Drug Class: Non-Dihydropyridine Calcium Channel Blocker | Form: Sustained-Release Oral Capsule | Prescription Status: Prescription Only (Rx) — DRAP Registered
What is Herbesser SR 90mg Capsule? Herbesser SR 90mg contains Diltiazem Hydrochloride 90mg — the standard lower starting dose for initiating Diltiazem therapy in hypertension and angina management. Starting at this lower strength allows the cardiovascular system to adjust gradually to Diltiazem's combined vasodilatory and heart rate-slowing effects before cautious dose escalation to higher maintenance doses if clinically required. The sustained-release formulation provides consistent Diltiazem blood levels over 24 hours from a once-daily dose — avoiding peaks and troughs of immediate-release formulations and delivering smoother blood pressure and heart rate control throughout the day and overnight. Like all Diltiazem formulations it must never be stopped suddenly and requires regular cardiological monitoring throughout treatment.
What is Herbesser SR 90mg Used For?
- Hypertension initiation — low starting dose for blood pressure management (ہائی بلڈ پریشر کی ابتدائی خوراک)
- Chronic stable angina — prevention of chest pain from reduced coronary blood flow (سینے کے درد کی روک تھام)
- Vasospastic angina — Prinzmetal angina caused by coronary artery spasm (خون کی نالیوں کی اینٹھن سے سینے کا درد)
- Rate control in atrial fibrillation — at lower starting dose under specialist supervision
- Elderly hypertensive patients — requiring cautious lower dose initiation (بزرگ مریضوں میں ہائی بلڈ پریشر)
- Step-up therapy — initial dose before gradual increase to 180mg or higher maintenance dose
How Does it Work? Diltiazem blocks L-type voltage-gated calcium channels in vascular smooth muscle — causing relaxation and dilation of peripheral and coronary blood vessels, reducing vascular resistance and improving coronary blood flow. Simultaneously it slows calcium-dependent conduction in the sinoatrial and atrioventricular nodes — reducing heart rate and prolonging cardiac refractory period. At the 90mg SR dose these dual cardiac and vascular effects are introduced gradually — allowing safe cardiovascular adaptation before dose escalation. The sustained-release mechanism maintains steady therapeutic Diltiazem blood concentrations over 24 hours — preventing the heart rate and blood pressure fluctuations associated with immediate-release dosing.
Dosage and Administration
⚠️ Swallow capsule whole — never crush or chew. Never stop suddenly — always reduce dose gradually under cardiologist supervision. Monitor heart rate and blood pressure regularly. Never combine with beta-blockers without strict specialist cardiological supervision. Take at the same time each day.
| Indication | Starting Dose | Titration | Frequency |
|---|---|---|---|
| Hypertension | 90mg | Increase to 180mg or higher if needed | Once daily |
| Chronic stable angina | 90mg | Increase gradually under supervision | Once daily |
| Vasospastic angina | 90mg | Adjusted by cardiologist | Once daily |
| Elderly patients | 90mg | Very cautious increase only | Once daily |
Active Ingredients
| Ingredient | Strength |
|---|---|
| Diltiazem Hydrochloride | 90mg (Sustained-Release) |
Who Should NOT Take Herbesser SR 90mg?
- 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 extensively metabolised by liver
- Pregnancy and breastfeeding — consult cardiologist before use
- Currently taking intravenous beta-blockers
Side Effects
Common: Slow heart rate (دل کی دھڑکن کا سست ہونا), mild ankle swelling (ٹخنوں کی ہلکی سوجن), facial flushing and warmth (گرمی کا احساس), mild headache, mild dizziness especially on standing, mild nausea, mild fatigue, mild constipation — generally well tolerated at this lower starting dose.
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 (فوری مدد لیں), complete heart block — very slow irregular pulse with loss of consciousness (فوری ہسپتال جائیں), severe allergic reaction with swelling of face or throat, 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.
Drug Interactions
| Medicine | Interaction |
|---|---|
| Beta-blockers (Atenolol, Metoprolol, Bisoprolol) | Severely additive cardiac depression — dangerous heart block and bradycardia risk; never combine without strict specialist supervision |
| Digoxin | Diltiazem significantly increases Digoxin blood levels — serious toxicity risk; monitor Digoxin levels closely |
| Simvastatin / Lovastatin | Diltiazem increases statin blood levels — increased myopathy risk; limit statin dose |
| Cyclosporine | Diltiazem significantly increases Cyclosporine blood levels — toxicity risk |
| Rifampicin | Dramatically reduces Diltiazem blood levels — significantly reduced effectiveness |
| Carbamazepine / Phenytoin | Diltiazem increases their blood levels — toxicity risk; monitor closely |
| Midazolam / Triazolam | Diltiazem significantly increases sedative levels — increased sedation risk |
| Other antihypertensives | Additive blood pressure lowering — increased hypotension risk |
| Lithium | May increase Diltiazem 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 90mg used as a starting dose rather than going straight to 180mg? Starting at 90mg allows the heart and blood vessels to adjust gradually to Diltiazem's dual heart rate-slowing and vasodilatory effects — minimising the risk of excessive bradycardia or hypotension during the initiation phase before cautiously escalating to higher maintenance doses if blood pressure or angina control is insufficient.
Q: What is the difference between Herbesser SR 90mg and Herbesser SR 180mg? Herbesser SR 90mg is the standard starting and lower maintenance dose used for initiation and in elderly or sensitive patients. Herbesser SR 180mg delivers double the Diltiazem dose providing stronger and more sustained blood pressure and heart rate reduction — used when 90mg provides insufficient control after proper titration under cardiologist supervision.
Q: Can Herbesser SR 90mg capsule be taken at night instead of the morning? Herbesser SR provides 24-hour sustained release — consistent timing is more important than specific time of day. However taking it at the same time daily is essential for stable blood levels. Your cardiologist may advise morning or evening dosing based on your individual blood pressure pattern and response to treatment.
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.