calcium channel blockers. It works by making your blood vessels wider. This helps to lower your blood pressure. It also makes it easier for your heart to pump blood around the body. This helps to prevent the chest pain caused by angina.

Zemret XL is used to treat:

■    high blood pressure

■    angina (chest pain)

What you need to know before you take Zemret XL

Do not take Zemret XL

■    If you are allergic (hypersensitive) to diltiazem hydrochloride or any of the other ingredients of this medicine (listed in section 6"Contents of the pack and other information”)

■    If you have any of the following serious heart problems, unless you have a pacemaker fitted:

-    Second or third degree heart block, which may cause dizziness, tiredness, shortness of breath or chest pain

-    Sick sinus syndrome, which may cause dizziness, fainting, confusion, palpitations, shortness of breath or tiredness

-    Left ventricular failure with lung congestion, which may cause breathlessness, excessive sweating, anxiety and pale skin

■    Severe bradycardia (a very slow heart beat of less than 50 beats per minute)

■    If you are already taking a medicine containing ivabradine for the treatment of certain heart diseases

■    If you are breast-feeding

■    If you are having a medicine called dantrolene infusion (used for severe muscle spasms or severe fever). (see "Other medicines and Zemret XL”)

Warnings and precautions

Talk to your doctor or pharmacist before taking this medicine:

■    If you have any other problems with your heart such as:

-    Reduced left ventricular function, which may cause breathlessness, wheezing, dizziness, confusion or cold extremities

-    Slow heart beat (mild bradycardia), as it may become worse

-    First degree heart block, which may cause skipped beats

-    Prolonged PR interval (detected on an electrocardiogram ECG)

Your doctor will monitor your treatment.

■    If you are to have a general anaesthesia as you must tell the anaesthetist that you are taking Zemret XL

■    If you are at risk of mood changes, including depression

■    If you have liver or kidney problems or you are elderly. You should be closely monitored by your doctor at the beginning of treatment, in particular your heart rate

■    If you are at risk of developing a blockage of the bowel, which may cause stomach pain, constipation, diarrhoea or wind

■    If you have diabetes

Other medicines and Zemret XL

Tell your doctor or pharmacist if you are taking or have recently taken or might take any other medicines, including those obtained without a prescription.

Zemret XL should not be taken with the following:

Other medicines which may interact with or be affected by Zemret XL:

■    Lithium, used to treat depression or mania

■    Nitrates, such as glyceryl trinitrate (GTN) or isosorbide trinitrate, used to treat angina

■    Rifampicin, an antibiotic used to treat various infections, in particular tuberculosis

■    Carbamezepine, used to treat epilepsy

■    Ciclosporin, used to treat severe psoriasis (type of skin disease) or to prevent rejection of an organ following a transplant

■    Theophylline, used to treat breathing problems

■    Digoxin and other medicines such as amiodarone, used to treat irregular heart beat and heart failure.

Particular care is needed if you are taking amiodarone or digoxin with Zemret XL and you are elderly or you are taking a high dose

■    Medicines used to treat indigestion and stomach ulcers e.g. cimetidine and ranitidine.

You should be carefully monitored when starting or stopping treatment with such medicines and your dose of Zemret XL may need to be adjusted

■    Medicines for high blood pressure such as doxazosin, tamsulosin, atenolol, propranolol or acebutolol

■    Midazolam or triazolam, used produce sleepiness or drowsiness before an operation or during minor surgery

■    Methylprednisolone, used for inflammation and allergic reactions

■    Statins, used to lower lipids known as cholesterol and triglycerides in the blood e.g. atorvastatin, fluvastatin or simvastatin

Zemret XL with food and drink

It is advisable to limit the amount of grapefruit juice you drink while taking Zemret XL 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.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking any medicine.

Pregnancy

You should not take this medicine if you are pregnant. Women of child-bearing potential should exclude the possibility of pregnancy before commencing treatment. If it is at all possible that you could become pregnant while taking this medicine you should use suitable contraception. You may wish to discuss this with your doctor.

Breast-feeding

As low amounts of diltiazem pass into breast milk, breast-feeding must be stopped while taking this medicine.

Driving and using machines

Zemret XL should not affect your ability to drive or operate machinery. However, common side effects of this medicine are feeling dizzy or unwell. If affected you should not drive or operate machinery.

Zemret XL contains sucrose, if you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

How to take Zemret XL

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

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