Before Using This Medicine

In 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