Herbesser 180 SR Special Precautions

General: Since it is described in case reports that symptoms were aggravated after sudden withdrawal of calcium antagonists medication, reduce the dose gradually and observe the symptoms carefully if Herbesser 180 SR is to be withdrawn. Give patients precaution not to discontinue Herbesser 180 SR medication without physician's directions.
Herbesser 180 SR is to be carefully administered in the following cases:
Patients with severe bradycardia (<50 bpm) or 1st-degree atrioventricular block.
Experience with the use of diltiazem HCl in combination with β-blockers in patients with impaired ventricular function is limited. Caution should be exercised when using this combination.
Decreases in blood pressure associated with diltiazem HCl therapy may occasionally result in symptomatic hypotension.
Patients with impaired renal or hepatic function.
Use in pregnancy & lactation: Since animal experiments have proved teratogenic and feticidal effects of diltiazem HCl, Herbesser 180 SR is contraindicated to pregnant women and women of suspected being pregnant. It is not recommended to administer Herbesser 180 SR to nursing mothers since it is reported that diltiazem HCl is excreted in human milk. If administration is necessitated, nursing should be avoided.
Use in children: Safety of Herbesser 180 SR in children has not been established.