[42] The risk of miscarriage is increased in those with poorly controlled insulin-dependent diabetes mellitus. Antiarrhythmic agents can have serious adverse effects (e.g., changes in mental function, appetite, behavior, heart function, or increased risk for falls) in older individuals. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. [113] The term fetal death applies variably in different countries and contexts, sometimes incorporating weight, and gestational age from 16 weeks in Norway, 20 weeks in the US and Australia, 24 weeks in the UK to 26 weeks in Italy and Spain. Paclitaxel: (Minor) Additive bradycardia may occur in patients receiving paclitaxel and other drugs known to cause bradycardia, such as certain calcium-channel blockers, such as diltiazem. Thrombopoietin receptor agonists, including romiplostim (Nplate) and eltrombopag (Promacta), help prevent bruising and bleeding by causing your bone marrow to produce more platelets. Concomitant use may increase daridorexant exposure and the risk for daridorexant-related adverse effects. Management of newly diagnosed immune thrombocytopenia: Can we change outcomes? Diltiazem is contraindicated in patients with sick sinus syndrome (SSS). BACTRIM (sulfamethoxazole and trimethoprim) injection is supplied as follows: 10-mL Vials, containing 160 mg trimethoprim (16 mg/mL) and 800 mg sulfamethoxazole (80 mg/mL) for infusion with 5% dextrose in water. Subjects being treated with 200 mg ketoconazole twice daily for 7 days received a single 90 mg cinacalcet dose on day 5 of therapy. Coadministration with another strong CYP3A4 inducer lowered diltiazem plasma concentrations to undetectable levels. Disease-Associated Maternal And/Or Embryo/Fetal Risk. Diltiazem increases the simvastatin exposure by approximately 5-fold. Heart attack: Thrombocytopenia may decrease the amount of blood flow to your heart. [144][32], Among women who know they are pregnant, the miscarriage rate is roughly 10% to 20%, while rates among all fertilized zygotes are around 30% to 50%. It is recommended to avoid this combination when hydrocodone is being used for cough. General principles of treatment include the administration of intravenous fluids if urine output is low and renal function is normal. Concomitant use may result in additive effects in prolonging AV conduction and additive antihypertensive effects. Lorlatinib: (Major) Avoid coadministration of diltiazem and lorlatinib if possible due to decreased plasma concentrations of diltiazem; if unavoidable, monitor blood pressure and heart rate and adjust the diltiazem dose based on clinical response. Nabumetone: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. BACTRIM may inhibit the hepatic metabolism of phenytoin (a CYP2C9 substrate). Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor for symptoms of hypotension and edema if coadministration of amlodipine with diltiazem is necessary; adjust the dose of amlodipine as clinically appropriate. These effects could be more pronounced in patients also receiving a CYP2D6 inhibitor. Sirolimus is a sensitive CYP3A substrate with a narrow therapeutic range; diltiazem is a moderate CYP3A inhibitor. Life threatening hyperkalemia and acidosis secondary to trimethoprimsulfamethoxazole treatment. Coadministration is contraindicated in patients with renal or hepatic impairment because colchicine accumulation may be greater in these populations. The mean AUC of an extended-release diltiazem formulation is minimally (approximately 16%) higher when given to postprandial vs. fasting patients. Sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid (PABA). There are a variety of known risk factors in non-human animals. Methamphetamine: (Minor) Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, like calcium-channel blockers. This is especially true after theyve been sick with another viral illness, like chickenpox, mumps, and measles. Moh R, et al. Administration of diltiazem concomitantly with propranolol in 5 normal volunteers resulted in increased propranolol concentrations in all subjects, and bioavailability of propranolol was increased approximately 50%. Infigratinib is a CYP3A4 substrate and diltiazem is a moderate CYP3A4 inhibitor. When used concomitantly, anesthetics and calcium-channel blockers should be titrated carefully to avoid excessive cardiovascular depression. Diltiazem is a CYP3A4 substrate and cobicistat is a strong CYP3A4 inhibitor. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. [1] Risk begins to increase around the age of 30. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. [64] Some available data suggest that there is a small increased risk of miscarriage for women taking any antidepressant,[65][66] though this risk becomes less statistically significant when excluding studies of poor quality.[63][67]. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. Probenecid; Colchicine: (Major) Due to the risk for serious colchicine toxicity including multi-organ failure and death, avoid coadministration of colchicine and diltiazem in patients with normal renal and hepatic function unless the use of both agents is imperative. Cobicistat: (Moderate) Monitor blood pressure and heart rate if coadministration of diltiazem with cobicistat is necessary. Like other sulfonamide-containing drugs, BACTRIM potentiates the effect of oral hypoglycemic that are metabolized by CYP2C8 (e.g., pioglitazone, repaglinide, and rosiglitazone) or CYP2C9 (e.g., glipizide and glyburide) or eliminated renally via OCT2 (e.g., metformin). Mitapivat: (Moderate) Do not exceed mitapivat 20 mg PO twice daily during coadministration with diltiazem and monitor hemoglobin and for adverse reactions from mitapivat. The most common symptom of a miscarriage is vaginal bleeding with or without pain. Coadministration may result in increased zanubrutinib exposure and toxicity (e.g., infection, bleeding, and atrial arrhythmias). [23][24][25] Bleeding can be a symptom of miscarriage, but many women also have bleeding in early pregnancy and do not miscarry. Cancer treatments like chemotherapy can cause nerve damage, which may cause leg cramps. Brigatinib is a CYP3A4 substrate; diltiazem is a moderate CYP3A4 inhibitor. See additional information. Berotralstat: (Moderate) Monitor blood pressure and heart rate if coadministration of diltiazem with berotralstat is necessary. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Codeine; Guaifenesin; Pseudoephedrine: (Moderate) Concomitant use of codeine with diltiazem may increase codeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased morphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. In physiologically based pharmacokinetic (PBPK) simulations, the Cmax and AUC values of acalabrutinib were increased by 2- to almost 3-fold when acalabrutinib was coadministered with moderate CYP3A inhibitors. Diltiazem is a moderate inhibitor of CYP3A4. (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. The plasma concentrations of naldemedine may be increased during concurrent use. In the two factorial analyses of variance, mean alcohol consumption per day in the 30 days before the blood tests showed a highly significant effect for GGT [FP. Initially, 30 mg PO 4 times per day administered before meals and at bedtime, gradually increasing the dosage at 1- or 2-day intervals until angina is optimally controlled. Well-controlled hypertensive patients receiving decongestant sympathomimetics at recommended doses do not appear to be at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. Certain types of massage, such as deep tissue, are more likely to cause post-massage soreness. When chromosomal abnormalities are found in more than one miscarriage, genetic testing of both parents may be done. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. [citation needed], In some women, cervical incompetence or cervical insufficiency occurs with the inability of the cervix to stay closed during the entire pregnancy. Ritonavir: (Moderate) Ritonavir is expected to decrease the hepatic CYP metabolism of diltiazem, resulting in increased diltiazem concentrations. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. Lumacaftor; ivacaftor may reduce the efficacy of diltiazem by decreasing its systemic exposure. [62], There is no significant association between antidepressant medication exposure and spontaneous abortion. [33] These conditions also may contribute to premature birth. One of 3 rat studies showed cleft palate at doses approximately 5 times the recommended human dose on a body surface area basis; the other 2 studies did not show teratogenicity at similar doses. Well-controlled hypertensive patients receiving decongestant sympathomimetics at recommended doses do not appear to be at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. Monitor for signs of opioid withdrawal. The following countries offer paid or unpaid leave to women who have had a miscarriage. Finerenone: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or diltiazem; a finerenone dosage reduction may be necessary. Levonorgestrel; Ethinyl Estradiol: (Minor) Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. New Journal Launched! Monitor blood pressure and heart rate. Rifapentine: (Major) Avoid coadministration of diltiazem and rifapentine due to decreased plasma concentrations of diltiazem. What Causes a Low Platelet Count? Coadministration may increase the plasma concentrations of ivabradine further increasing the risk for bradycardia exacerbation and conduction disturbances. Dosage adjustments of the antihypertensive medication may be required. Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Ritonavir is expected to decrease the hepatic CYP metabolism of diltiazem, resulting in increased diltiazem concentrations. [114] In the UK, Rho(D) immune globulin is recommended in Rh-negative women after 12 weeks gestational age and before 12 weeks gestational age in those who need surgery or medication to complete the miscarriage. 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