Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Experience in the use of antiarrhythmic agents following maintenance infusion of diltiazem hydrochloride injection is limited. Based on the results of pharmacokinetic studies in healthy volunteers administered different oral diltiazem hydrochloride formulations, constant rate intravenous infusions of diltiazem hydrochloride at 3, 5, 7, and 11 mg/h are predicted to produce steady-state plasma diltiazem concentrations equivalent to 120-, 180-, 240-, and 360-mg total daily oral doses of diltiazem hydrochloride tablets or diltiazem hydrochloride extended-release capsules. official website and that any information you provide is encrypted Photographic documentation can be helpful for follow-up procedures. IV Infiltration - Definition, Signs, Treatment, Management f8.5$_t_ htt_t_ htu 8|?f|o_xR}A)xcw{|YwO]oz46Qm` QOSi p"e3b9Ez1xr&(^L{/s<<1XW^YQIN2MZ_t_ htt_t_ htu?D_sunm5]BZ>,t vncs; xF,~kjM+`}h_. PDF 3364-133-125 Treatment of Intravenous Non-Chemoterapeutic Extravasations Concepts in oncology therapeutics: a self-instructional course. %%EOF Diltiazem may impair your thinking or reactions. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. Liver cirrhosis was shown to reduce diltiazem's apparent oral clearance and prolong its half-life. The primary outcome was the change in SBP 60 min (+/- 30 min) after initial IV diltiazem administration. The usual dose range of oral diltiazem for the treatment of hypertension is 180 to 360 mg daily. National Center for Biotechnology Information Cardiac Failure: Administer inotropic agents (isoproterenol, dopamine, or dobutamine) and diuretics. 0000022294 00000 n * 5 mg/h may be appropriate for some patients. The .gov means its official. These problems may be less likely to occur if blood pressure is controlled. It has a pH range of 3.7 to 4.1. hbbbd`b``3 Diltiazem (Oral Route) Your gift holds great power - donate today! Nervous System: Abnormal dreams, amnesia, depression, extrapyramidal symptoms, gait abnormality, hallucinations, insomnia, nervousness, personality change, somnolence, tremor Other: acute generalized exanthematous pustulosis, allergic reactions, angioedema (including facial or periorbital edema), CPK elevation, epistaxis, eye irritation, gingival hyperplasia, hemolytic anemia, hyperglycemia, impotence, increased bleeding time, leukopenia, muscle cramps, myopathy, nasal congestion, nocturia, osteoarticular pain, photosensitivity (including lichenoid keratosis and hyperpigmentation at sun-exposed skin areas), polyuria, retinopathy, sexual difficulties, thrombocytopenia, tinnitus. trailer Use diltiazem as a continuous IV infusion for rate control in supraventricular tachycardiain patients without concomitant LV systolic dysfunction.33-35 (Class II, Level B) 14.2. Patients with sick sinus syndrome except in the presence of a functioning ventricular pacemaker. Hypotension: Vasopressors (e.g., dopamine or norepinephrine). This relaxes the blood vessels, lowers blood pressure, and increases the supply of blood and oxygen to the heart while reducing its workload. Tips Extended-release diltiazem capsules should be taken on an empty stomach (this means one hour before food or two hours after food). Stopping suddenly may make your condition worse. Risk factors can be classified under patient-related, procedure-related, and product or product-related factors. Narcotic analgesics may be required to reduce severe pain around widespread extensive necrosis. Intravenous diltiazem and intravenous beta-blockers should not be administered together or in close proximity (within a few hours). Monitor heart rate in patients receiving concomitant diltiazem and clonidine. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. } !1AQa"q2#BR$3br No report of Extravasation is found in people who take Diltiazem hydrochloride. Distributed by: It has a molecular weight of 451.0. Although drugs can be administered by methods (e.g., micro-patch, micro-injection) other than IV injection, extravasation cannot be totally avoided because there are drugs that can only be administered through IV or central vein injection. Diltiazem has no significant electrophysiologic effects on tissues in the heart that are fast sodium channel dependent, e.g., His-Purkinje tissue, atrial and ventricular muscle, and extranodal accessory pathways. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. HCl Injection Pharmacokinetics and Metabolism Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. 3. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Diltiazem plasma levels were not significantly affected by lovastatin or pravastatin. For the most part, blood does not backflow. Continuous Intravenous Infusion In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapeutic drugs in the tissues surrounding the IV site. Journal of Educational Evaluation for Health Professions, http://creativecommons.org/licenses/by/4.0/, https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Policy_V5.0_June_18.pdf, http://www.uic.edu/pharmacy/centers/drug_information_center/faq/extravasation.php, https://manchestercancer.files.wordpress.com/2014/09/extravasation_sept20131.pdf, Tissue loss exposing muscle/bone with a deep crater or necrosis. Cardiac Conduction - Diltiazem prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm. It is the brilliant info like a diamond that is useful for the training of the interns, nurses, and medical laboratory technicians who routinely work for the vascular injection. Extravasation kit includes the following: 25G needle, 10-cc syringe, and 1-mL syringe; disinfection swabs, sterile gauze, and adhesive bandage; saline solution (1 ampule); sterile distilled water (1 ampule); dimethyl sulfoxide 99% solution; hyaluronidase 1,500 U/mL (refrigerated); hydrocortisone cream 1%; sodium thiosulfate 25% solution; and warm pack and an ice pack (frozen). injury. You should not stop using diltiazem suddenly. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Be careful if you drive or do anything that requires you to be alert. Geriatric Use 0000006222 00000 n <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys . Anti-anxiety medications called benzodiazepines (such as midazolam, triazolam, and others) as well as busipirone; Beta-blockers (such as atenolol, carvedilol, metoprolol, propranolol, sotalol, and others); Cholesterol medication called statins (such as atorvastatin, lovastatin, simvastatin, rosuvastatin, and others). Discuss the use of grapefruit products with your doctor. tiazac. Diltiazem is a calcium channel blocker. Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Management of Drug Extravasations The frequency of extravasation in adults is reported to be between 0.1% and 6%. endstream endobj 513 0 obj <. - Directions: apply hot fomentations for 20 to 30 minutes four to 6 times per day (for 1 day or more). 0000029746 00000 n 25 mg per 5 mL (5 mg/mL) 5 mL Single-Dose Vials Blood backflow works well, and edema or ulcer do not occur. 25 mL Single-Dose Vials Supplement 5. Guideline for the management of extravasation of a cytotoxic agent or a monoclonal antibody used in the treatment of malignant disease: version 4.2. Drug information handbook for oncology: a complete guide to combination chemotherapy regimens. This content does not have an English version. In controlled clinical trials, therapy with antiarrhythmic agents to maintain reduced heart rate in atrial fibrillation or atrial flutter or for prophylaxis of PSVT was generally started within 3 hours after bolus administration of diltiazem hydrochloride injection. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. 1Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, Korea, 2Department of Clinical Nursing, University of Ulsan, Seoul, Korea. The patients normal activities, such as at home, work, school, etc., may be disrupted until the patient is fully recovered. This document is only valid for the day on which it is accessed. severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. Swallow it whole. Following oral administration, 2% to 4% of the unchanged diltiazem appears in the urine. The use of vasopressor medications is the mainstay in management of patients with distributive shock in intensive care unit (ICU). These metabolites are observed, however, following 24 hour constant rate intravenous infusion. .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 - For observation, do not cover the cannula area with opaque gauze. Diltiazem is in a class of medications called calcium-channel blockers. If you are being treated for high blood pressure, keep using this medicine even if you feel well. Three solutions were used: 1/2 saline (154 mOsm), normal saline (308 mOsm), and 3% saline (1027 mOsm). Rheumatology (Oxford) 2000; 39:333. Discoloration and edema do not occur. Particular information must be given when a vesicant drug is administered. 113. Based on this relationship, the mean plasma diltiazem concentration required to produce a 20% decrease in heart rate was determined to be 80 ng/mL. Advertising revenue supports our not-for-profit mission. In patients with atrial fibrillation and atrial flutter, a significant correlation was observed between the percent reduction in HR and plasma diltiazem concentration using the Sigmoidal Emax model. Diltiazem | RxWiki Follow your diet, medication, and exercise routines very closely. hb```l Packaged in a Carton of 10 NDC 55150-427-10 Store product under refrigeration 2 to 8C (36 to 46F). Duration of infusion longer than 24 hours and infusion rates greater than 15 mg/h have not been studied. However, if you have symptoms of low blood pressure (dizziness, fainting, weakness, or blurred vision), call your doctor and stop taking diltiazem. Diltiazem extravasation. You should not use diltiazem if you have very low blood pressure, a serious heart condition such as "sick sinus syndrome" or "second- or third-degree AV block" (unless you have a pacemaker), or if you have recently had a heart attack and you have a build-up of fluid in your lungs. The average age of the children in this study was about 3 years. Drugs with high osmolarity. . If you are being treated for high blood pressure, keep using this medicine even if you feel well. General Package insert / product label These pharmacokinetic effects seen during diltiazem coadministration can result in increased clinical effects (e.g. Received 2020 Jul 16; Accepted 2020 Jul 16. 1997. Patients taking other drugs that are substrates of CYP450 3A4, especially patients with renal and/or hepatic impairment, may require dosage adjustment when starting or stopping concomitantly administered diltiazem in order to maintain optimum therapeutic blood levels. Diltiazem shows dose-dependent, non-linear pharmacokinetics. Calcinosis cutis: Management - UpToDate 5. Cardizem, Cartia XT, Dilt-XR, Cardizem CD, +7 more. Ivabradine - Concurrent use of diltiazem increases exposure to ivabradine and may exacerbate bradycardia and conduction disturbances. 8600 Rockville Pike Immediately following bolus administration of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) diltiazem hydrochloride injection and reduction of heart rate, begin an intravenous infusion of diltiazem hydrochloride injection. Metoprolol Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Medication Thermal Therapy Antidote Dose Treatment Nitroglycerin Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Norepinephrine Heat Nitroglycerin 2% paste n/a Apply thin layer to area of extravasation q 6 hr x 24 hr Chemically, diltiazem hydrochloride is 1,5-benzothiazepin-4-(5H)-one,3-(Acetyloxy)-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(-4-methoxyphenyl)-, monohydrochloride, (+)-cis-. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, GUID:367E9C1D-E270-4114-AA3D-21C537398B1B, GUID:D253D40D-77BC-48AC-A9B8-1814B76155B0, GUID:AD28B884-86A0-4E06-8641-E315D06B067F, GUID:3AC69EF7-5706-454E-AEA5-D87005B23EF4, GUID:D75BDE9D-DD6A-421F-A27E-A2A0FE0A12C1, GUID:6CED1AD4-FC08-4A32-B5E3-E0B71BFF0284, Extravasation, Antidotes, Intravenous injections, Patient care, Risk factors. INTRODUCTION. IV Push IVPB IVPB IVPB EXTRAVASATION PRECAUTION - May be Harmful. Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician. Patients with low body weights should be dosed on a mg/kg basis. Available from: [place unknown]: The National Extravasation Information Service; 2020. However, reference should be made to the respective agent manufacturer's package insert for information relative to dosage and administration. (5 mg/mL) Please enable it to take advantage of the complete set of features! Discard unused portion. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Waltham (MA): UpToDate Inc; c2020. - Assess patients sensory changes, tingling or burning, and always pay attention to the words of patients. hb``d``f`c`P "@1vG(r8}C#7mcH`KfYtfnzv$@,BKK~x$3$shElVVp A_8{.>9UiiGK:&ALg>)tvNV-+>'(yqnSg@Em.P^''*.^. 42 . Administration of oral doses ranging from five to ten times greater (on a mg/kg basis) than the daily recommended oral antianginal therapeutic dose has resulted in embryo and fetal lethality. Packaged in a Carton of 10 NDC 55150-426-10 government site. Occurs due to contraction of the vessel wall and usually happens as soon as the fluid injection begins. The use of diltiazem hydrochloride injection should be undertaken with caution when the patient is compromised hemodynamically or is taking other drugs that decrease any or all of the following: peripheral resistance, myocardial filling, myocardial contractility, or electrical impulse propagation in the myocardium. Oral administration of diltiazem with propranolol in five normal volunteers resulted in increased propranolol levels in all subjects and bioavailability of propranolol was increased approximately 50%. . Therefore, infusion duration exceeding 24 hours and infusion rates exceeding 15 mg/h are not recommended. - Do not insert the cannula in the antecubital fossa area, where it is extremely difficult to detect extravasation. The T1/2 and Tmax of buspirone were not significantly affected by diltiazem. Overdosage experience is limited. - Secure the cannula during the administration of the drug. Asymptomatic hypotension occurred in 4.3% of patients. 2737 0 obj <> endobj See this image and copyright information in PMC. Reproduction studies have been conducted in mice, rats, and rabbits. Competitive in vitro ligand binding studies have shown that diltiazem binding is not altered by therapeutic concentrations of digoxin, phenytoin, hydrochlorothiazide, indomethacin, phenylbutazone, propranolol, salicylic acid, tolbutamide, or warfarin. Give a list of all your medicines to any healthcare provider who treats you. If intravenous diltiazem is administered to patients receiving chronic oral beta-blocker therapy, the possibility for bradycardia, AV block, and/or depression of contractility should be considered (see CONTRAINDICATIONS). The study suggested that diltiazem ointment was better than GTN at healing anal fissures in children (23 out of 28 using diltiazem were healed compared with 11 out of 28 using GTN). Spots or solid lines with blisters can be suddenly felt along the vessels injected with drugs. Cardizem and Infusion site extravasation - eHealthMe If coadministration of simvastatin with diltiazem is required, limit the daily doses of simvastatin to 10 mg and diltiazem to 240 mg. Drug classes: Calcium channel blocking agents, Group IV antiarrhythmics. BIT Druginfo website [Internet] [cited 2020 Jul 10]. Your doctor will tell you which of these are most important for you. Subsequent intravenous bolus doses should be individualized for each patient. Follow all directions on your prescription label. - Watch for edema, inflammation, and pain around the cannula during administration. Diltiazem Diltiazem hydrochloride injection is a clear, colorless, sterile, nonpyrogenic solution. High-degree AV Block: Treat as for bradycardia above. National Library of Medicine Diltiazem is a calcium channel blocker. No potential conflict of interest relevant to this article was reported. Hyderabad 500032 Drug information provided by: Merative, Micromedex. IV Push IV infusion . 0000002293 00000 n Accessibility They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. Rapid conversion of paroxysmal supraventricular tachycardias (PSVT) to sinus rhythm. Effect of warm and cold applications on the resolution of i.v Diltiazem (Oral Route) Proper Use - Mayo Clinic Only 1 of the studies of diltiazem was in children. Reduction in mean arterial pressure correlated linearly with diltiazem plasma concentration in a group of hypertensive patients. The https:// ensures that you are connecting to the Avoid drinking alcohol while taking diltiazem. Before In vitro studies suggest alpha1-acid glycoprotein binds approximately 40% of the drug at clinically significant concentrations. PDF Treatment and Care of Peripheral Intravenous Extravasations 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. Bookshelf 0000019842 00000 n Patients should be dosed on an individual basis and reference should be made to the respective manufacturer's package insert for information relative to dosage and administration. Heart rate reduction may last from 1 to 3 hours. Diltiazem hydrochloride injection was found to be physically compatible and chemically stable in the following parenteral solutions for at least 24 hours when stored in glass or polyvinylchloride (PVC) bags at controlled room temperature 15 to 30C (59 to 86F) or under refrigeration 2 to 8C (36 to 46F). 279 Princeton-Hightstown Rd. (5 mg/mL) The medical teams continuous education on extravasation is essential. Renal insufficiency, or even end-stage renal disease, does not appear to influence diltiazem disposition following oral administration. You should not breastfeed while using this medicine. Phase IV trials are used to detect adverse drug outcomes and monitor drug effectiveness in the real world. Management of Extravasation Injuries: A Focused Evaluation of Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. 125 mg per 25 mL (5 mg/mL) Supplement 6. It is soluble in water, methanol, and chloroform. After oral administration, diltiazem undergoes extensive metabolism in man by deacetylation, N-demethylation, and O-demethylation via cytochrome P-450 (oxidative metabolism) in addition to conjugation. Pharmacologic interventions for extravasation You may need to use blood pressure medicine for the rest of your life. These doses, in some studies, have been reported to cause skeletal abnormalities. Infusions of calcium for 24 hours or more may be required. Nervous System: Dizziness, paresthesia The following are common drugs that interact with diltiazem; Not all possible interactions are listed in this medication guide. Common symptoms and signs of extravasation include pain, stinging or burning sensations, and edema around the intravenous (IV) injection site. Dermatologic: Pruritus, sweating 8600 Rockville Pike Disclaimer. In some cases intravenous calcium has been administered (1 g calcium chloride or 3 g calcium gluconate) over 5 minutes, and repeated every 10 to 20 minutes as necessary. In renal and cardiac transplant recipients, a reduction of cyclosporine dose ranging from 15% to 48% was necessary to maintain cyclosporine trough concentrations similar to those seen prior to the addition of diltiazem. Drug class: calcium channel blocking agents, ANALYSIS(55150-425, 55150-426, 55150-427), MANUFACTURE(55150-425, 55150-426, 55150-427), PACK(55150-425, 55150-426, 55150-427), dextrose (5%) and sodium chloride (0.45%) injection, USP. The infusion may be maintained for up to 24 hours. Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. Administration of other calcium channel blockers to patients with wide complex tachycardia (QRS 0.12 seconds) has resulted in hemodynamic deterioration and ventricular fibrillation. The use of local warming therapy (dry heat) is based on the theory that it enhances vasodilation, thus enhancing the dispersion of the vesicant agent and decreasing drug accumulation in the local tissue. Writingreview & editing: JTK, JYP, HJL, YJC. Available from: [place unknown]: [publisher unknown]; 2018.
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