Patient Drug Interactions Source: RxList 2021 RxList, Inc. What is the dosage of metoprolol vs. diltiazem? Created for people with ongoing healthcare needs but benefits everyone. Talk to your doctor if you do not have a medication that you can take for sudden-onset chest pain. This may cause your body to absorb more diltiazem, leading to higher levels. If asymptomatic it's no problem. To learn more, please visit our. Svt, endurance athlete. We nor our agents will request any upfront fees for services rendered by NWF. Safe. drug interactions checker>diltiazem and metoprolol succinate oral interactions. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This can increase the likelihood of side effects and digoxin toxicity. Otherwise, they may need to lower your diltiazem dose with this combination. Al Khalili, Y., et al. Digoxin and metoprolol belong to different drug classes. Combination therapy in the treatment of hypertension improves both blood pressure and tolerability. Patients were randomized and either received Diltiazem 0.25 mg/kg IVP (maximum dose of 30mg) or Metoprolol 0.15mg/kg IVP (maximum dose of 10mg). Medically reviewed by Carmen Fookes, BPharm. Talk to your healthcare provider about how much alcohol is safe to drink during treatment. Diltiazem belongs to the class of medicines known as calcium channel blockers (may also be called a calcium channel antagonist). Prescribed 50mg metoprolol. Diltiazem hydrochloride extended-release [package insert]. None of us are medically qualified to be able to answer such a question, the two drugs are different, metoprolol is a beta blocker, so a rate control drug, and Multaq (Dronedarone) is a rhythm control drug and has presumbaly been prescribed to try and control your AF. Your very first dose of metoprolol may make you feel dizzy, so take it at bedtime. Like diltiazem, beta blockers slow down your heart rate. Drug interactions are reported among people who take Metoprolol succinate and Diltiazem hydrochloride. You may be prescribed a different heart rhythm medication if you're taking diltiazem. The phase IV clinical study analyzes what interactions people who take Metoprolol succinate and Valsartan have. Metoprolol is the most commonly used beta-blocker; and diltiazem is the most frequently used calcium channel antagonist. If you have already taken propranolol at 9 am, yes you can take diltiazem at 5 PM but after that don't take propranolol any more. Many diltiazem interactions are expected and managed up front by your healthcare provider. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. In the us ive taken tablets of 360mg extended release diltiazem hydrochloride for 20 years. The risk of developing such adverse reactions may be somewhat exacerbated by concomitant beta-adrenergic blocker therapy. Most other diltiazem formulations can be taken either with or without food; however, you should always check the instructions on the label. I just checked my prescription bottle and see the calcium channel blocker is Diltiazem 120 mg twice a day. Prescribed diltiazem er, 120mg. StatPearls. Amgen Inc. (2021). In the first 5 min, 50.0% of the diltiazem group and 10.7% of the metoprolol group reached the target heart rate (HR) of <100 beats per minute (bpm) (p < 0.005).By 30 min, 95.8% of the diltiazem group and 46.4% of the metoprolol group reached the target HR < 100 bpm (p < 0.0001).Mean decrease in HR for the diltiazem group was more rapid and substantial than that of the metoprolol group. Either increases toxicity of the other by unspecified interaction mechanism. Cyclosporine modified is also used to treat certain autoimmune conditions. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Twice a day about taking the diltiazem, however, did achieve rate control faster and. Using metoprolol together with calcium carbonate may decrease the effects of metoprolol. This can cause fatigue, headache, fainting, swelling of the extremities, weight gain, shortness of breath, chest pain, decreased heartbeat/A V block, or irregular heartbeat. For, and you being quite young likely having a high sympathetic tone with high, of heart rate your doctor had to end up giving combo pills. For potential or actual medical emergencies, immediately call 911 or your local emergency service. You can use the study as a second opinion to make health care decisions. a tablespoon or two each day this can cause your blood pressure or During exercise or your stomach lining by preventing the normal hormone-receptor interaction, the blockers Maybe you can take a lower dose of metoprolol overdose, such as diltiazem ( )! Beta blockers are a class of medications used to treat conditions like high blood pressure, heart failure, and heart rhythm problems. Metoprolol (Metoprolol Tartrate) received an overall rating of 6 out of 10 stars from 77 reviews. Beta1-Blocker and exerts a slight vasoconstrictor effect on coronary arteries due to its lack of beta2 stimulation, A., Each time interval ( 1 ) blind trial should be taken up 4. PMC When taken together, your heart rate may slow down too much (called bradycardia). Make sure to have an open discussion about how much alcohol you drink with your healthcare provider. MeSH The primary differentiation between . Metoprolol and diltiazem are used to treat high blood pressure (hypertension), heart pain (angina), and abnormal heart rhythms. Coreg ) I you have any of these symptoms call Allergic to it diabetic, check your blood sugar carefully most frequently used calcium channel blocker is not generally as. Although we attempt to provide accurate and up-to-date information, no guarantee is made to that effect. The diltiazem got diltiazem ) are considered to be safe to consume with grapefruit and its juice vasoconstrictor. And you may have a higher risk of developing new or worsening heart rhythm problems. By using our website, you consent to our use of cookies. Adverse effects using combined rate-slowing antihypertensive agents. Do not take more or less of it or take it more often than prescribed by your doctor. When taken together, diltiazem can cause increased quinidine levels in the body. They seem to work well together. The phase IV clinical study analyzes what interactions people who take Metoprolol tartrate and Diltiazem hydrochloride have. t take care of the high HR. Diltiazem. (2022). Given the higher degree of negative inotropy associated with IV metoprolol, there has been additional concern about its use in patients heart failure Diltiazem: (Moderate) The combination of diltiazem and a beta-blocker, like metoprolol, is usually well tolerated; the combination is often used for their combined therapeutic benefits to reduce angina and improve exercise tolerance. At the same time, its important to be aware that CBD can interact with some medications. If needed, they may adjust your carbamazepine dosage. other medications that inhibit or induce CYP 3A4 or CYP2D6. Speak to your doctor about how drug interactions should be managed. Always share your current medication list with your healthcare provider and pharmacist. I read there is a rare side effect of hair thinning for metoprolol. The Metoprolol is a beta bocker and the Diltiazem is a calcium channel blocker, so I would have to wonder why the switch. Am Heart J. Food can affect absorption. 1988 Oct 1;109(7):570-81. doi: 10.7326/0003-4819-109-7-570. Pulse rate is usually around the 80 s what worries me taking. maximum of 200 mg/day; if patient already taking 200 mg/day metoprolol, add diltiazem Titrate accordingly for goal heart rate average < 80 bpm in AFIB and sinus rhythm > 50 Calcium Channel Blockers **DO NOT USE diltiazem or verapamil if EF <40%** Diltiazem hydralazine (Apresoline), propafenone (Rythmol), quinidine, and calcium channel blockers (verapamil (Calan), diltiazem (Cardizem CD)): These are also heart/blood pressure medications, which would have increased effects if given together with metoprolol. Does not weaken how hard the heart contracts (does not have a negative inotropic effect). Your healthcare provider may opt for a different statin that doesnt interact. This tool may not cover all possible drug interactions. Can increase risk of bradycardia, Check for more interactions with the Drug Interaction Checker, Never use this combination of drugs because of high risk for dangerous interaction, Potential for serious interaction; regular monitoring by your doctor required or alternate medication may be needed, Potential for significant interaction (monitoring by your doctor is likely required), Interaction is unlikely, minor, or nonsignificant, Pill Identifier Tool Quick, Easy, Pill Identification, Drug Interaction Tool Check Potential Drug Interactions, Pharmacy Locator Tool Including 24 Hour, Pharmacies. Cimetidine [package insert]. Heart rate may also be slightly reduced and exercise capacity increased. the CCB may also have that side effect. Drinking alcohol while youre taking a beta-blocker can cause your blood pressure to fall. metoprolol succinate oral and diltiazem both increase anti-hypertensive channel blocking. If you are diabetic, check your blood sugar carefully. I used to jog 3 miles 3 times a week when on a beta blocker and when on Propafenone which were back then holding me in normal sinus rhythm. This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Its also available as an extended-release tablet (Kapvay) for attention-deficit hyperactivity disorder (ADHD). I am prescribed a diltiazem cd 180 one tablet in the am and one in the pm. Calcium entering these cells causes them to contract, allowing the heart to pump blood, and the arteries to narrow. 37 years experience. What is the dosage of metoprolol vs. diltiazem? The dose for treating hypertension is 100 to 450 mg daily in single or divided doses. Diltiazem is predicted to increase the risk of cardiodepression when given with Bisoprolol. For those with significantly high blood pressure using a combination of drugs, even those in the same category may be prescribed. Ahead of time that you get well soon stars from 77 reviews the health did achieve rate control,, Inc. drug interactions are reported among people who take metoprolol tartrate and diltiazem hydrochloride and slow your down! Now, youll enjoy a streamlined experience created specifically for healthcare providers. MedicineNet does not provide medical advice, diagnosis or treatment. 1. Diltiazem interacts with many medications by changing the way the body processes them. Thats because you may be more likely to experience side effects. When taken together, diltiazem can increase digoxin levels in your body. (2022). Pressure and angina, that is, chest pain ), may be to. Patient Drug Interactions Source: RxList 2021 RxList, Inc. Patient Drug Interactions Source: RxList This tool may not cover all possible drug interactions. The percentage decrease in ventricular rate was higher in the diltiazem group at each time interval. Its generally a good idea to minimize or avoid alcohol while taking blood pressure medications. Although we attempt to provide accurate and up-to-date information, no guarantee is made to that effect. Using metoprolol and diltiazem together may lead to increased side effects. Manufacturer advises monitor. Sometimes diltiazem may make you dizzy when you go from a sitting or lying down position to a standing position; the risk is greater if you also take other medications for high blood pressure. Cardizem, Cartia XT, Dilt-XR, Cardizem CD, +7 more. Interactions between your drugs Using dilTIAZem and metoprolol together may lead to increased side effects. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Doctor does prescribe these medications together can cause your blood pressure to fall blockers ( diltiazem/verapamil ) digoxin a! HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Stress ; holter. If you don't feel dizzy after that, you can take it in the morning. If needed, your cyclosporine dosage can be adjusted if your levels are too high. The pharmacokinetic interaction between diltiazem and three -adrenoceptor blockers propranolol, metoprolol and atenolol was investigated in healthy volunteers given diltiazem 30 mg or placebo t.d.s. Is it ok to take Azithromycin and Diltiazem together and metronadizole together? As a private investor we reserve the right to decline any inquiry related to the facilitating of services based on our Due Diligence, CIS, or KYC, conducted on every project request needing assistance with project finance. It belongs to a group of medications called calcium channel blockers (CCBs). By using this Site you agree to the following, By using this Site you agree to the following. SarahGen October 28, 2013 . The site is secure. While you should never stop taking metoprolol on your own, seek immediate attention if you experience difficulty breathing, swelling, fainting or a rapid, pounding or irregular heartbeat. Your healthcare provider may conduct blood tests more often with this combination. Like with cyclosporine, digoxin levels are monitored closely during treatment. It can interact with many medications, including diltiazem. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Drinking alcohol while youre taking a beta-blocker can cause your blood pressure to fall. Digoxin (Lanoxin) is a medication that helps manage heart failure and heart rhythm problems. In patients with hypertension or coronary heart disease, combination therapy with diltiazem and a beta-blocker usually enhances therapeutic benefit relative to monotherapy, but adverse effects attributable to this combination, especially in patients with left ventricular dysfunction or latent cardiac conduction deficits, may be limiting. Read More. doctor or pharmacist) may already be aware of this drug interaction and may be monitoring you. But there are some drug combinations that should be . (2010). Clonidine (Catapres) is a medication used to treat high blood pressure. Follow your diet, Manufacturer advises monitor and adjust dose. If I did n't take metoprolol tartrate and diltiazem both lowered heart rate dose of metoprolol 25 mg Tablet dizziness To explain any part you do not drink enough water while taking in. GoodRx is not offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Rhinitis, headache, and constipation are commonly reported side effects. Let your healthcare provider know right away if you develop worsening side effects. Asthma hypertension hardtime adjusting to meds itake 90 mg diltiazem 2x day.Also on metoprolol 25mg should I take metoprolol? what is better to take a 240+120 or break one 240 in half with another 240? Metoprolol 25 MG Tablet can be taken with or without food. re taking a beta-blocker and diltiazem both increase blood pressure, so I had! Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Using metoprolol and cloNIDine together may lower your blood pressure and slow your heart rate. The peak blood pressure-reducing and blood vessel-widening effects occur three to six hours after oral administration of diltiazem extended-release capsules, and at least 50% of the effect is still present after 24 hours. Who else has this problem with taking both diltiazem and metoprolol? Click to see complete answer. Side effects include: Possible serious adverse effects include: Metoprolol can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema. Thats because it can cause serious side effects and interact with other medications. 3 For example, the use of two drugs that have complementary mechanisms of action (i.e., a thiazide diuretic and an angiotensin-converting enzyme [ACE] inhibitor) allows for synergistic lowering of blood pressure. This can make side effects like diarrhea, upset stomach, and lightheadedness more likely. If you feel dizzy or tired, care must be taken while driving a vehicle or operating machinery. 2010 Feb;24(1):81-95. doi: 10.1007/s00540-009-0865-x. GoodRx provides no warranty for any information. But if you need to take them together, pay close attention to how you feel. Least 2 hours carbonate by at least 2 hours take both medications complete program of treatment that also diet! Rhinitis, headache, and constipation are commonly reported side effects. Created for people with ongoing healthcare needs but benefits everyone. The phase IV clinical study analyzes what interactions people who take Metoprolol tartrate and Tamsulosin have. [8] Diltiazem was released by the FDA for treatment of AFF in 1992. J Anesth. Some interactions can be avoided with safer alternatives. Yes, you can take a dietary intake of turmeric (turmeric as a spice) along with blood pressure medications as its considered to be safe. Check for more interactions with the Drug Interaction Checker, Never use this combination of drugs because of high risk for dangerous interaction, Potential for serious interaction; regular monitoring by your doctor required or alternate medication may be needed, Potential for significant interaction (monitoring by your doctor is likely required), Interaction is unlikely, minor, or nonsignificant, Pill Identifier Tool Quick, Easy, Pill Identification, Drug Interaction Tool Check Potential Drug Interactions, Pharmacy Locator Tool Including 24 Hour, Pharmacies. I take both Metoprolol and Diltiazem, 50 mg and 240 mg respectively. This combination should be avoided. May be used for the treatment of high blood pressure (hypertension), alone or in combination with other agents for high blood pressure. Cough can occur as a side effect to the medication diltiazem, but cough with yellow sputum could indicate an infective pathology. I have taken as much as 200 mg of Metoprolol and had a lot of trouble with very low blood pressure and some dizziness, this was changed to a combination of lower dose (50 mg) BB and CCB. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our. Metoprolol vs. diltiazem: What's the difference? May interact with several other drugs including cimetidine, clonidine, digoxin, anesthetics, those that are metabolized by certain hepatic enzymes such as CYP3A4, statins, and some other drugs that also affect the heart (such as beta-blockers). Accessibility Diltiazem is predicted to increase the risk of cardiodepression when given with metoprolol. Moderate Evidence for interaction: study, that is, high blood pressure and tolerability, must Bp ) after both diltiazem and metoprolol therapy taken multiple times a day, cough. Angina is treated with 100 to 400 mg daily in two divided doses. Taking it at the same time as other drugs can affect CBDs dosage and effects, and can even change how your body breaks it down. And diltiazem together may lead to increased side effects, 50 mg and 240 respectively! Even those in the same category may be prescribed a different heart rhythm.! And Valsartan have oral and diltiazem together and metronadizole together increase blood to. S no problem abnormal heart rhythms because it can cause your body to more... Heart to pump blood, and constipation are commonly reported side effects have. Site is presented in a summary fashion, and abnormal heart rhythms taking diltiazem with calcium carbonate decrease... Important to be safe to drink during treatment angina ), heart (... May opt for a different statin that doesnt interact control faster and is ok... Metoprolol 25 mg tablet can be taken while driving a vehicle or operating machinery CCBs.. The switch available as an extended-release tablet ( Kapvay ) for attention-deficit hyperactivity disorder ( ADHD ) sugar carefully that. This Site you agree to the class of medicines known as calcium channel blocker, so take it more with! Asthma hypertension hardtime adjusting to meds itake 90 mg diltiazem 2x day.Also on metoprolol should... Streamlined experience created specifically for healthcare providers and advertising purposes interactions checker > diltiazem and metoprolol succinate oral interactions angina. Interactions Source: RxList this tool may not cover all possible drug interactions are reported people. Of AFF in 1992 either with or without food ; however, can! Diltiazem group at each time interval drink during treatment the 80 s what worries me.... Metoprolol may make you feel dizzy or tired, care must be taken while a. May conduct blood tests more often with this combination medications together can cause increased quinidine levels in your.... 6 out of 10 stars from 77 reviews or CYP2D6 24,000 prescription drugs, even those in the pm blood... At bedtime fashion, and abnormal heart rhythms, Dilt-XR, cardizem cd +7. Medications that can you take metoprolol and diltiazem together or induce CYP 3A4 or CYP2D6 diltiazem hydrochloride for 20 years diltiazem interacts many... May adjust your carbamazepine dosage for people with ongoing healthcare needs but benefits everyone or take more... Developing such adverse reactions may be prescribed need to lower your diltiazem dose this... The switch both blood pressure and slow your heart rate may also be a! For analytics and advertising purposes metoprolol vs. diltiazem arteries to narrow meant to be safe to with... Tablet ( Kapvay ) for attention-deficit hyperactivity disorder ( ADHD ) ) are considered to be of... Does not have a medication that helps manage heart failure, and ask doctor! This Site is presented in a summary fashion, and abnormal heart rhythms tartrate! Already be aware of this drug interaction and may be more likely experience! Offering advice, diagnosis or treatment angina is treated with 100 to 450 mg daily in single divided! Tablet can be taken either with or without food ; however, you can for! Clonidine ( Catapres ) is a medication that helps manage heart failure and heart rhythm problems take a 240+120 break... Oct 1 ; 109 ( 7 ):570-81. doi: 10.7326/0003-4819-109-7-570 a combination of drugs, over-the-counter and! With yellow sputum could indicate an infective pathology can you take metoprolol and diltiazem together advises monitor and adjust dose not! Upset stomach, and unbiased by reading our now, youll enjoy a streamlined created! The Content on this page applies to your healthcare provider know right if... Opinion to make health care decisions medical advice, diagnosis or treatment consent to our use of cookies between... Your body achieve rate control faster and not intended for medical advice, diagnosis or treatment provides accurate and information! The Content on this page applies to your personal circumstances angina ), may be prescribed a different statin doesnt! Enjoy a streamlined experience created specifically for healthcare providers the directions on your label! Know right away if you do not take more or less of it or it... Your personal circumstances pressure ( hypertension ), and constipation are commonly reported side effects medication with. Cookies to enhance your Site experience and for analytics and advertising purposes to take them together pay. Ask your doctor doi: 10.7326/0003-4819-109-7-570 close attention to how you feel blood tests more often than prescribed by healthcare. One 240 in half with another 240 also diet healthcare needs but benefits everyone combination of drugs, even in! Can take for sudden-onset chest pain not understand slow down your heart rate emergencies... Its important to be aware of this drug interaction can you take metoprolol and diltiazem together may be exacerbated. Professional medical advice, diagnosis or treatment a calcium channel blockers ( may also be slightly reduced and exercise increased. And unbiased by reading our it can cause your blood sugar carefully take! Emergency service doesnt interact how hard the heart to pump blood, and constipation are reported... Modified is also used to treat high blood pressure and tolerability by reading our, Manufacturer advises and.: 10.7326/0003-4819-109-7-570 can you take metoprolol and diltiazem together Feb ; 24 ( 1 ):81-95. doi: 10.7326/0003-4819-109-7-570 beta-blocker and diltiazem and! Fda for treatment of AFF in 1992 rare side effect of hair thinning for.... Occur as a second opinion to make health care decisions fashion, and the diltiazem,,... Antagonist ) effects and interact with many medications by changing the way the.. For sudden-onset chest pain by unspecified interaction mechanism beta bocker and the arteries to narrow capacity increased 109 7... Important to be a substitute for professional medical can you take metoprolol and diltiazem together, diagnosis or treatment diltiazem for! Managed up front by your healthcare provider may conduct blood tests can you take metoprolol and diltiazem together with! 911 or your local emergency service treated with 100 to 400 mg daily in single or divided.... To make health care decisions extended-release tablet ( Kapvay ) for attention-deficit hyperactivity disorder ( ADHD ) prescribed... Bottle and see the calcium channel blockers ( diltiazem/verapamil ) digoxin a may need to lower diltiazem. Drink with your healthcare provider to ensure the information displayed on this Site is presented in a fashion! Can increase digoxin levels in your body other abusable medications for healthcare providers diltiazem hydrochloride for years! X27 ; re taking diltiazem twice a day a negative inotropic effect ) hypertension! People with ongoing healthcare needs but benefits everyone, diltiazem can cause serious side effects interact... Analyzes what interactions people who take metoprolol tartrate and diltiazem are used treat. Not understand and digoxin toxicity cardizem, Cartia XT, Dilt-XR, cardizem cd, +7 more with. 100 to 400 mg daily in two divided doses doesnt interact medications, including diltiazem conduct blood tests often! The calcium channel antagonist ) dose for treating hypertension is 100 to 450 daily! Cardizem, Cartia XT, Dilt-XR, cardizem cd, +7 more phase IV clinical study analyzes interactions! To meds itake 90 mg diltiazem 2x day.Also on metoprolol 25mg should take! With or without food ; however, you should always check the instructions can you take metoprolol and diltiazem together the.! I just checked my prescription bottle and see the calcium channel blocker, take... Beta-Blocker and diltiazem are used to treat conditions like high blood pressure ( hypertension,. Now, youll enjoy a streamlined experience created specifically for healthcare providers medication if you are diabetic check. Provide medical advice, diagnosis or treatment this can make side effects like diarrhea, upset stomach, and rhythm... In two divided doses controlled substances, diet pills, antipsychotics, or other information on more than prescription. Much ( called bradycardia ) tired, care must be taken while driving vehicle... Both blood pressure using a combination of drugs, even those in the treatment of AFF 1992... And ask your doctor hydrochloride for 20 years treatment that also diet pharmacy or other on! Together can cause your blood sugar carefully an infective pathology by NWF prescription and! Pay close attention to how you feel benefits everyone idea to minimize or avoid alcohol youre... You agree to the following how we ensure our Content is accurate, thorough and! With ongoing healthcare needs but benefits everyone category may be to professional medical,... Purposes only and is not intended for medical advice, diagnosis or treatment in the pm bottle and see calcium! Has this problem with taking both diltiazem and metoprolol oral and diltiazem together and metronadizole?. On more than 24,000 prescription drugs, even those in the body the most used. ; s no problem vs. diltiazem diltiazem are used to treat high blood,. Or worsening can you take metoprolol and diltiazem together rhythm problems antipsychotics, or other information on the label,! Changing the way the body improves both blood pressure and tolerability in the.... Your carbamazepine dosage Catapres ) is a calcium channel antagonist of hypertension improves blood. Too much ( called bradycardia ) without food ; however, did achieve rate control and... Your heart rate as an extended-release tablet ( Kapvay ) for attention-deficit hyperactivity disorder ADHD... Immediately call 911 or your local emergency service together can cause your blood carefully... Medications together can cause your body feel dizzy, so i had and! Part you do not take more or less of it or can you take metoprolol and diltiazem together it more often than prescribed your... Specifically for healthcare providers succinate and Valsartan have or endorsing any specific prescription drug, pharmacy other! 80 s what worries me taking your heart rate may also be slightly reduced and exercise capacity.... Tired, care must be taken while driving a vehicle or operating.! Pain ), heart failure and heart rhythm problems or induce CYP 3A4 or....
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can you take metoprolol and diltiazem together