 20 mg or decreased to 5 mg based on efficacy and side effects. Encorafenib: (Major) Avoid coadministration of encorafenib and diltiazem due to increased encorafenib exposure. Budesonide; Formoterol: (Minor) Diltiazem may increase plasma concentrations of oral budesonide due to inhibition of the CYP3A4 isoenzymet, and can enhance the cortisol suppression associated with budesonide administered via inhalation. Common side effects may include: flushing (warmth, redness, or tingly feeling); stuffy nose, sinus pain; headache, dizziness; upset stomach; or. Colesevelam: (Moderate) Colesevelam may decrease the absorption of diltiazem. If diltiazem is discontinued, hydrocodone plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to hydrocodone. Coadministration of another strong CYP3A4 inhibitor with twice daily doses of midostaurin increased Day 28 trough concentrations of midostaurin, CGP62221, and CGP52421 by 2.1-fold, 1.2-fold, and 1.3-fold respectively compared with day 21 trough levels with midostaurin alone. 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