Herbesser R 100/Herbesser R 200 Special Precautions

Herbesser R 100/R 200 should be administered with care in the following patients:
Patients with congestive heart failure. (The symptoms may be exacerbated.)
Patients with severe bradycardia (<50 beats/min) or with 1st degree atrioventricular block. (The inhibitory action on sinus rhythm and cardiac conduction of the drug may occur excessively.)
Patients with severe hypotension. (The blood pressure may be reduced further.)
Patients with severe hepatic and renal dysfunction. (The action of Herbesser R 100/R 200 may be enhanced due to the delayed metabolism and excretion.)
It has been reported that abrupt withdrawal of Herbesser R 100/R 200 may result in aggravation of symptoms in patients receiving treatment with calcium antagonists. If the drug is withdrawn, the dosage should be gradually reduced and the patients should be closely monitored. The patients should be instructed not to discontinue taking the drug without consulting a physician.
It has been reported that concomitant use of other antiarrhythmic agents (disopyramide phosphate) with terfenadine may result in QT interval prolongation and ventricular arrhythmia including torsades de pointes.
Effects on the Ability to Drive or Operate Machinery: Since dizziness, etc due to hypotensive effect may occur, the patients should be cautioned against engaging in potentially hazardous activities requiring alertness eg, driving a car, working at heights or operating machinery, etc.
Use in lactation: It is advisable to avoid using Herbesser R 100/R 200 in lactating mothers. If use of the drug is judged to be essential, breastfeeding must be discontinued during treatment. (It has been reported that Herbesser R 100/R 200 is excreted in breast milk.)
Use in children: The safety of Herbesser R 100/R 200 in children has not been established.
Use in the elderly: An excessive reduction in blood pressure is undesirable in elderly patients. Therapy should therefore be instituted with special care, starting at a reduced dosage with careful monitoring of the patient's condition.