Drug Class: Non-Dihydropyridine Calcium Channel Blocker | Form: Sustained-Release Oral Capsule | Prescription Status: Prescription Only (Rx) — DRAP Registered
What is Herbesser SR 180mg Capsule? Herbesser SR 180mg contains Diltiazem Hydrochloride — a non-dihydropyridine calcium channel blocker that acts on both the heart and blood vessels simultaneously. Unlike dihydropyridine calcium channel blockers such as Amlodipine that act primarily on blood vessels, Diltiazem also slows heart rate and reduces cardiac conduction — making it uniquely effective for both hypertension and angina while also providing rate control in certain cardiac arrhythmias. The sustained-release formulation delivers consistent Diltiazem blood levels throughout the day from a convenient once or twice daily dose — avoiding the peaks and troughs of immediate-release formulations and providing smoother blood pressure and heart rate control. Always used under strict cardiological supervision.
What is Herbesser SR 180mg Used For?
- Chronic stable angina — prevention of chest pain from reduced coronary blood flow (سینے کے درد کی روک تھام)
- Hypertension — high blood pressure management (ہائی بلڈ پریشر)
- Rate control in atrial fibrillation — slowing rapid heart rate in AF (دل کی بے قاعدہ اور تیز دھڑکن کو سست کرنا)
- Supraventricular tachycardia — rate control in certain rapid heart rhythm disorders
- Vasospastic angina — Prinzmetal angina caused by coronary artery spasm (خون کی نالیوں کی اینٹھن سے سینے کا درد)
- Hypertension with angina — where single medicine addressing both conditions is preferred
How Does it Work? Diltiazem blocks L-type voltage-gated calcium channels in two complementary locations. In vascular smooth muscle it prevents calcium entry — causing relaxation and dilation of peripheral and coronary blood vessels, reducing vascular resistance and blood pressure, and improving coronary blood flow to the heart muscle. In the heart's electrical conduction system — particularly the sinoatrial and atrioventricular nodes — it slows calcium-dependent conduction, reducing heart rate and prolonging the refractory period. This dual cardiac and vascular action makes Diltiazem uniquely valuable for conditions where both blood vessel relaxation and heart rate reduction are therapeutically beneficial — particularly angina and hypertension with tachycardia.
Dosage and Administration
⚠️ Swallow capsule whole — never crush or chew the sustained-release capsule. Never stop suddenly — gradual dose reduction under cardiologist supervision required. Monitor heart rate and blood pressure regularly throughout treatment. Never combine with beta-blockers without specialist cardiological supervision — risk of dangerous heart rate reduction.
| Indication | Usual Adult Dose | Frequency | Notes |
|---|---|---|---|
| Hypertension | 180 – 240mg | Once or twice daily | Adjusted by cardiologist |
| Chronic stable angina | 180 – 360mg | Once or twice daily | Titrated to symptom control |
| Atrial fibrillation rate control | 180 – 360mg | Once or twice daily | Under specialist supervision |
| Vasospastic angina | 180 – 360mg | Once or twice daily | As prescribed |
Active Ingredients
| Ingredient | Strength |
|---|---|
| Diltiazem Hydrochloride | 180mg (Sustained-Release) |
Who Should NOT Take Herbesser SR 180mg?
- Allergy to Diltiazem or any calcium channel blocker
- Severe bradycardia — resting heart rate below 50 beats per minute
- Second or third degree heart block without a functioning pacemaker
- Sick sinus syndrome without a pacemaker
- Severe hypotension — systolic blood pressure below 90mmHg
- Acute myocardial infarction with pulmonary congestion
- Wolff-Parkinson-White syndrome with associated arrhythmias
- Severe liver impairment — Diltiazem is extensively metabolised by the liver
- Pregnancy and breastfeeding — consult cardiologist before use
- Currently taking IV beta-blockers — dangerous additive cardiac depression
Side Effects
Common: Slow heart rate (دل کی دھڑکن کا سست ہونا), ankle swelling (ٹخنوں کی سوجن), facial flushing and warmth, mild headache, mild dizziness especially on standing, mild nausea, mild fatigue, constipation — generally well tolerated at therapeutic doses.
Serious — Stop and seek emergency help immediately: Severely slow heart rate below 50 beats per minute with dizziness or fainting (دل کی دھڑکن بہت سست — فوری ہسپتال جائیں), significant worsening of heart failure — sudden breathlessness with severe ankle swelling and weight gain (فوری مدد لیں), severe allergic reaction with swelling of face or throat and difficulty breathing, severe liver toxicity — yellowing of skin or eyes (یرقان — فوری مدد لیں), significant low blood pressure with fainting (بے ہوشی — فوری مدد لیں), severe skin reactions including blistering or peeling, complete heart block — very slow irregular pulse with loss of consciousness.
Drug Interactions
| Medicine | Interaction |
|---|---|
| Beta-blockers (Atenolol, Metoprolol) | Severely additive cardiac depression — dangerous heart block and bradycardia risk; never combine without specialist supervision |
| Digoxin | Diltiazem significantly increases Digoxin blood levels — serious toxicity risk; reduce Digoxin dose and monitor levels |
| Simvastatin / Lovastatin | Diltiazem increases statin blood levels dramatically — increased myopathy and rhabdomyolysis risk; limit statin dose |
| Cyclosporine | Diltiazem significantly increases Cyclosporine blood levels — toxicity risk; monitor closely |
| Rifampicin | Dramatically reduces Diltiazem blood levels — significantly reduced effectiveness |
| Carbamazepine / Phenytoin | Diltiazem increases their blood levels — increased side effect and toxicity risk |
| Midazolam / Triazolam | Diltiazem significantly increases sedative blood levels — increased sedation risk |
| Antihypertensives | Additive blood pressure lowering — increased hypotension risk |
| Lithium | Diltiazem may increase neurotoxicity risk — monitor closely |
| Alcohol (شراب) | Increases blood pressure lowering and dizziness — avoid excessive consumption |
Storage: Store below 25°C in a cool, dry place. Protect from moisture and direct sunlight. Keep capsule in original packaging. Keep out of reach of children (بچوں کی پہنچ سے دور رکھیں). Do not use after expiry date.
FAQs
Q: Why is Herbesser SR preferred over dihydropyridine calcium channel blockers like Amlodipine for certain patients? Diltiazem uniquely combines vasodilation with heart rate reduction — making it more suitable than Amlodipine for patients with both hypertension and angina or those with tachycardia, where slowing the heart rate alongside blood vessel relaxation provides superior combined cardiac benefit.
Q: Can Herbesser SR 180mg be taken with beta-blockers for better blood pressure control? This combination requires strict specialist supervision only — both Diltiazem and beta-blockers slow heart conduction independently and combining them carries serious risk of dangerous bradycardia and complete heart block. Never combine without explicit cardiologist instruction and close monitoring.
Q: Can Herbesser SR capsule be opened and the contents sprinkled on food for easier swallowing? Never open or crush the sustained-release capsule — this destroys the controlled-release mechanism and releases the full dose immediately, causing dangerous rapid blood pressure and heart rate reduction. If swallowing is difficult consult your cardiologist for an alternative formulation or administration method.
Medical Disclaimer: This information is for general awareness only and does not replace medical advice. Always consult a qualified doctor or pharmacist before taking any prescription medicine.