Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

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Angitil SR/XL Capsules

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Diltiazem hydrochloride may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Diltiazem hydrochloride
Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

for Angitil SR and XL Capsules contain diltiazem hydrochloride which belongs to a group of medicines called calcium-channel blockers that act on the cardiovascular system (the heart and blood vessels). Angitil Capsules has been prescribed by your doctor to treat your high blood pressure or to reduce the frequency of your anginal attacks. They are called prolonged-release capsules because they are manufactured in a way that allows the diltiazem hydrochloride to be released and slowly absorbed by your body over a period of several hours. In high blood pressure, diltiazem hydrochloride works by widening the blood vessels. This creates less resistance to the blood flow, and results in lower blood pressure, which in turn reduces the strain on your heart. In angina, diltiazem hydrochloride works by opening up the arteries supplying the heart muscle and this allows more blood and oxygen to reach the muscle, decreasing the chances of angina (chest pains) occurring when extra strain is placed upon the heart.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

What you need to know before you take it

e Angitil Capsules Do not take Angitil Capsules if:

  • You are allergic (hypersensitive) to diltiazem hydrochloride or any of the other ingredients in Angitil Capsules (listed in Section 6). Signs of an allergic reaction include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue.
  • You are breast-feeding or planning to breast-feed (see Section below: 'Pregnancy and breastfeeding').
  • You are having a medicine called dantrolene used for severe muscle spasms or severe fever (see below: 'Other medicines and Angitil Capsules').
  • You have a very slow heartbeat – less than 50 beats per minute.
  • You are already taking a medicine containing ivabradine for the treatment of certain heart diseases.
  • You have heart failure and problems with blood flow to your lungs. With these illnesses, you may feel out of breath and have swollen ankles.
  • You have any other serious problems with your heart. This includes having an uneven heartbeat (unless you have a pacemaker).
  • You are already taking a medicine containing lomitapide used for the treatment of high cholesterol levels (see section: 'Other medicines and Angitil Capsules').
  • You are already taking a medicine containing asunaprevir used for the treatment of hepatitis C virus infection (see section: 'Other medicines and Angitil Capsules'). Do not take this medicine if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Angitil Capsules. Warnings and precautions Talk to your doctor or pharmacist or nurse before taking Angitil Capsules if:
  • You have a history of heart failure, new shortness of breath, slow heartbeat or low blood pressure. As cases of kidney injury in patients with such conditions have been reported, your doctor may need to monitor your kidney function.
  • You have any other problem with your heart, apart from angina or those described in the previous section.
  • You are going to have an operation and/or an anaesthetic.
  • You are at risk of mood changes, including depression.
  • You are at risk of gut problems.
  • You are taking blood thinners such as direct acting oral anti-coagulants (example: dabigatran, rivaroxaban, apixaban) along with Angitil Capsules.
  • You suffer from porphyria, an inherited blood disorder that can cause increased sensitivity to light. Your doctor will check you more closely particularly when you first start taking the capsules if:
  • You are over 65 years old.
  • You have liver or kidney problems.
  • You have diabetes.
  • You have or ever had asthma.
  • You take any beta blocker medicines. If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Angitil Capsules. You may notice remains of the medication in your stool. However, this has no clinical relevance. Other medicines and Angitil Capsules Tell your doctor or pharmacist if you are taking or have recently taken or might take any other medicines. This includes medicines you buy without a prescription, including herbal medicines. This is because Angitil Capsules can affect the way some other medicines work. Also, some medicines can affect the way Angitil Capsules works. If you have to go to a doctor, dentist or hospital for any reason, tell them that you are taking Angitil Capsules. This is especially important if you are likely to have an anaesthetic or an operation. Angitil Capsules may lead to increase in level of colchicine (drug used to treat gout) when administered concomitantly. Angitil Capsules may lead to increased risk of bleeding if taken along with blood thinners such as direct acting oral anti-coagulants (example: dabigatran, rivaroxaban, apixaban). Angitil Capsules may lead to QT prolongation (ECG changes such as changes in heart rate, rhythm along with symptoms of dizziness), when administered along with drugs with the potential/known for prolonging the QT interval. In particular, do not take this medicine and tell your doctor if you are taking:
  • Dantrolene (an infusion) used for severe muscle spasms or severe fever (called 'malignant hyperthermia').
  • Medicines containing ivabradine used for the treatment of certain heart diseases.
  • Medicines containing lomitapide used for the treatment of high cholesterol levels. Diltiazem may increase the concentration of the lomitapide that may lead to an increase in the likelihood and severity of liver related side effects.
  • Medicines containing asunaprevir used for the treatment of hepatitis C virus infection. Diltiazem may increase the concentration of the asunaprevir that may lead to an increase in the likelihood and severity of liver related side effects. Angitil Capsules may increase the effect of the following medicines:
  • Medicines for high blood pressure such as doxazosin, tamsulosin, atenolol, propranolol or acebutolol.
  • Medicines used for an uneven heartbeat such as amiodarone and digoxin.
  • Medicines used for angina, such as glyceryl trinitrate or isosorbide trinitrate.
  • Medicines used for high levels of cholesterol such as simvastatin, fluvastatin and atorvastatin.
  • Ciclosporin used for psoriasis or used to stop the rejection of organs after a transplant.
  • Phenytoin and carbamazepine used for epilepsy.
  • Antiplatelet medicines used to reduce the chance of blood clots forming, such as aspirin or clopidogrel.
  • Iodinated contrast media (used for tests involving X-rays).
  • Theophylline used for breathing problems.
  • Lithium used for some types of mental illness (depression or a manic-depressive disorder).
  • Medicines used for sleeplessness and anxiety, such as triazolam or midazolam.
  • Methylprednisolone used for inflammation.
  • Cilostazol used for intermittent cramp-like pain in your legs when you walk caused by insufficient blood supply in your legs. Angitil Capsules may make the following medicine work less well:
  • Rifampicin used for tuberculosis. The following medicines can increase the effect of Angitil Capsules: Medicines for stomach ulcers such as cimetidine and ranitidine. Angitil Capsules with food, drink and alcohol It is advisable to limit the amount of grapefruit juice you drink while taking Angitil Capsules as it can increase the blood levels of the active ingredient diltiazem and may increase your chance of getting side effects. If you are concerned you should stop drinking grapefruit juice and consult your doctor. Do not take Angitil Capsules at the same time as an alcoholic drink. Pregnancy and breast-feeding You should not take Angitil Capsules if you are pregnant, might become pregnant or think you may be pregnant. This is because Angitil Capsules can cause problems for your baby. Talk to your doctor if you might be pregnant. Do not breast-feed if you are taking Angitil Capsules. This is because small amounts may pass into mothers' milk. If you are breast- feeding or planning to breast-feed, talk to your doctor or pharmacist before taking any medicine. Driving and using machines You may feel dizzy while taking this medicine. If this happens, do not drive or use any tools or machines. Angitil Capsules contain sucrose Angitil Capsules contain sucrose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product. This medicine contains less than 1 mmol sodium (23 mg) per capsule, that is to say essentially 'sodium-free'.

How to take it

Angitil Capsules Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. Taking this medicine

  • Take this medicine by mouth.
  • Swallow your capsule whole with a glass of water.
  • Do not break, crush or chew your capsules.
  • Take your capsules at the same time each day.
  • Angitil Capsules is formulated so that you only have to take your capsule once or twice a day.This depends on which strength capsule you are taking.
  • If you are taking your capsule twice a day, it is important that the second dose is taken 12 hours after the first dose and that no more than 2 capsules are taken in any 24 hour period.
  • If you feel the effect of your medicine is too weak or too strong, do not change the dose yourself, but ask your doctor.

Like all medicines, this medicine can cause side effects, although not everybody gets them. Stop taking and see a doctor or go to a hospital straight away if: Frequency unknown (cannot be estimated from the available data)

  • You have an allergic reaction. The signs may include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue.
  • You have a red or lumpy skin rash, swollen eyelids, face, lips, throat, or tongue, difficulty in swallowing.
  • Your asthma gets worse.
  • You have difficulty breathing, wheezing, tightness in the chest (called 'bronchospasm').
  • You get blistering or peeling of the skin around the lips, eyes, mouth, nose and genitals, flu-like symptoms and fever. This could be an illness called 'Stevens-Johnson syndrome'.
  • You get a severe blistering rash in which layers of the skin may peel off to leave large areas of raw exposed skin over the body. You may feel generally unwell and have a fever, chills and aching muscles. This could be an illness called 'Toxic Epidermal Necrolysis'.
  • You have a skin rash or skin lesions with a pink/red ring and a pale centre which may be itchy, scaly, or filled with fluid. The rash may appear especially on the palms or soles of your feet. These could be signs of a serious allergy to the medicine called 'erythema multiforme'. Tell your doctor straight away if you notice any of the following serious side effects – you may need urgent medical treatment: Common (affects less than 1 in 10 people)
  • Slow or uneven heartbeat
  • Very fast, uneven or forceful heartbeat (palpitations) Frequency unknown (cannot be estimated from the available data)
  • Skin rash caused by narrow or blocked blood vessels (called 'vasculitis')
  • Being short of breath, feeling tired along with swollen ankles and legs. This could be signs of heart failure.
  • Unusual movements of the tongue, muscle spasms in your face, rolling eyes and trembling
  • High temperature, feeling tired, loss of appetite, stomach pain, feeling sick, yellowing of skin or eyes. These can be signs of inflammation of the liver (called 'hepatitis').
  • Passing large amounts of urine, excessive thirst and having a dry mouth or skin. These may be signs of high blood sugar (hyperglycaemia).
  • Get sunburnt easier, and which may be more severe than in someone not taking Angitil Capsules. You should use sun protection whilst taking this medicine.
  • Breast enlargement in men Tell your doctor as soon as possible if you have any of the following side-effects: Very common (affects more than 1 in 10 people)
  • Swelling of the lower legs Common (affects less than 1 in 10 people)
  • Indigestion, stomach pain, constipation Uncommon (affects less than 1 in 100 people)
  • Feeling dizzy, light-headed or faint when you stand or sit up quickly (low blood pressure) Rare (affects less than 1 in 1000 people)
  • Dry mouth
  • Itchy, lumpy rash (called 'urticaria') Frequency unknown (cannot be estimated from the available data)
  • Swollen gums Tell your doctor or pharmacist if any of the following side effects get serious or lasts longer than a few days: Common (affects less than 1 in 10 people)
  • Headache
  • Flushing (feeling of warmth)
  • Feeling sick (nausea)
  • General feeling of being unwell
  • Weakness or tiredness
  • Feeling dizzy
  • Skin redness Uncommon (affects less than 1 in 100 people)
  • Nervousness
  • Difficulty sleeping
  • Being sick (vomiting), diarrhoea Frequency unknown (cannot be estimated from the available data)
  • Mood changes, including depression
  • Reduction in blood platelets, which increases risk of bleeding or bruising under the skin
  • A condition in which the body's defence system attacks normal tissue causing symptoms such as swollen joints, tiredness and rashes (called 'lupus-like syndrome')
  • Rash that may occur on the skin or sores in the mouth (Lichenoid drug eruption). Blood tests Angitil Capsules can change the levels of liver enzymes shown up in blood tests. This can mean that your liver is not working properly. Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra. gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

How to store it

Angitil Capsules

  • Keep this medicine out of the sight and reach of children.
  • Do not store above 30°C. Store in the original packaging.
  • Do not use this medicine after the expiry date which is stated on the blister and carton. The expiry date refers to the last day of that month.
  • Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

Contents of the pack and other information

What Angitil Capsules contain:

  • The active substance in your capsules is diltiazem hydrochloride. Each capsule contains 90 mg, 120 mg, 180 mg, 240 mg or 300 mg of diltiazem hydrochloride.
  • The other ingredients are sucrose, maize starch, povidone, ethylcellulose, talc, sodium lauryl sulfate, cetyl alcohol, dibutyl sebacate, gelatine, titanium dioxide (E171), red iron oxide (E172) [120mg and 180mg capsules only], yellow iron oxide (E172) [120mg, 180mg and 300mg capsules only], black iron oxide (E172), indigotine (E132) [120mg capsules only], shellac, propylene glycol, ammonium hydroxide and potassium hydroxide. What Angitil Capsules look like and the contents of the pack: Each strength of Angitil SR and XL Capsules can be identified by its colour and marking. 90 mg capsules are transparent and white marked with "90 mg" 120 mg capsules are transparent and brown marked with "120 mg" 180 mg capsules are transparent and pale brown marked with "180 mg" 240 mg capsules are white marked with "240 mg" 300 mg capsules are transparent and yellow marked with "300 mg" Angitil SR 90 mg, 120 mg and 180 mg Capsules are available in blister packs of 56 capsules. Angitil XL 240 mg and 300 mg Capsules are available in blister packs of 28 capsules. Marketing Authorisation Holder Ethypharm 194, Bureaux de la Colline – Bâtiment D 92213 Saint-Cloud Cedex France Manufacturer Macarthys Laboratories Limited TA Martindale Pharma Bampton road, Harold hill, Romford, RM38UG United Kingdom This leaflet does not contain all the information about your medicine. If you have any questions or are not sure about anything, ask your doctor or pharmacist. For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder: United Kingdom: Ethypharm UK Ltd – email: [email protected] This leaflet was last revised in July 2025.

100mm Measurement Verification Bar

6455-G

DEVELOPMENT ARTWORK Component Code: D06455 Prod: Diltiazem Hydrochloride PIL Angitil SR120 Angitil SR180 Angitil SR90 Angitil XL240 Angitil XL300 UK Paper Size: 148 x 500mm Version Control

Date

By

Version A:

02/04/25

RP

Version B:

03/04/25

RP

Version C:

08/04/25

RP

Version D:

22/04/25

ML

Version E:

30/06/25

ML

Version F:

02/07/25

RP

Version G:

03/07/25

ML

Version H: Version I: Version K: Version L: Version M: Version N: Version O: me&you The Old Printworks, High Street, Otford, Sevenoaks, Kent. TN14 5PQ t: +44 (0) 1732 743 455 e: [email protected] www.meandyou.co.uk

Frequently asked questions about Angitil SR/XL Capsules

How do I take Angitil SR/XL Capsules?

Angitil SR/XL Capsules comes as capsule. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Angitil SR/XL Capsules?

The active substance in Angitil SR/XL Capsules is diltiazem hydrochloride.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Angitil SR/XL Capsules, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Angitil SR/XL Capsules without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Diltiazem hydrochloride (27 medicines)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

For the management of angina pectoris. For the management of mild to moderate hypertension.

4.2. Posology and method of administration

Posology:

Individual patients' responses to diltiazem may vary, necessitating careful titration.

Angitil SR 90 mg, 120 mg and 180 mg Capsules are taken twice daily. Angitil XL 240 mg and 300 mg Capsules are taken once daily.

Adults:

The usual initial dose is 90 mg twice daily. Dosage may be increased gradually to 120 mg twice daily or 180 mg twice daily if required.

Patients currently receiving a total daily dose of 180 mg diltiazem (as 90 mg bd), may be titrated up to 240 mg (od). A patient receiving 240 mg per day of diltiazem (as 120 mg bd), should commence treatment on the 240 mg capsule (od), titrating to the 300 mg capsule (od), if required.

Elderly and patients with impaired renal or hepatic dysfunction:

The starting dose should be 60 mg diltiazem twice daily. If necessary, the dose may be increased gradually but careful monitoring of this group of patients is advised. Where the patient is currently prescribed 120 mg this dose may, by careful titration, be increased to 240 mg (od).

Paediatric population:

Diltiazem preparations are not recommended for children. Safety and efficacy in children have not been established.

In order to avoid confusion, it is suggested that patients once titrated to an effective dose should remain on this treatment and should not be changed between different presentations.

Method of administration

Route of administration: Oral

The capsules should be swallowed whole and not chewed. Dosage may be taken with or without food.

4.3. Contraindications

• Hypersensitivity to diltiazem or to any of the excipients listed in section 6.1.

• Sick sinus syndrome, 2nd or 3rd degree AV block in patients without a functioning pacemaker.

• Severe bradycardia (less than 50 beats per minute).

• Left ventricular failure with pulmonary stasis.

• Decompensated cardiac failure.

• Lactation.

• Concurrent use with dantrolene infusion (see section 4.5).

• Combination with ivabradine (see section 4.5).

• Concurrent use with lomitapide (see section 4.5).

• Concurrent use with asunaprevir (see section 4.5).

4.4. Special warnings and precautions for use

Close observation is necessary in patients with reduced left ventricular function, bradycardia (risk of exacerbation) or with a 1st degree AV block or prolonged PR interval detected on the electrocardiogram (risk of exacerbation and rarely, of complete block).

Cases of acute renal failure secondary to decreased renal perfusion have been reported in patients with existing cardiac disease especially reduced left ventricular function, severe bradycardia or severe hypotension. Careful monitoring of renal function is advised.

Increase of plasma concentrations of diltiazem may be observed in the elderly and patients with renal or hepatic insufficiency. The contraindications and precautions should be carefully observed and close monitoring, particularly of heart rate, should be carried out at the beginning of treatment.

In the case of general anaesthesia, the anaesthetist must be informed that the patient is taking diltiazem. The depression of cardiac contractility, conductivity and automaticity as well as the vascular dilatation associated with anaesthetics may be potentiated by calcium channel blockers.

Treatment with diltiazem may be associated with mood changes, including depression (see section 4.5 and 4.8). Early recognition of relevant symptoms is important, especially in predisposed patients. In such cases, drug discontinuation should be considered.

Diltiazem has an inhibitory effect on intestinal motility. Therefore, it should be used with caution in patients at risk of developing an intestinal obstruction.

Careful monitoring is necessary in patients with latent or manifest diabetes mellitus due to a possible increase in blood glucose.

The use of diltiazem may induce bronchospasm, including asthma aggravation, especially in patients with preexisting bronchial hyper-reactivity. Cases have also been reported after dose increase. Patients should be monitored for signs and symptoms of respiratory impairment during diltiazem therapy.

Diltiazem in considered unsafe in patients with acute porphyria.

Residues from slow-release formulations of the product may pass into the patient's stools; however, this finding has no clinical relevance.

Caution should be exercised when direct oral anticoagulants (DOACs) are co-administered with Diltiazem which is a moderate CYP3A4 and a weak P-gp inhibitor, particularly in patients at high risk of bleeding (see section 4.5).

This medicine contains less than 1 mmol sodium (23mg) per capsule, that is to say essentially 'sodium-free'.

4.5. Interaction with other medicinal products and other forms of interaction

Combination Contraindicated For Safety Reasons:

Dantrolene (infusion)

Lethal ventricular fibrillation is regularly observed in animals when intravenous verapamil and dantrolene are administered concomitantly.

The combination of a calcium antagonist and dantrolene is therefore potentially dangerous (see section 4.3).

Ivabradine

Concomitant use with ivabradine is contraindicated due to the additional heart rate lowering effect of diltiazem to ivabradine (see section 4.3).

Lomitapide

Diltiazem (a moderate CYP3A4 inhibitor) may increase lomitapide plasma concentrations through CYP3A4 inhibition leading to increased risk of elevations in liver enzymes (see section 4.3).

Asunaprevir

Diltiazem (a moderate CYP3A4 inhibitor) may increase asunaprevir plasma concentrations through CYP3A4 inhibition (see section 4.3).

Combinations Requiring Caution:

Alpha-antagonists

Increased anti-hypertensive effects. Concomitant treatment with alpha- antagonists may produce or aggravate hypotension. The combination of diltiazem with an alpha antagonist should be considered only with strict monitoring of blood pressure.

Beta-blockers

Possibility of rhythm disturbances (pronounced bradycardia, sinus arrest), sino-atrial and atrio-ventricular conduction disturbances and heart failure (synergistic effect).

Such a combination must only be used under close clinical and ECG monitoring, particularly at the beginning of treatment.

An increased risk of depression has been reported when diltiazem is co-administered with beta-blockers (see section 4.8).

Amiodarone, Digoxin

Increased risk of bradycardia; caution is required when these are combined with diltiazem, particularly in elderly subjects and when high doses are used.

Antiarrhythmic agents

Since diltiazem has antiarrhythmic properties, its concomitant prescription with other antiarrhythmic agents is not recommended due to the risk of increased cardiac adverse effects due to an additive effect. This combination should only be used under close clinical and ECG monitoring.

Nitrate derivatives

Increased hypotensive effects and faintness (additive vasodilating effects).

In all patients treated with calcium antagonists, the prescription of nitrate derivatives should only be carried out at gradually increasing doses.

Ciclosporin

Increase in circulating ciclosporin levels. It is recommended that the ciclosporin dose be reduced, renal function be monitored, circulating ciclosporin levels be assayed and that the dose should be adjusted during combined therapy and after its discontinuation.

Phenytoin

When co-administered with phenytoin, diltiazem may increase phenytoin plasma concentration.

It is recommended that the phenytoin plasma concentrations be monitored.

X-Ray Contrast Media

Cardiovascular effects of an intravenous bolus of an ionic X-ray contrast media, such as hypotension, may be increased in patients treated with diltiazem.

Special caution is required in patients who concomitantly receive diltiazem and X-ray contrast media.

Carbamazepine

Increase in circulating carbamazepine levels. It is recommended that the plasma carbamazepine concentrations be assayed and that the dose should be adjusted if necessary.

Theophylline

Increase in circulating theophylline levels.

Anti-H2 agents (cimetidine and ranitidine)

Increase in plasma diltiazem concentrations. Patients currently receiving diltiazem therapy should be carefully monitored when initiating or discontinuing therapy with anti-H2 agents. An adjustment in diltiazem daily dose may be necessary.

Rifampicin

Risk of decrease of diltiazem plasma levels after initiating therapy with rifampicin. The patient should be carefully monitored when initiating or discontinuing rifampicin treatment.

Lithium

Risk of increase in lithium-induced neurotoxicity.

Antiplatelet drugs

In a pharmacodynamic study, diltiazem was shown to inhibit platelet aggregation. Although the clinical significance of this finding is unknown, potential additive effects when used with antiplatelet drugs should be considered.

Combinations To Be Taken Into Account:

Diltiazem is metabolised by CYP3A4. A moderate (less than 2-fold) increase of diltiazem plasma concentration in cases of co-administration with a stronger CYP3A4 inhibitor has been documented.

Grapefruit juice may increase diltiazem exposure (1.2 fold). Patients who consume grapefruit juice should be monitored for increased adverse effects of diltiazem. Grapefruit juice should be avoided if an interaction is suspected.

Diltiazem is also a CYP3A4 isoform inhibitor. Co- administration with other CYP3A4 substrates may result in an increase in plasma concentration of either co-administered drug. Co-administration of diltiazem with a CYP3A4 inducer may result in a decrease of diltiazem plasma concentrations.

Statins

Diltiazem is an inhibitor of CYP3A4 and has been shown to significantly increase the AUC of some statins. The risk of myopathy and rhabdomyolysis is increased by concomitant administration of diltiazem with statins metabolised by CYP3A4 (e.g. atorvastatin, fluvastatin, and simvastatin). An adjustment of the dose of statin may be necessary (see also product information of the relevant statin). When possible, it is recommended to use a statin not metabolised by CYP3A4 (e.g. pravastatin) with diltiazem. Otherwise, close monitoring for signs and symptoms of potential statin toxicity is required.

Cilostazol

Inhibition of cilostazol metabolism (CYP3A4). Diltiazem has been shown to increase cilostazol exposure and to enhance its pharmacological activity.

Benzodiazepines (midazolam, triazolam)

Diltiazem significantly increases plasma concentrations of midazolam and triazolam and prolongs their half-life. Special care should be taken when prescribing short-acting benzodiazepines metabolised by the CYP3A4 pathway in patients using diltiazem.

Corticosteroids (methylprednisolone)

Diltiazem can increase methylprednisolone levels (through inhibition of CYP3A4 and possible inhibition of P-glycoprotein). The patient should be monitored when initiating methylprednisolone treatment. An adjustment to the dose of methylprednisolone may be necessary.

Colchicine

Colchicine is a substrate for both CYP3A and the efflux transporter P-glycoprotein (P-gp). Diltiazem is known to inhibit CYP3A and P-gp. When Diltiazem and colchicine are administered together, inhibition of P-gp and/or CYP3A by Diltiazem may lead to increased exposure to colchicine. Combined use is not recommended.

Diltiazem which is a moderate CYP3A4 and weak P-gp inhibitor may increase the plasma concentration of DOACs when co-administered with Diltiazem.

Diltiazem may lead to QT prolongation, when administered with drugs with potential/ known for prolonging the QT interval. Co-administration of diltiazem with drugs known to prolong the QT interval must be based on a careful assessment of the potential risks and benefits of the treatment.

General Information To Be Taken Into Account:

Due to the potential for additive effects, caution and careful titration are necessary in patients receiving diltiazem concomitantly with other agents known to affect cardiac contractility and/or conduction.

Angitil capsules should not be taken at the same time as alcohol. In vitro data suggests that in combination with Angitil capsules, alcohol may increase the rate of in vivo release of the product from the prolonged-release preparation. Alcohol may increase dose-dependent effects and lead to potential adverse pharmacodynamic interactions. Alcohol use could therefore increase the rate and seriousness of diltiazem adverse drug reactions such as vasodilatory related events.

4.6. Fertility, pregnancy and lactation

Pregnancy

There is very limited data from the use of diltiazem in pregnant patients. Diltiazem has been shown to have reproductive toxicity (see section 5.3) in certain animal species (rat, mice, rabbit). Diltiazem is therefore not recommended during pregnancy, as well as in women of child-bearing potential not using effective contraception.

Breast feeding

As this drug is excreted in breast milk, breast feeding whilst taking diltiazem is contraindicated.

4.7. Effects on ability to drive and use machines

On the basis of reported adverse drug reactions, i.e. dizziness (common), malaise (common), the ability to drive and use machines could be altered. However, no studies have been performed.

4.8. Undesirable effects

The following CIOMS frequency rating is used, when applicable: Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to ≤1/100); rare (≥1/10,000 to ≤1/1,000); very rare (≤1/10,000); not known (cannot be estimated from the available data).

Within each frequency grouping, adverse events are presented in order of decreasing seriousness.

Very common

Common

Uncommon

Rare

Not known

Blood and lymphatic system disorders

Thrombocytopenia

Psychiatric disorders

Nervousness, insomnia

Mood changes including depression

Nervous system disorders

Headache, dizziness

Extrapyramidal syndrome

Respiratory, thoracic and mediastinal disorders

Bronchospasm (including asthma aggravation)

Cardiac disorders

Atrioventricular block (may be of first, second or third degree; bundle branch block may occur), palpitations

Bradycardia

Sinoatrial block, congestive heart failure

sinus arrest, cardiac arrest (asystole)

Vascular disorders

Flushing

Orthostatic hypotension

Vasculitis (including leukocytoclastic vasculitis)

Gastrointestinal disorders

Constipation, dyspepsia, gastric pain, nausea

Vomiting, diarrhoea

Dry mouth

Gingival hyperplasia

Metabolism and nutrition disorders

Hyperglycemia

Hepatobiliary disorders

Hepatic enzymes increase (AST, ALT, LDH, ALP increase)

Hepatitis

Skin and subcutaneous tissue disorders

Erythema

Urticaria

Photosensitivity (including lichenoid keratosis at sun exposed skin areas), angioneurotic oedema, rash, erythema multiforme (including Steven-Johnson's syndrome and toxic epidermal necrolysis), sweating, exfoliative dermatitis, acute generalized exanthematous pustulosis, occasionally desquamative erythema with or without fever, lupus-like syndrome, lichenoid drug eruption

Reproductive system and breast disorders

Gynecomastia

General disorders and administration site conditions

Peripheral oedema

Malaise

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9. Overdose

The clinical effects of acute overdose can involve pronounced hypotension leading to collapse and acute kidney injury, sinus bradycardia with or without isorhythmic dissociation, sinus arrest, atrioventricular conduction disturbances and cardiac arrest.

Non-cardiogenic pulmonary oedema has rarely been reported as a consequence of diltiazem overdose that may manifest with a delay onset (24-48 hours post-ingestion) and require ventilatory support. Early resuscitative measures (including fluid overload) to maintain perfusion and cardiac output may be precipitating factors.

Treatment, under hospital supervision, will include gastric lavage, osmotic diuresis. Conduction disturbances may be managed by temporary cardiac pacing.

Proposed corrective treatments: atropine, vasopressors, inotropic agents, glucagon and calcium gluconate infusion.

🇷🇴 Known in Romania as

Medicines sold in Romania with the same active substance: Cunoscut în România ca

  • DILTIAZEM LPH 60 mg prescriptionDILTIAZEMUM · taken by mouth
  • DILTIAZEM ARENA 60 mg prescriptionDILTIAZEMUM · taken by mouth
  • DILTIAZEM EIPICO 60 mg prescriptionDILTIAZEMUM · taken by mouth

Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Romanian medicines in the UK →

🇵🇱 Known in Poland as

Medicines sold in Poland with the same active substance: W Polsce znany jako

  • Dilzem retardDiltiazemi hydrochloridum · taken by mouth
  • Dilzem 120 retardDiltiazemi hydrochloridum · taken by mouth
  • Dilzem 180 retardDiltiazemi hydrochloridum · taken by mouth
  • Oxycardil 60Diltiazemi hydrochloridum · taken by mouth

Same active substance. The strength, the form and whether you need a prescription can differ. Always ask a pharmacist before you switch. Polish medicines in the UK →

💬 Ask about this leaflet

Ask anything about Angitil SR/XL Capsules. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.

Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.

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