• Enalapril

    (e nal' a pril)

    IMPORTANT WARNING:

    Do not take enalapril if you are pregnant. If you become pregnant while taking enalapril, call your doctor immediately. Enalapril may harm the fetus.

    WHY is this medicine prescribed?

    Enalapril is used alone or in combination with other medications to treat high blood pressure. It is also used in combination with other medications to treat heart failure. Enalapril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.

    HOW should this medicine be used?

    Enalapril comes as an immediate and extended release tablet to take by mouth. It is usually taken once or twice a day with or without food. To help you remember to take enalapril, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take enalapril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Your doctor will probably start you on a low dose of enalapril and gradually increase your dose.
    Enalapril controls high blood pressure and heart failure but does not cure them. Continue to take enalapril even if you feel well. Do not stop taking enalapril without talking to your doctor.

    Are there OTHER USES for this medicine?

    Enalapril is also sometimes used to treat kidney disease related to diabetes. Talk to your doctor about the possible risks of using this medication for your condition.
    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking enalapril,
    • tell your doctor and pharmacist if you are allergic to enalapril, benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik), or any other medications.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin); diuretics ('water pills'); lithium (Eskalith, Lithobid); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor if you have or have ever had heart or kidney disease; lupus; scleroderma; diabetes; or angioedema, a condition that causes difficulty swallowing or breathing and painful swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs.
    • tell your doctor if you plan to become pregnant or are breast-feeding.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking enalapril.
    • you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.

    What SPECIAL DIETARY instructions should I follow?

    Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Enalapril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • cough
    • dizziness
    • rash
    • weakness
    Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
    • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
    • hoarseness
    • difficulty breathing or swallowing
    • yellowing of the skin or eyes
    • fever, sore throat, chills, and other signs of infection
    • lightheadedness
    • fainting
    Enalapril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include:
    • lightheadedness
    • fainting

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to enalapril. Your doctor may order certain lab tests to check your body's response to enalapril.
    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Lexxel® (as a combination product containing Enalapril, Felodipine)
    • Teczem® (as a combination product containing Diltiazem, Enalapril)
    • Vasotec®
    • Also available generically

    Enalapril and Hydrochlorothiazide

    (e nal' a pril) (hye droe klor oh thye' a zide)

    IMPORTANT WARNING:

    Do not take enalapril and hydrochlorothiazide if you are pregnant. If you become pregnant while taking enalapril and hydrochlorothiazide, call your doctor immediately. Enalapril and hydrochlorothiazide may harm the fetus.

    WHY is this medicine prescribed?

    The combination of enalapril and hydrochlorothiazide is used to treat high blood pressure. Enalapril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly. Hydrochlorothiazide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.

    HOW should this medicine be used?

    The combination of enalapril and hydrochlorothiazide comes as a tablet to take by mouth. It is usually taken with or without food once or twice a day. To help you remember to take enalapril and hydrochlorothiazide, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take enalapril and hydrochlorothiazide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Enalapril and hydrochlorothiazide controls high blood pressure but does not cure it. Continue to take enalapril and hydrochlorothiazide even if you feel well. Do not stop taking enalapril and hydrochlorothiazide without talking to your doctor.

    Are there OTHER USES for this medicine?

    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking enalapril and hydrochlorothiazide,
    • tell your doctor and pharmacist if you are allergic to enalapril (Vasotec), hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide), benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik), sulfa drugs, or any other medications.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as indomethacin (Indocin); cholestyramine (Questran); colestipol (Colestid); diuretics ('water pills'); insulin or oral medications for diabetes; lithium (Eskalith, Lithobid); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); other medications for high blood pressure; pain medications; phenobarbital (Luminal, Solfoton); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor if you have or have ever had heart, parathyroid, liver, or kidney disease; lupus; diabetes; allergies; asthma; gout; or angioedema, a condition that causes hives, difficulty breathing, and painful swelling of the face, lips, throat, tongue, hands, or feet.
    • tell your doctor if you plan to become pregnant or are breast-feeding.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking enalapril and hydrochlorothiazide.
    • ask your doctor about the safe use of alcoholic beverages while you are taking enalapril and hydrochlorothiazide. Alcohol can make the side effects from enalapril and hydrochlorothiazide worse.
    • you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.

    What SPECIAL DIETARY instructions should I follow?

    Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Enalapril and hydrochlorothiazide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • cough
    • dizziness
    • headache
    • excessive tiredness
    • muscle cramps
    • decrease in sexual ability
    Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
    • lightheadedness
    • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
    • hoarseness
    • difficulty breathing or swallowing
    • fever, sore throat, chills, and other signs of infection
    • yellowing of the skin or eyes
    • dry mouth
    • thirst
    • weakness
    • infrequent urination
    • upset stomach
    • vomiting
    • fainting
    • chest pain
    • fast or irregular heartbeat
    Enalapril and hydrochlorothiazide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to enalapril and hydrochlorothiazide. Your doctor may order certain lab tests to check your body's response to enalapril and hydrochlorothiazide.
    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Vaseretic® (as a combination product containing Enalapril, Hydrochlorothiazide)
    • Also available generically

    Diltiazem

    (dil tye' a zem)

    WHY is this medicine prescribed?

    Diltiazem is used to treat high blood pressure and to control angina (chest pain). Diltiazem is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart.

    HOW should this medicine be used?

    Diltiazem comes as a tablet, an extended-release (long-acting) tablet, and an extended-release capsule to take by mouth. The regular tablet is usually taken three or four times a day. The extended-release capsule and tablet are usually taken one or two times a day. Ask your pharmacist if you should take diltiazem with or without food, because instructions may vary with each product. Take diltiazem at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take diltiazem exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Swallow the extended-release capsules and tablets whole; do not chew or crush them.
    Your doctor will probably start you on a low dose of diltiazem and gradually increase your dose, not more than once every 7 to 14 days if you are taking the extended-release tablet or capsule and not more than once every 1 to 2 days if you are taking the regular tablet.
    If taken regularly, diltiazem may control chest pain, but it does not stop chest pain once it starts. Your doctor may give you a different medication to take when you have chest pain.
    Diltiazem controls high blood pressure and chest pain (angina) but does not cure them. It may take up to 2 weeks before you feel the full benefit of diltiazem. Continue to take diltiazem even if you feel well. Do not stop taking diltiazem without talking to your doctor.

    Are there OTHER USES for this medicine?

    Diltiazem is also sometimes used to treat certain types of arrhythmias (abnormal heart rhythms). Talk to your doctor about the risks of using this medication for your condition.
    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking diltiazem,
    • tell your doctor and pharmacist if you are allergic to diltiazem, any other medications, or any of the ingredients in diltiazem. Ask your pharmacist for a list of the ingredients.
    • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: atazanavir (Reyataz); benzodiazepines such as midazolam (Versed) and triazolam (Halcion); beta blockers such as atenolol (Tenormin), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); buspirone (BuSpar); carbamazepine (Carbatrol, Epitol, Tegretol); cimetidine (Tagamet); cyclosporine (Gengraf, Neoral, Sandimmune); digoxin (Lanoxin, Lanoxicaps); lovastatin (Altoprev, Mevacor, in Advicor); quinidine (Quinidex); and rifampin (Rifadin, in Rifamate, in Rifater, Rimactane). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with diltiazem, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
    • tell your doctor if you have or have ever had a myocardial infarction (MI); a narrowing or blockage of your digestive system or any other condition that causes food to move through your digestive system more slowly; low blood pressure; or heart, liver, or kidney disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking diltiazem, call your doctor.
    • if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking diltiazem.

    What SPECIAL DIETARY instructions should I follow?

    If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Diltiazem may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • dizziness or lightheadedness
    • flushing (feeling of warmth)
    • headache
    • weakness
    • slow heartbeat
    • vomiting
    • diarrhea
    • constipation
    • nasal congestion
    • cough
    Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
    • swelling of the face, eyes, lips, tongue, hands, arms, feet, ankles, or lower legs
    • difficulty breathing or swallowing
    • fainting
    • rash
    • yellowing of the skin or eyes
    • nausea
    • extreme tiredness
    • unusual bleeding or bruising
    • lack of energy
    • loss of appetite
    • pain in the upper right part of the stomach
    • flu-like symptoms
    • increase in frequency or severity of chest pain (angina)
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include:
    • slow, fast, or irregular heartbeat
    • fainting
    • difficulty breathing
    • seizures
    • dizziness
    • confusion
    • nausea
    • vomiting
    • increased sweating

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to diltiazem.
    Your doctor may ask you to check your pulse (heart rate) daily and will tell you how fast it should be. If your pulse is slower than it should be, call your doctor for directions on taking diltiazem that day. Ask your doctor or pharmacist to teach you how to check your pulse.
    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Cardizem®
    • Cardizem® CD
    • Cardizem® LA
    • Cardizem® SR
    • Cartia® XT
    • Dilacor® XR
    • Dilt-CD®
    • Diltzac®
    • Taztia® XT
    • Tiamate®[¶]
    • Tiazac®
    • Teczem® (as a combination product containing Diltiazem, Enalapril)[¶]
    • Also available generically
    This branded product is no longer on the market. Generic alternatives may be available.

    Felodipine

    (fe loe' di peen)

    WHY is this medicine prescribed?

    Felodipine is used to treat high blood pressure. It relaxes your blood vessels so your heart does not have to pump as hard.

    HOW should this medicine be used?

    Felodipine comes as an extended release tablet to take by mouth. It is usually taken once a day. Do not crush, chew, or divide felodipine tablets. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take felodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Felodipine controls high blood pressure but does not cure it. Continue to take felodipine even if you feel well. Do not stop taking felodipine without talking to your doctor.

    Are there OTHER USES for this medicine?

    Felodipine is also used sometimes to treat Raynaud's syndrome and congestive heart failure. Talk to your doctor about the possible risks of using this drug for your condition.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking felodipine,
    • tell your doctor and pharmacist if you are allergic to felodipine or any other drugs.
    • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially antiseizure medicines such as carbamazepine (Tegretol), phenytoin (Dilantin), and phenobarbital; cimetidine (Tagamet); erythromycin (E.E.S., E-Mycin, others); itraconazole (Sporanox); ketoconazole (Nizoral); ranitidine (Zantac); and vitamins.
    • tell your doctor if you have or have ever had heart, liver, or kidney disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking felodipine, call your doctor.
    • if you are having surgery, including dental surgery, tell your doctor or dentist that you take felodipine.

    What SPECIAL DIETARY instructions should I follow?

    Talk to your doctor about drinking grapefruit juice or eating grapefruit while taking felodipine.
    Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Felodipine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • headache
    • flushing (feeling of warmth)
    • dizziness or lightheadedness
    • weakness
    • fast heartbeat
    • heartburn
    • constipation
    • enlargement of gum tissue around teeth
    If you experience any of the following symptoms, call your doctor immediately:
    • swelling of the face, eyes, lips, tongue, arms, or legs
    • difficulty breathing or swallowing
    • fainting
    • rash
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to felodipine.
    Good dental hygiene decreases the chance and severity of gum swelling. Brush your teeth regularly and schedule dental cleanings every 6 months.
    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Lexxel® (as a combination product containing Enalapril, Felodipine)
    • Plendil®
    • Also available generically
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