Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
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.
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.
e Angitil Capsules Do not take Angitil Capsules if:
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
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)
Angitil Capsules
What Angitil Capsules contain:
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
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.
The active substance in Angitil SR/XL Capsules is diltiazem hydrochloride.
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.
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.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
For the management of angina pectoris. For the management of mild to moderate hypertension.
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.
• 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).
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'.
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.
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.
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.
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.
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.
Medicines sold in Romania with the same active substance: Cunoscut în România ca
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 →
Medicines sold in Poland with the same active substance: W Polsce znany jako
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 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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