Do not take this medicine if:

• You are allergic (hypersensitive) to diltiazem hydrochloride or any of the other ingredients of Tildiem (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 below: ‘Pregnancy and breast-feeding’).
• You are having a medicine called dantrolene used for severe muscle spasms or severe fever (see below: ‘Other medicines and Tildiem’).
• You have a very slow heartbeat – less than 50 beats per minute.
• 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 are already taking a medicine containing ivabradine for the treatment of certain heart diseases.
• 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 Tildiem).
• You are already taking a medicine containing asunaprevir used for the treatment of hepatitis C virus infection (see section: ‘Other medicines and Tildiem).

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 Tildiem.

Warnings and precautions

Talk to your doctor or pharmacist before taking your medicine if:

• You have a history of heart failure, new shortness of breath, slow heartbeat or low blood pressure. Cases of kidney injury in patients with such conditions have been reported.
• 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.
• You are at risk of mood changes, including depression.
• You are at risk of gut problems.

Your doctor will check you more closely particularly when you first start taking the tablets 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 Tildiem.

Other medicines and Tildiem

Tell your doctor or pharmacist if you are taking or have recently taken any other medicines.

This includes medicines you buy without a prescription, including herbal medicines. This is because Tildiem can affect the way some other medicines work. Also some medicines can affect the way Tildiem works.

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.

Tildiem 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 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.
• Medicines used for sleeplessness or 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.

Tildiem may make the following medicine work less well:

• Rifampicin used for tuberculosis.

The following medicines can increase the effect of Tildiem:

• Medicines for stomach ulcers such as cimetidine and ranitidine.

Tildiem with food and drink

It is advisable to limit the amount of grapefruit juice you drink while taking Tildiem 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

• You should not take Tildiem if you are pregnant, might become pregnant or think you may be pregnant. This is because Tildiem can cause problems for your baby. Talk to your doctor if you might be pregnant.
• Do not breast-feed if you are taking Tildiem. 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.

Tildiem contains:

• Lactose. If you have been told by your doctor that you cannot tolerate some sugars, talk to your doctor before taking this medicine.
• Hydrogenated castor oil. May cause stomach upset and diarrhoea.