Diltiazem / enalapril Side Effects

Not all side effects for diltiazem / enalapril may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to diltiazem / enalapril: oral tablet extended release

If you experience any of the following serious side effects, stop taking diltiazem and enalapril and call your doctor immediately or seek emergency medical treatment:

  • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

  • jaundice (yellowing of your skin or eyes);

  • unusually fast or slow heartbeats;

  • difficulty breathing;

  • abnormal behavior or psychosis;

  • swelling of your legs or ankles;

  • little or no urine;

  • chest pain; or

  • severe dizziness or fainting.

Other, less serious side effects may be more likely to occur. Continue to take diltiazem and enalapril and talk to your doctor if you experience

  • mild dizziness or lightheadedness;

  • headache;

  • dry, tickling cough;

  • flushing (redness);

  • insomnia and vivid dreams;

  • numbness or tingling in the hands, feet, arms, or legs;

  • nausea, constipation, or diarrhea;

  • weakness or fatigue; or

  • a rash.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

For Healthcare Professionals

Applies to diltiazem / enalapril: oral tablet extended release

General

In general, side effects associated with this combination drug are similar to those associated with each component. There does not appear to be side effects unique to the combination drug. Side effects are typically mild and transient.[Ref]

Nervous system

Nervous system side effects include headache in 3% to 7% (less than placebo), dizziness in approximately 3%, and asthenia/fatigue in approximately 3% of patients. Depression, sleeping problems (either insomnia or somnolence), ataxia, confusion, peripheral neuropathy, taste alterations, tinnitus, tearing, amblyopia, eye irritation, retinopathy, and vertigo have been reported in less than 1% of patients.[Ref]

Cardiovascular

Angioedema associated with the use of ACE inhibitors may be a sign of allergy and is generally an indication to discontinue therapy with this agent and to avoid other ACE inhibitors. Angioedema that involves the face, larynx, or neck IS an absolute contraindication to therapy. The incidence of angioedema appears slightly higher in Black than in non-Black patients.[Ref]

Cardiovascular side effects may be related to either component, and include edema or swelling in 3% and chest pain (relationship to drug questionable) in 0.5% to 1.6%. Calcium channel blockade can rarely result in bradycardia, AV block (1st, 2nd, and even 3rd-degree AV block), heart failure, and hypotension. Excessive hypotension related to either enalapril or diltiazem has rarely resulted in angina pectoris, myocardial infarction, and stroke. Palpitations have been rarely reported.[Ref]

Respiratory

Respiratory side effects including cough is a common respiratory system complaint associated with ACE inhibitors that occurs in approximately 3% of patients who are taking this combination drug. Nasal congestion, pharyngitis, pulmonary infiltrates and bronchitis have rarely been reported.[Ref]

Metabolic

Less common metabolic problems (associated with diltiazem) include hyperglycemia, hyperuricemia (with rare cases of gout), hypokalemia, and increased creatine kinase.[Ref]

Metabolic side effects are related to enalapril. By inhibiting angiotensin II-mediated aldosterone secretion, ACE inhibitors can induce mild hyperkalemia, particularly in patients with renal insufficiency.[Ref]

Renal

Renal side effects including new or worsened renal insufficiency has been associated with ACE inhibitors. Patients at increased risk include patients with heart failure, renal insufficiency, and renal artery stenosis.[Ref]

Hypersensitivity

Late-onset enalapril-induced angioedema (more than three months) is reported in at least one patient who had taken enalapril without incident for three years. Patients with intestinal angioedema generally present with abdominal pain (with or without nausea or vomiting) and in some cases there was no prior history of facial angioedema, and C-1 esterase levels were normal. These symptoms resolve after stopping the ACE inhibitor.[Ref]

Hypersensitivity reactions to enalapril, as with some other angiotensin converting enzyme (ACE) inhibitors, may be life-threatening. Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx have been reported rarely in patients receiving ACE inhibitors. Obstructive laryngeal and glossal angioedema due to enalapril is a rare, but potentially fatal reaction. In addition, intestinal angioedema has been reported in patients treated with ACE inhibitors. It is recommended that any patient with dyspnea, dysphagia, or significant facial angioedema stop therapy immediately and avoid ACE inhibitor therapy in general. Enalapril is not recommended for patients with a history of idiopathic angioedema.

Other hypersensitivity reactions associated with enalapril including photosensitivity in 0.1%, or urticaria in 0.3% of patients have been reported. A single case of Henoch-Schonlein purpura has also been reported.[Ref]

Dermatologic

Dermatologic side effects are typically mild. Rashes have been reported in 2% of patients. The following side effects have rarely been associated with either or both drugs when given alone: alopecia, diaphoresis, erythema multiforme, exfoliative dermatitis, pemphigus, photosensitivity, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis, and urticaria. Hypersensitivity reactions to ACE inhibitors can present as angioedema and severe rash.[Ref]

Gastrointestinal

Rarely, constipation, anorexia, dry mouth, dyspepsia, glossitis, and cholestatic jaundice/hepatitis, pancreatitis, ileus, stomatitis, vomiting, gingival hyperplasia (associated with the use of some calcium channel blockers) have been associated with the use of enalapril or diltiazem.[Ref]

Gastrointestinal problems, such as nausea and diarrhea, have been reported in up to 2% of patients. These side effects were as prevalent among placebo-treated patients in controlled trials.[Ref]

Musculoskeletal

Musculoskeletal discomfort has been reported in up to 1% of patients.[Ref]

Hematologic

Rare cases of hemolytic anemia have been reported in patients who are taking enalapril, particularly patients with G-6-PD deficiency.[Ref]

Hematologic side effects are rare, and are remarkable for rare cases of agranulocytosis in patients who are taking ACE inhibitors. In clinical trials, less than 0.1% of patients discontinued therapy due to anemia. Thrombocytopenia has also rarely been reported.[Ref]

Immunologic

Immunologic side effects have been rarely associated with the use of enalapril. This complex may include a positive ANA, an elevated erythrocyte sedimentation rate, arthralgia/arthritis, myalgia/myositis, fever, serositis, vasculitis, leukocytosis, eosinophilia, photosensitivity, rash, and other dermatologic manifestations.[Ref]

Genitourinary

Genitourinary complaints including impotence among male patients are extremely rare.[Ref]

References

1. "Product Information. Teczem (diltiazem-enalapril)." Merck & Co, Inc, West Point, PA.

2. Kinney EL, Moskowitz RM, Zelis R "The pharmacokinetics and pharmacology of oral diltiazem in normal volunteers." J Clin Pharmacol 21 (1981): 337-42

3. Hutt V, Janik F, Kappler J, Pabst G, Ravelli V, Maccari M, Jaeger H "Evaluation of pharmacokinetics, bioavailability and dose linearity of diltiazem in healthy volunteers." Arzneimittelforschung 43 (1993): 737-43

4. Hormigo A, Alves M "Peripheral neuropathy in a patient receiving enalapril." Br Med J 305 (1992): 1332

5. Francis GS, Rucinska EJ "Long-term effects of a once-a-day versus twice-a-day regimen of enalapril for congestive heart failure." Am J Cardiol 63 (1989): d17-21

6. Palat GK, Hooker EA, Movahed A "Secondary mania associated with diltiazem." Clin Cardiol 7 (1984): 611-2

7. Dick RS, Barold SS "Diltiazem-induced parkinsonism." Am J Med 87 (1989): 95-6

8. Fagher B, Katzman P, Hulthen UL, et al "Antihypertensive efficacy and tolerability of enalapril and slow-release verapamil in essential hypertension: a double-blind, cross-over study." J Intern Med 230 (1991): 219-26

9. Palat GK, Hooker EA, Movahed A "Secondary mania associated with diltiazem." Clin Cardiol 8 (1985): 251-2

10. Ahmad S "Diltiazem myopathy." Am Heart J 126 (1993): 1494-5

11. Kubota K, Pearce GL, Inman WHW "Vasodilation-related adverse events in diltiazem and dihydropyridine calcium antagonists studied by prescription-event monitoring." Eur J Clin Pharmacol 48 (1995): 1-7

12. Weir MR "Diltiazem: ten years of clinical experience in the treatment of hypertension." J Clin Pharmacol 35 (1995): 220-32

13. Palat GK, Hooker EA, Movahed A "Secondary mania associated with diltiazem." Clin Cardiol 9 (1986): 39

14. Antonios TFT, Macgregor GA "Angiotensin converting enzyme inhibitors in hypertension: potential problems." J Hypertens 13 Suppl (1995): s11-6

15. Brink DD "Diltiazem and hyperactivity." Ann Intern Med 100 (1984): 459-60

16. Berman JL "Dysomia, dysgeusia, and diltiazem." Ann Intern Med 102 (1985): 558

17. Johnson BF, Eisner GM, Mcmahon FG, Jain AK, Rudd P, Sowers JR "A multicenter comparison of adverse reaction profiles of isradipine and enalapril at equipotent doses in patients with essential hypertension." J Clin Pharmacol 35 (1995): 484-92

18. Jacobs MB "Diltiazem and akathisia." Ann Intern Med 99 (1983): 794-5

19. Graham DF, Stewartwynne EG "Diltiazem - induced acute parkinsonism." Aust N Z J Med 24 (1994): 70

20. Todd PA, Heel RC "Enalapril: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure." Drugs 31 (1986): 198-248

21. Inman WH, Rawson NS, Wilton LV, et al "Postmarketing surveillance of enalapril. I: results of prescription-event monitoring." Br Med J 297 (1988): 826-9

22. Nicaise J, Neveux E, Blondin P, Aquino JP, Barrel A, Fanon JL, Coupez JM, Hargrave DC "Antihypertensive efficacy and safe use of once-daily sustained-release diltiazem in the elderly: a comparison with captopril." J Int Med Res 23 (1995): 244-53

23. Graney WF "Clinical experience with a once-daily, extended-release formulation of diltiazem in the treatment of hypertension." Am J Med 93 (1992): s56-64

24. Dickstein K, Chang P, Willenheimer R, Haunso S, Remes J, Hall C, Kjekshus J "Comparison of the effects of losartan and enalapril on clinical status and exercise performance in patients with moderate or severe chronic heart failure." J Am Coll Cardiol 26 (1995): 438-45

25. Cutler NR, Eff J, Fromell G, Brass EP, Archer S, Chrysant SG, Fiddes R "Dose-ranging study of a new, once-daily diltiazem formulation for patients with stable angina." J Clin Pharmacol 35 (1995): 189-95

26. Nadeau C, Hilton D, Savard D, Morin Y, Baird M, Alexander M, Langer G, Roth D, Boulet AP, Lariviere L "Three-month efficacy and safety of once-daily diltiazem in chronic stable angina pectoris." Am J Cardiol 75 (1995): 555-8

27. Eisner GM, Johnson BF, McMahon FG, et al "A multicenter comparison of the safety and efficacy of isradipine and enalapril in the treatment of hypertension." Am J Hypertens 4 (1991): s154-7

28. Ellenbogen KA, Roark SF, Smith MS, et al "Effects of sustained intravenous diltiazem infusion in healthy persons." Am J Cardiol 58 (1986): 1055-60

29. Nagle RE, Low-Beer T, Horton R "Diltiazem and heart block." Lancet Apr (1989): 907

30. Gunkel AR, Thurner KH, Kanonier G, Sprinzl GM, Thumfart WF "Angioneurotic edema as a reaction to angiotensin-converting enzyme inhibitors." Am J Otolaryngol 17 (1996): 87-91

31. Bajaj AK "Topics in clinical pharmacology: enalapril, a second-generation angiotensin converting enzyme inhibitor." Am J Med Sci 296 (1988): 332-5

32. Patel R, Lipper B, Schwartzbard A, Nelson C, Oconnor MA, Frishman W "Toxic effects of diltiazem in a patient with chronic renal failure." J Clin Pharmacol 34 (1994): 273-4

33. Gannon TH, Eby TL "Angioedema from angiotensin converting enzyme inhibitors: a cause of upper airway obstruction." Laryngoscope 100 (1990): 1156-60

34. Goldenberg IF, Lewis WR, Dias VC, Heywood JT, Pedersen WR "Intravenous diltiazem for the treatment of patients with atrial fibrillation or flutter and moderate to severe congestive heart failure." Am J Cardiol 74 (1994): 884-9

35. Andrivet P, Beaslay V, Kiger JP, Gnoc CV "Complete sinus arrest during diltiazem therapy - clinical correlates and efficacy of intravenous calcium." Eur Heart J 15 (1994): 350-4

36. Roberts JR, Wuerz RC "Clinical characteristics of angiotensin-converting enzyme inhibitor-induced angioedema." Ann Emerg Med 20 (1991): 555-8

37. Gianos ME, Klaustermeyer WB, Kurohara M, et al "Enalapril induced angioedema." Am J Emerg Med 8 (1990): 124-6

38. Orfan N, Patterson R, Dykewicz MS "Severe angioedema related to ACE inhibitors in patients with a history of idiopathic angioedema." JAMA 264 (1990): 1287-9

39. Chin HL, Buchan DA "Severe angioedema after long-term use of an angiotensin-converting enzyme inhibitor ." Ann Intern Med 112 (1990): 312-3

40. Cooper WD, Sheldon D, Brown D, et al "Post-marketing surveillance of enalapril: experience in 11,710 hypertensive patients in general practice." J R Coll Gen Pract 37 (1987): 346-9

41. Woehler TR, Eff J, Graney W, et al "Multicenter evaluation of the efficacy and safety of sustained-release diltiazem hydrochloride for the treatment of hypertension." Clin Ther 14 (1992): 148-57

42. Friedland S, Kaplan S, Lahav M, Shapiro A "Proptosis and periorbital edema due to diltiazem treatment." Arch Ophthalmol 111 (1993): 1027-8

43. Lind L, Lithell H, Johansson CG, Morlin C, Ljunghall S "Electrocardiographic changes during antihypertensive treatment with diltiazem in relation to the achieved serum levels of the drug." Scand J Clin Lab Invest 54 (1994): 337-40

44. Abidin MR, Eisele DW "Angioedema after long-term use of angiotensin-converting enzyme inhibitor ." Arch Otolaryngol Head Neck Surg 117 (1991): 1059

45. Russell RM, Jones RM "Postoperative hypotension associated with enalapril." Anaesthesia 44 (1989): 837-8

46. Todd PA, Goa KL "Enalapril: a reappraisal of its pharmacology and therapeutic use in hypertension." Drugs 43 (1992): 346-81

47. Imamura T, Koiwaya Y, Nakamura M "Sinoatrial block induced by oral diltiazem." Clin Cardiol 9 (1986): 33-4

48. Boden WE, Moss AJ, Herbert PN, Savitelli A, Oakes D, Eberly S "Effect of long-term-diltiazem administration on serum lipids in post-myocardial infarction survivors." Am J Cardiol 73 (1994): 513-4

49. Semple PF "Putative mechanisms of cough after treatment with angiotensin converting enzyme inhibitors." J Hypertens 13 Suppl (1995): s17-21

50. Fennerty A, Littley M, Reid P "Enalapril-induced nasal blockage ." Lancet 2 (1986): 1395-6

51. Visser LE, Stricker BHC, Vandervelden J, Paes AHP, Bakker A "Angiotensin converting enzyme inhibitor associated cough: a population-based case-control study." J Clin Epidemiol 48 (1995): 851-7

52. Elliott WJ "Higher incidence of discontinuation of angiotensin converting enzyme inhibitors due to cough in black subjects." Clin Pharmacol Ther 60 (1996): 582-8

53. Cichelli AV, Lenchner GS, Promisloff RA, Segal SL "Enalapril-induced cough ." Am J Med 83 (1987): 1009-10

54. Lindgren BR, Rosenqvist U, Ekstrom T, et al "Increased bronchial reactivity and potentiated skin responses in hypertensive subjects suffering from coughs during ACE-inhibitor therapy." Chest 95 (1989): 1225-30

55. Mue S, Tamura G, Yamauchi K, et al "Bronchial responses to enalapril in asthmatic, hypertensive patients." Clin Ther 12 (1990): 335-43

56. McEwan JR, Choudry N, Street R, Fuller RW "Change in cough reflex after treatment with enalapril and ramipril." Br Med J 299 (1989): 13-6

57. Woo KS, Nicholls MG "High prevalence of persistent cough with angiotensin converting enzyme inhibitors in chinese." Br J Clin Pharmacol 40 (1995): 141-4

58. Kaufman J, Casanova JE, Riendl P, Schlueter DP "Bronchial hyperreactivity and cough due to angiotensin-converting enzyme inhibitors." Chest 95 (1989): 544-8

59. Roth A "Chronic cough caused by angiotensin converting enzyme inhibitors." Ann Allergy 64 (1990): 47-8

60. Herings RMC, Deboer A, Stricker BHC, Leufkens HGM, Porsius A "Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme." Lancet 345 (1995): 1195-8

61. Saracheck NS, London RL, Matulewicz TJ, et al "Diltiazem and granulomatous hepatitis." Gastroenterology 88 (1985): 1260-2

62. Ljungman S, Kjekshus J, Swedberg K "Renal function in severe congestive heart failure during treatment with enalapril." Am J Cardiol 70 (1992): 479-87

63. Champ JD "Case report: azotemia secondary to enalapril and diuretic use and the diagnosis of renovascular hypertension." Am J Med Sci 305 (1993): 25-7

64. Shallcross H, Padley SP, Glynn MJ, Gibbs DD "Fatal renal and hepatic toxicity after treatment with diltiazem." Br Med J 295 (1987): 1256-7

65. Thind GS "Renal insufficiency during angiotensin-converting enzyme inhibitor therapy in hypertensive patients with no renal artery stenosis." J Clin Hypertens 1 (1985): 337-43

66. Schwartz D, Averbuch M, Pines A, et al "Renal toxicity of enalapril in very elderly patients with progressive, severe congestive heart failure." Chest 100 (1991): 1558-61

67. O'Donnell D "Renal failure due to enalapril and captopril in bilateral renal artery stenosis: greater awareness needed." Med J Aust 148 (1988): 525-7

68. ter Wee PM, Rosman JB, van der Geest S "Acute renal failure due to diltiazem." Lancet 2 (1984): 1337-8

69. Moots RJ,Keeling PJ, Morgan SH "Adult schonlein-henoch purpura after enalapril." Lancet 340 (1992): 304-5

70. Seggev JS, Lagstein Z "Photosensitivity skin reactions to calcium channel blockers." J Allergy Clin Immunol 97 (1996): 852-5

71. Lavrijsen APM, Van Dijke C, Vermeer BJ "Diltiazem-associated exfoliative dermatitis in a patient with psoriasis." Acta Derm Venereol 66 (1986): 536-8

72. Romano A, Pietrantonio F, Garcovich A, et al "Delayed hypersensitivity to diltiazem in two patients." Ann Allergy 69 (1992): 31-2

73. Sheehan-Dare RA, Goodfield MJ "Severe cutaneous vasculitis induced by diltiazem." Br J Dermatol 119 (1988): 134

74. Sousa-Basto A, Azenha A, Duarte ML, Pardal-Oliveira F "Generalized cutaneous reaction to diltiazem." Contact Dermatitis 29 (1993): 44-5

75. Sheehan-Dare RA, Goodfield MJD "Widespread cutaneous vasculitis associated with diltiazem." Postgrad Med J 64 (1988): 467-8

76. Jain M, Armstrong L, Hall J "Predisposition to and late onset of upper airway obstruction following angiotensin-converting enzyme inhibitor therapy." Chest 102 (1992): 871-4

77. Dominguez EA, Hamill RJ "Drug-induced fever due to diltiazem." Arch Intern Med 151 (1991): 1869-70

78. Sanders CJ, Neumann HA "Erythema multiforme, Stevens-Johnson syndrome, and diltiazem." Lancet 341 (1993): 967

79. Gonnering RS, Hirsch SR "Delayed drug-induced periorbital angioedema ." Am J Ophthalmol 110 (1990): 566-8

80. Lambert DG, Dalac S, Beer F, et al "Acute generalized exanthematous pustular dermatitis induced by diltiazem." Br J Dermatol 118 (1988): 308-9

81. Taylor JW, Cleary JD, Atkinson RC "Stevens-Johnson syndrome associated with diltiazem." Clin Pharm 9 (1990): 948-50

82. Wakelin SH, James MP "Diltiazem-induced acute generalised exanthematous pustulosis." Clin Exp Dermatol 20 (1995): 341-4

83. Carmichael AJ, Paul CJ "Vasculitic leg ulcers associated with diltiazem." Br Med J 297 (1988): 562

84. Carrington PR, Sanusi ID, Zahradka S, Winder PR "Enalapril-associated erythema and vasculitis." Cutis 51 (1993): 121-3

85. Scolnick B, Brinberg D "Diltiazem and generalized lymphadenopathy." Ann Intern Med 102 (1985): 558

86. Wakeel RA, Gavin MP, Keefe M "Severe toxic erythema caused by diltiazem." Br Med J 296 (1988): 1071

87. Avila JR "Elevation of hepatic enzymes after cutaneous reaction caused by diltiazem." Ann Pharmacother 29 (1995): 317-8

88. Stern R, Khalsa JH "Cutaneous adverse reactions associated with calcium channel blockers." Arch Intern Med 149 (1989): 829-32

89. Ahmad S "Enalapril and reversible alopecia ." Arch Intern Med 151 (1991): 404

90. Crowson AN, Magro CM "Diltiazem and subacute cutaneous lupus erythematosis-like lesions." N Engl J Med 333 (1995): 1429

91. Heckerling PS "Enalapril and vulvovaginal pruritis ." Ann Intern Med 112 (1990): 879-80

92. Shelton RM "Pemphigus foliaceus associated with enalapril." J Am Acad Dermatol 24 (1991): 503-4

93. Kanwar AJ, Dhar S, Ghosh S "Photosensitive lichenoid eruption due to enalapril." Dermatology 187 (1993): 80

94. Trimarco B, Radzik D, Vanmieghem W, Neveux E, Wajman A, Attali P, Ponsonnaille J "Efficacy and safety of the 200-300 mg sustained release formulation of diltiazem administered once daily in patients with stable angina." Eur J Clin Pharmacol 47 (1995): 493-6

95. Smith EP, Taylor TB, Meyer LJ, Zone JJ "Antigen identification in drug-induced bullous pemphigoid." J Am Acad Dermatol 29 (1993): 879-82

96. Jones SK, Reynolds NJ, Crossley J, Kennedy CT "Cutaneous reaction to diltiazem resulting in an exacerbation of angina." Clin Exp Dermatol 14 (1989): 457-8

97. Vignes S, Paul C, Flageul B, Dubertret L "Ramipril-induced superficial pemphigus." Br J Dermatol 135 (1996): 657-8

98. Wirebaugh SR, Geraets DR "Reports of erythematous macular skin eruptions associated with diltiazem therapy." DICP 24 (1990): 1046-9

99. Firth NA, Reade PC "Angiotensin-converting enzyme inhibitors implicated in oral mucosal lichenoid reactions." Oral Surg Oral Med Oral Pathol 67 (1989): 41-4

100. Davies RO, Irvin JD, Kramsch PK, Walker JF, Moncloa F "Enalapril worldwide experience." Am J Med 77 (1984): 23-35

101. Bullon P, Machuca G, Msahuquillo A, Rojas J, Lacalle JR, Rios JV, Velasco E "Clinical assessment of gingival size among patients treated with diltiazem." Oral Surg Oral Med Oral Pathol 79 (1995): 300-4

102. Bullon P, Machuca G, Martinezsahuquillo A, Rios JV, Velasco E, Rojas J, Lacalle JR "Evaluation of gingival and periodontal conditions following causal periodontal treatment in patients treated with nifedipine and diltiazem." J Clin Periodontol 23 (1996): 649-57

103. Giustiniani S, Cuna F, Marieni M "Hyperplastic gingivitis during diltiazem therapy." Int J Cardiol 15 (1987): 247-9

104. Steele RM, Schuna AA, Schreiber RT "Calcium antagonist-induced gingival hyperplasia." Ann Intern Med 120 (1994): 663-4

105. King GN, Fullinfaw R, Higgins TJ, Walker RG, Francis DM, Wiesenfeld D "Gingival hyperplasia in renal allograft recipients receiving cyclosporin-A and calcium antagonists." J Clin Periodontol 20 (1993): 286-93

106. Farraye FA, Peppercorn MA, Steer ML, et al "Acute small-bowel mucosal edema following enalapril use ." JAMA 259 (1988): 3131

107. Tam IM, Wandres DL "Calcium-channel blockers and gingival hyperplasia." Ann Pharmacother 26 (1992): 213-4

108. Mantzoros CS, Prabhu AS, Sowers JR "Paralytic ileus as a result of diltiazem treatment." J Intern Med 235 (1994): 613-4

109. Bowman JM, Levy BA, Grubb RV "Gingival overgrowth induced by diltiazem." Oral Surg Oral Med Oral Pathol 65 (1988): 183-5

110. Leloet X, Moore N, Deshayes P "Pseudopolymyalgia rheumatica during treatment with enalapril." Br Med J 298 (1989): 325

111. Peppers MP "Myalgia and arthralgia associated with enalapril and ramipril." Am J Health Syst Pharm 52 (1995): 203-4

112. Lahav M, Arav R "Diltiazem and thrombocytopenia." Ann Intern Med 110 (1989): 327

113. Loftus WK, Ierino F, Mathew TH "Enalapril and anaemia ." Med J Aust 148 (1988): 209-10

114. Gossmann J, Thurmann P, Bachmann T, Weller S, Kachel HG, Schoeppe W, Scheuermann EH "Mechanism of angiotensin converting enzyme inhibitor-related anemia in renal transplant recipients." Kidney Int 50 (1996): 973-8

115. Ring ME, Corrigan JJ, Fenster PE "Effects of oral diltiazem on platelet function: alone and in combination with "low dose" aspirin." Thromb Res 44 (1986): 391-400

116. Saunders FW, Shedden P "Diltiazem: possible hematologic complications." Surg Neurol 25 (1986): 82-4

117. Vlahakos DV, Canzanello VJ, Madaio MP, Madias NE "Enalapril-associated anemia in renal transplant recipients treated for hypertension." Am J Kidney Dis 17 (1991): 199-205

118. Elis A, Lishner M, Lang R, Ravid M "Agranulocytosis associated with enalapril." Drug Intell Clin Pharm 25 (1991): 461-2

119. Ring ME, Corrigan JJ Jr, Fenster PE "Antiplatelet effects of oral diltiazem, propranolol, and their combination." Br J Clin Pharmacol 24 (1987): 615-20

120. Kitai E, Sandiuk A, Zalewski S "Enalapril-induced immunologic impairment of hepatic function." J Fam Pract 33 (1991): 301-2

121. Schwartz D, Pines A, Averbuch M, Levo Y "Enalapril-induced antinuclear antibodies ." Lancet 336 (1990): 187

122. Casanova JE "Incontinence after use of enalapril ." J Urol 143 (1990): 1237-8

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

Hide
(web3)