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Diltiazem / enalapril Side Effects

Applies to diltiazem / enalapril: oral tablet extended release.

Warning

Do not take diltiazem and enalapril if you are pregnant or planning a pregnancy. When used during the second and third trimesters of pregnancy, ACE inhibitors (enalapril) can cause injury and even death to the developing fetus. Notify your doctor immediately if you think you might be pregnant.

Do not stop taking this medication unless your doctor approves. If you stop taking your medication, your condition could become much worse.

Use caution when driving, operating machinery, or performing other hazardous activities. Diltiazem and enalapril may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Also use caution when rising from a sitting or lying position.

Heavy sweating, vomiting, diarrhea, or other causes of fluid loss may lead to very low blood pressure, dizziness, and fainting during therapy with diltiazem and enalapril. Maintain proper fluid intake to prevent dehydration and related adverse effects.

Do not break, crush, or chew this medication. Swallow the pills whole.

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:

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

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

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]

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]

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

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]

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

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]

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]

Musculoskeletal

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

Hematologic

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]

Rare cases of hemolytic anemia have been reported in patients who are taking enalapril, particularly patients with G-6-PD deficiency.[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. 2001;PROD.

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

3. Brink DD. Diltiazem and hyperactivity. Ann Intern Med. 1984;100:459-60.

4. Palat GK, Hooker EA, Movahed A. Secondary mania associated with diltiazem. Clin Cardiol. 1984;7:611-2.

5. Palat GK, Hooker EA, Movahed A. Secondary mania associated with diltiazem. Clin Cardiol. 1985;8:251-2.

6. Dick RS, Barold SS. Diltiazem-induced parkinsonism. Am J Med. 1989;87:95-6.

7. Jacobs MB. Diltiazem and akathisia. Ann Intern Med. 1983;99:794-5.

8. Berman JL. Dysomia, dysgeusia, and diltiazem. Ann Intern Med. 1985;102:558.

9. Palat GK, Hooker EA, Movahed A. Secondary mania associated with diltiazem. Clin Cardiol. 1986;9:39.

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

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

12. 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. 1989;63:d17-21.

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

14. Hormigo A, Alves M. Peripheral neuropathy in a patient receiving enalapril. Br Med J. 1992;305:1332.

15. 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. 1991;230:219-26.

16. 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. 1991;4:s154-7.

17. 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. 1993;43:737-43.

18. Ahmad S. Diltiazem myopathy. Am Heart J. 1993;126:1494-5.

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

20. 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. 1995;35:189-95.

21. 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. 1995;75:555-8.

22. Weir MR. Diltiazem: ten years of clinical experience in the treatment of hypertension. J Clin Pharmacol. 1995;35:220-32.

23. 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. 1995;48:1-7.

24. 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. 1995;35:484-92.

25. 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. 1995;26:438-45.

26. 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. 1995;23:244-53.

27. Antonios TFT, Macgregor GA. Angiotensin converting enzyme inhibitors in hypertension: potential problems. J Hypertens. 1995;13 Suppl:s11-6.

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

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

30. Imamura T, Koiwaya Y, Nakamura M. Sinoatrial block induced by oral diltiazem. Clin Cardiol. 1986;9:33-4.

31. 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. 1992;14:148-57.

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

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

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

35. Gianos ME, Klaustermeyer WB, Kurohara M, et al. Enalapril induced angioedema. Am J Emerg Med. 1990;8:124-6.

36. Russell RM, Jones RM. Postoperative hypotension associated with enalapril. Anaesthesia. 1989;44:837-8.

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

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

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

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

41. 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. 1987;37:346-9.

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

43. 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. 1994;73:513-4.

44. 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. 1994;34:273-4.

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

46. 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. 1994;54:337-40.

47. 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. 1994;74:884-9.

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

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

50. Cichelli AV, Lenchner GS, Promisloff RA, Segal SL. Enalapril-induced cough . Am J Med. 1987;83:1009-10.

51. Roth A. Chronic cough caused by angiotensin converting enzyme inhibitors. Ann Allergy. 1990;64:47-8.

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

53. 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. 1989;95:1225-30.

54. Fennerty A, Littley M, Reid P. Enalapril-induced nasal blockage . Lancet. 1986;2:1395-6.

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

56. 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. 1995;48:851-7.

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

58. Semple PF. Putative mechanisms of cough after treatment with angiotensin converting enzyme inhibitors. J Hypertens. 1995;13 Suppl:s17-21.

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

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

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

62. Saracheck NS, London RL, Matulewicz TJ, et al. Diltiazem and granulomatous hepatitis. Gastroenterology. 1985;88:1260-2.

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

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

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

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

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

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

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

70. Scolnick B, Brinberg D. Diltiazem and generalized lymphadenopathy. Ann Intern Med. 1985;102:558.

71. Dominguez EA, Hamill RJ. Drug-induced fever due to diltiazem. Arch Intern Med. 1991;151:1869-70.

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

73. Carmichael AJ, Paul CJ. Vasculitic leg ulcers associated with diltiazem. Br Med J. 1988;297:562.

74. Wakeel RA, Gavin MP, Keefe M. Severe toxic erythema caused by diltiazem. Br Med J. 1988;296:1071.

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

76. Sheehan-Dare RA, Goodfield MJ. Severe cutaneous vasculitis induced by diltiazem. Br J Dermatol. 1988;119:134.

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

78. Taylor JW, Cleary JD, Atkinson RC. Stevens-Johnson syndrome associated with diltiazem. Clin Pharm. 1990;9:948-50.

79. Moots RJ, Keeling PJ, Morgan SH. Adult schonlein-henoch purpura after enalapril. Lancet. 1992;340:304-5.

80. Gonnering RS, Hirsch SR. Delayed drug-induced periorbital angioedema . Am J Ophthalmol. 1990;110:566-8.

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

82. Sanders CJ, Neumann HA. Erythema multiforme, Stevens-Johnson syndrome, and diltiazem. Lancet. 1993;341:967.

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

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

85. Avila JR. Elevation of hepatic enzymes after cutaneous reaction caused by diltiazem. Ann Pharmacother. 1995;29:317-8.

86. Wakelin SH, James MP. Diltiazem-induced acute generalised exanthematous pustulosis. Clin Exp Dermatol. 1995;20:341-4.

87. Seggev JS, Lagstein Z. Photosensitivity skin reactions to calcium channel blockers. J Allergy Clin Immunol. 1996;97:852-5.

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

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

90. Wirebaugh SR, Geraets DR. Reports of erythematous macular skin eruptions associated with diltiazem therapy. DICP. 1990;24:1046-9.

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

92. Ahmad S. Enalapril and reversible alopecia . Arch Intern Med. 1991;151:404.

93. Shelton RM. Pemphigus foliaceus associated with enalapril. J Am Acad Dermatol. 1991;24:503-4.

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

95. Kanwar AJ, Dhar S, Ghosh S. Photosensitive lichenoid eruption due to enalapril. Dermatology. 1993;187:80.

96. 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. 1995;47:493-6.

97. Crowson AN, Magro CM. Diltiazem and subacute cutaneous lupus erythematosis-like lesions. N Engl J Med. 1995;333:1429.

98. Vignes S, Paul C, Flageul B, Dubertret L. Ramipril-induced superficial pemphigus. Br J Dermatol. 1996;135:657-8.

99. Bowman JM, Levy BA, Grubb RV. Gingival overgrowth induced by diltiazem. Oral Surg Oral Med Oral Pathol. 1988;65:183-5.

100. Tam IM, Wandres DL. Calcium-channel blockers and gingival hyperplasia. Ann Pharmacother. 1992;26:213-4.

101. Giustiniani S, Cuna F, Marieni M. Hyperplastic gingivitis during diltiazem therapy. Int J Cardiol. 1987;15:247-9.

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

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

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

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. 1993;20:286-93.

106. Steele RM, Schuna AA, Schreiber RT. Calcium antagonist-induced gingival hyperplasia. Ann Intern Med. 1994;120:663-4.

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

108. 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. 1995;79:300-4.

109. 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. 1996;23:649-57.

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

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

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

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

114. Saunders FW, Shedden P. Diltiazem: possible hematologic complications. Surg Neurol. 1986;25:82-4.

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

116. Loftus WK, Ierino F, Mathew TH. Enalapril and anaemia . Med J Aust. 1988;148:209-10.

117. Elis A, Lishner M, Lang R, Ravid M. Agranulocytosis associated with enalapril. Drug Intell Clin Pharm. 1991;25:461-2.

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

119. 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. 1996;50:973-8.

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

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

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

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