Angitil SR (diltiazem ER) is a generic version of the better-known medication Cardizem SR.

The SR in this product, and in its counterpart Cardizem SR, stands for sustained release, meaning it's usually taken just once per day, while fast-acting tablets are often taken twice per day. There are exceptions to both, however; sometimes Angitil SR is taken twice per day and regular tablets just once. SR tablets must not be split, crushed, chewed, or otherwise damaged, as doing so will destroy the sustained-release effects.

Angitil SR, like all diltiazem products, is a calcium channel blocker. Calcium channel blockers ultimately relax arterial walls, increasing their diameter. This effect reduces blood pressure and can help reduce the frequency of angina attacks. Diltiazem also reduces the speed and strength of heartbeats, further reducing blood pressure and correcting certain arrhythmias.

There are many products available containing diltiazem, both brand name and generic, and while doses may be very similar most products are marketed to treat just one or two conditions. Angitil SR is marketed to help manage angina and to treat mild to moderate hypertension. Effects on heart arrhythmias have not been studied.

Managing Angina

Angitil SR is not a cure for angina, but should make attacks less frequent and, when they do occur, less severe. The medication is particularly beneficial in improving exercise tolerance.

Treatment is ideally individualized, meaning relatively frequent doctor checkups will be needed at first and dosage customized according to individual results. In most cases, treating angina is as follows:

• Start with 180 mg per day.
• This may be given as a single daily dose or divided into two 90 mg doses per day.
• Dosage may be increased at 7 to 14 day increments, up to a total of 360 mg per day.

Patients who are elderly, have kidney or liver impairment, or who are otherwise at risk of side effects may be started on lower doses. Doctors will want to be vigilant in monitoring the medication's effects as well as potentially-developing side effects.

As angina attacks may still occur while taking Angitil SR, and Angitil SR will not help stop a current angina attack, patients are often also prescribed fast-acting solutions, such as nitroglycerin, which can be used as-needed. Note that there are some interaction concerns with these two medications so rescue treatments should only be used if approved by a doctor.

Treating Mild to Moderate Hypertension

Angitil SR is an effective hypertension treatment in mild to moderate cases. It can be used on its own or with other blood pressure-lowering medications.

Again treatment should be individualized. Maximum benefit is usually seen within 14 days of starting treatment or dose adjustments. Treatment is typically:

• Patients are usually started on 180 to 240 mg.
• Treatment may be once per day, but some patients respond better if total dosage is divided into smaller doses taken throughout the day.
• Treatment may be increased, usually at 14 day intervals, up to 540 mg per day.

If other hypertension treatments are also being given doctors may reduce the daily dosage of Angitil SR or the other medications. Blood pressure should be monitored closely at the start of treatment and frequent doctor visits may be necessary until an effective dose is established.

Many patients who have high blood pressure also have diabetes. Angitil SR can influence glucose levels, usually by raising them. Blood sugar should also be checked frequently at the start of treatment, and again medications may need to be adjusted.

Adverse Effects

There are some other medical conditions that put patients at increased risk of serious complications when Angitil SR is taken, namely:

• Sick sinus syndrome
• Severe bradycardia (slow heartbeat)
• Heart failure
• Left ventricular failure
• Atrioventricular block

If certain procedures have been done to mitigate the above conditions (installation of a pacemaker, for example) Angitil SR may be used. Other patients will be given modified dosing, while still others will need to consider alternative medications.

Angitil SR, like Cardizem and all calcium channel blockers, will lower blood pressure and slow heart rate. Patients who have any medical condition or who take medications that reduce blood pressure and/or influence heart rate should use this product with caution. Be sure to inform the prescribing doctor of all other medical conditions and medications being taken, including over-the-counter varieties. Don't be afraid to ask questions, no matter how trivial they may seem.

Common side effects include:

• Mild dizziness
• Stomach upset
• Headache
• Constipation
• Edema in extremities
• Flushing

The above are usually transient, stopping after a week or two of taking the medication. If the above are severe or persistant, speak with a doctor.