In domestic controlled trials, bolus administration of diltiazem hydrochloride injection was effective in converting PSVT to normal sinus rhythm in 88% of patients within 3 minutes of the first or second bolus dose. The infusion rate may be increased in 5 mg/h increments up to 15 mg/h as needed, if further reduction in heart rate is required. Avoid concomitant use of ivabradine and diltiazem. 0000010698 00000 n Alteplase Adult Assess for hemorrhage during first hour of treatment. - Edema around the port insertion or in the chest, or medication leakage around the catheter insertion, - Redness in the chest, collarbone, or neck where a central venous catheter is inserted. HHS Vulnerability Disclosure, Help startxref %PDF-1.5 % Diltia XT, Dilt-XR, Diltzac, Matzim LA, Taztia XT, Tiadylt ER, Tiazac HCl Injection Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Chemically, diltiazem hydrochloride is 1,5-benzothiazepin-4-(5H)-one,3-(Acetyloxy)-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(-4-methoxyphenyl)-, monohydrochloride, (+)-cis-. PDF Treatment and Care of Peripheral Intravenous Extravasations 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. At the first sign of extravasation, the following steps are recommended: (1) stop administration of IV fluids immediately, (2) disconnect the IV tube from the cannula, (3) aspirate any residual drug from the cannula, (4) administer a drug-specific antidote, and (5) notify the physician (Fig. One hundred two (102) patients <65 had a response rate of 78%. Take diltiazem exactly as prescribed by your doctor. 6. Calcium channel blockers (CCBs) are among the most commonly used cardiovascular drugs in the adult population. The mean ejection fraction and cardiac output/index remained unchanged or increased. However, no guidelines can be perfect, and they need to be regularly updated. The staff involved in the infusion and management of cytotoxic drugs must be trained to implement several preventive protocols for the minimization of the risk of extravasation. Vinen CS, Patel S, Bruckner FE. The usual dose range of oral diltiazem for the treatment of hypertension is 180 to 360 mg daily. 279 Princeton-Hightstown Rd. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. High blood pressure may also increase the risk of heart attacks. Bookshelf Pain or tightening occurs along the vein, and it is caused mainly by drugs such as vinorelbine and dacarbazine. In subgroup analysis of double-blind and open-label trials following first-dose response, 116 patients 65 years of age had a response rate of 84%. High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys . 1). 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. This document is only valid for the day on which it is accessed. The audio recording of the abstract. Copyright: Merative US L.P. 1973, 2023. PDF Critical Care Intravenous Drug Administration Guide - SGUL HHS Vulnerability Disclosure, Help Physical Incompatibilities: Because of potential physical incompatibilities, it is recommended that diltiazem hydrochloride injection not be mixed with any other drugs in the same container. 0000029978 00000 n IV Push IV infusion . Should a dermatologic reaction persist, the drug should be discontinued. 2. Management of Drug Extravasations Available from: [place unknown]: [publisher unknown]; 2018. Diltiazem may impair your thinking or reactions. The patient should receive the skin graft for recovering her arm skin. National Center for Biotechnology Information - Regularly check the extravasation kit and refill any used medications. Liver cirrhosis was shown to reduce diltiazem's apparent oral clearance and prolong its half-life. The usual dose range of oral diltiazem for controlling chest pain is 120 to 480 mg daily. Elevation of the limb may aid in reabsorption of the infiltrate or extravasated vesicant by decreasing capillary hydrostatic pressure. DO NOT flush the line 7. Spots or solid lines with blisters can be suddenly felt along the vessels injected with drugs. Last updated on Mar 22, 2023. If you stop taking diltiazem suddenly, your condition may become worse. Diltiazem is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders. Infusions of calcium for 24 hours or more may be required. But it must be done carefully because this area can suffer a more severe injury due to extravasation. Renal insufficiency, or even end-stage renal disease, does not appear to influence diltiazem disposition following oral administration. Diltiazem: 7 things you should know - Drugs.com Rheumatology (Oxford) 2000; 39:333. The primary purpose of these guidelines is to minimize the side-effects of IV injection, by suggesting proper and prompt emergency measures for extravasation and the appropriate treatments corresponding to the properties of the injected drug. In addition, the following events were reported infrequently (less than 1%): Chicago (IL): University of Illinois College of Pharmac; c2020. 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 (Oral Route) Your gift holds great power - donate today! Patients with sick sinus syndrome except in the presence of a functioning ventricular pacemaker. IV Infiltration - Definition, Signs, Treatment, Management 50 mg per 10 mL 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. Eugia Pharma Specialities Limited To make sure diltiazem is safe for you, tell your doctor if you have: if you also take digoxin, or a beta blocker (such as atenolol, carvedilol, metoprolol, propranolol, sotalol, and others). Calcium gluconate has also been administered as a continuous infusion at a rate of 2 g per hour for 10 hours. Stopping suddenly may make your condition worse. 2783 0 obj <>/Filter/FlateDecode/ID[<6BD6636305F82045A9925B53BB86E57F><9F492AA58F605D44ADB81D4034C4D4D8>]/Index[2737 102]/Info 2736 0 R/Length 173/Prev 1462405/Root 2738 0 R/Size 2839/Type/XRef/W[1 3 1]>>stream Intravenous diltiazem and intravenous beta-blockers should not be administered together or in close proximity (within a few hours). Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Events such as myocardial infarction have been observed which are not readily distinguishable from the natural history of the disease for the patient. If you are being treated for high blood pressure, keep using this medicine even if you feel well. 0000025065 00000 n 0000003340 00000 n (5 mg/mL) 8600 Rockville Pike Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Worldwide experience in over 1,300 patients was similar. xref 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). In vitro, propranolol appears to be displaced from its binding sites by diltiazem. To prevent extravasation, a clinical specialist should perform the venipuncture or injection, who with relevant skills and management ability understands the properties of the injected drug. Englewood (CO): Micromedex Inc; [date unknown]. Patients with ventricular tachycardia. The infusion may be maintained for up to 24 hours. Blood backflow works well, and edema or ulcer do not occur. The therapeutic benefits of diltiazem in supraventricular tachycardias are related to its ability to slow AV nodal conduction time and prolong AV nodal refractoriness. We comply with the HONcode standard for trustworthy health information. Bethesda, MD 20894, Web Policies The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). An overdose of diltiazem can be fatal. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Be careful if you drive or do anything that requires you to be alert. sharing sensitive information, make sure youre on a federal There are no well-controlled studies in pregnant women; therefore, use diltiazem hydrochloride in pregnant women only if the potential benefit justifies the potential risk to the fetus. Do not use this medicine in larger or smaller amounts or for longer than recommended. Available for Android and iOS devices. official website and that any information you provide is encrypted The risk of myopathy and rhabdomyolysis with statins metabolized by CYP3A4 may be increased with concomitant use of diltiazem. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. This content does not have an Arabic version. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Keywords: Only 1 of the studies of diltiazem was in children. One report with oral diltiazem suggests that concentrations in breast milk may approximate serum levels. Narcotic analgesics may be required to reduce severe pain around widespread extensive necrosis. 2737 0 obj <> endobj However, in rare instances, worsening of congestive heart failure has been reported in patients with preexisting impaired ventricular function. The following adverse reaction rates are based on the use of diltiazem hydrochloride injection in over 400 domestic clinical trial patients with atrial fibrillation/flutter or PSVT under double-blind or open-label conditions. Therapists will always feel nervous during the medical team-patient communication because of guilt. Discard Unused Portion Store Under Refrigeration Intravenous Infusion (5 mg/mL) Patients who have demonstrated hypersensitivity to the drug. Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. Torralba TP, Li-Yu J, Navarra ST. You should not stop using diltiazem suddenly. Similar ventricular complexes have been noted during cardioversion, other pharmacologic therapy, and during spontaneous conversion of PSVT to sinus rhythm. These two medications are different than other calcium channel blockers because they have direct action on cardiac tissue at therapeutic levels. . Do not crush, chew, break, or open an extended-release diltiazem tablet or capsule. The heart rate reduction may last from 1 - 3 hours. - Even if there is an existing IV route, secure a new route when administering vesicant drugs. Diltiazem hydrochloride injection is for direct intravenous bolus injection and continuous intravenous infusion. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream 25-mg, 5-mL vialeach sterile vial contains 25 mg diltiazem hydrochloride, 3.75 mg citric acid USP, 3.25 mg sodium citrate dihydrate USP, 357 mg sorbitol solution USP, and water for injection USP up to 5 mL. Venous shock can occur when injecting very cold medication or when medication is injected at a rapid pace. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. The guidelines described herein are based on the authors best practice for the management and prevention of the extravasation. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Intravenous Infusion See this image and copyright information in PMC. Digitalis - Intravenous diltiazem has been administered to patients receiving either intravenous or oral digitalis therapy. Statins - Diltiazem is an inhibitor of CYP3A4 and has been shown to increase significantly the AUC of some statins. The frequency of extravasation in adults is reported to be between 0.1% and 6%. 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). However, the study had only a small number of 125 mg per 25 mL Atrial fibrillation or atrial flutter - In clinical studies with diltiazem hydrochloride injection for AF/FI, 135 of 257 patients were 65 years of age. Diltiazem (Cardizem, Tiazac, others) Felodipine; Isradipine; Nicardipine; Nifedipine (Procardia) Nisoldipine (Sular) Verapamil (Calan SR, Verelan) Sometimes, a doctor might prescribe a calcium channel blocker with other high blood pressure medications or with cholesterol-lowering drugs such as statins. 8600 Rockville Pike If possible, it is recommended that diltiazem hydrochloride injection not be co-infused in the same intravenous line. Paroxysmal Supraventricular Tachycardia Supplement 1. In patients administered bolus doses ranging from 2.5 mg to 38.5 mg, systemic clearance averaged 36 L/h. Calcium Channel Blockers (Verapamil and Diltiazem) - Picmonic - Watch for edema, inflammation, and pain around the cannula during administration. Revised: April 2023, Rx only NDC 55150-425-01 Waltham (MA): UpToDate Inc; c2020. %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz - Dilute stimulant drugs as much as possible and inject them at a proper rate. 113. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or in vitro in bacteria. In vitro studies suggest alpha1-acid glycoprotein binds approximately 40% of the drug at clinically significant concentrations. The purpose of these practice guidelines is to offer and share strategies for preventing extravasation and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled experts at intravenous (IV) injection. Reproduction studies have been conducted in mice, rats, and rabbits. Following a single intravenous injection in healthy male volunteers, diltiazem hydrochloride appears to obey linear pharmacokinetics over a dose range of 10.5 to 21.0 mg. Compatibility: Diltiazem hydrochloride injection was tested for compatibility with three commonly used intravenous fluids at a maximal concentration of 1 mg diltiazem hydrochloride per milliliter. 332 33 3. Use diltiazem cautiously in treatment of patients with concomitant LV systolic dysfunction because the negative inotropic effect can cause hypotension. 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. 2. Limited data suggest that plasmapheresis or charcoal hemoperfusion may hasten diltiazem elimination following overdose. If it continues for a long time, the heart and arteries may not function properly. Medically reviewed by Kaci Durbin, MD. When used concomitantly, anesthetics and calcium blockers should be titrated carefully. 0000008421 00000 n Diltiazem Uses, Dosage & Side Effects - Drugs.com Rifampin - Coadministration of rifampin with diltiazem lowered the diltiazem plasma concentrations to undetectable levels. If high-degree AV block occurs in sinus rhythm, intravenous diltiazem should be discontinued and appropriate supportive measures instituted (see OVERDOSAGE). HCl Injection The https:// ensures that you are connecting to the As with all drugs, care should be exercised when treating patients with multiple medications. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. Pharmacokinetics and Metabolism - Check if there is any local discomfort or swelling by running a saline solution through the catheter, and then inject the drug. Diltiazem is in a class of medications called calcium-channel blockers. Management of extravasation includes nursing intervention and thermal application. 0000015118 00000 n .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 42 . Review/update the Hemodynamics Due to concern of potential extravasation and local tissue injury, central venous catheter (CVC) is the preferred route for vasopressor administration [].Despite this concern, vasopressors are administered via peripheral lines, often in resource . Your doctor will adjust the dose and frequency of diltiazem to your needs. Extravasation refers to the leakage of injected drugs from blood vessels causing damage to the surrounding tissues. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. DO NOT apply pressure to the area 6. Carcinogenesis, Mutagenesis, Impairment of Fertility, Paroxysmal supraventricular tachycardia -, Direct Intravenous Single Injections (Bolus), Quantity of Diltiazem hydrochloride injection, Transition to Further Antiarrhythmic Therapy, diltiazem hydrochloride injection, solution. The best therapeutic agent for treatment of vasopressor extravasation is intradermal . 533 0 obj <>/Filter/FlateDecode/ID[<5163DCD1F2812548B2C0DA027F0BBFFB>]/Index[512 38]/Info 511 0 R/Length 98/Prev 107501/Root 513 0 R/Size 550/Type/XRef/W[1 2 1]>>stream 0000029456 00000 n 25 mL Single-Dose Vials Nursing Department, Asan Medical Center . 125 mg per 25 mL (5 mg/mL) Destroy after 1 month at room temperature. Amiodarone: Guidelines for Use and Monitoring | AAFP - It dilates the blood vessels around the extravasation site, increases dispersion and absorption of the medicinal fluid by increasing the blood flow, and helps to quickly purge medicinal fluid that has leaked from the extravasation site. Delayed extravasation:Symptoms occur 48 hours, or later, after drug administration. Mechanisms of Action 42, 48 In two cases of TPN extravasation, 25 units of hyaluronidase were injected intradermally around the inflamed area, resulting in clinical improvement within 6-12 hours. Discard unused portion. - Veins on the back of the hand can be used, and in some cases, observation is easier. Sterile eugia 10 x 10 mL Single-Dose Vials, Rx only NDC 55150-427-01 Differences in volume were determined by magnetic resonance imaging (MRI) at three intervals postinfiltration. This medicine is available only with your doctor's prescription. Barton-Burke M, Wilkes GM, Ingwersen KC, Bean CK, Berg D. Cancer chemotherapy: a nursing process approach. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. Overdosage experience is limited. No potential conflict of interest relevant to this article was reported. Supplement 3. - Small and fragile veins in infants, children, or elderly patients, - Cancer patients with hardened and thickened vessels due to frequent venipuncture, - Patients with vessels that move easily during venipuncture attempts, - Patients with excised lymph nodes, limb amputation, or closed vena cava, - Obesity in which peripheral venous access is more difficult, - Inadequate choice of equipment (peripheral catheter choice, size, or steel needle). Diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. 512 0 obj <> endobj hb``d``f`c`P "@1vG(r8}C#7mcH`KfYtfnzv$@,BKK~x$3$shElVVp A_8{.>9UiiGK:&ALg>)tvNV-+>'(yqnSg@Em.P^''*.^. PDF Guide to Extravasation Management in Adult & Pediatric Patients Project administration: JTK, JYP, HJL, YJC. Diltiazem (Oral Route) Description and Brand Names - Mayo Clinic IV push over 10 minutes or IVPB as directed. endstream endobj 513 0 obj <. The first method may be appropriate following extravasation of vesicant drugs and involves administration of an antidote (if available) and the application of cold compresses 3-4 . Sodium hydroxide or hydrochloric acid is used for pH adjustment. Supplement 6. These metabolites are observed, however, following 24 hour constant rate intravenous infusion. Available from: [place unknown]: [publisher unknown]; 2018. - Once the needle is removed, apply pressure to the puncture site for about five minutes and elevate the limb. Sterile eugia 10 x 25 mL Single-Dose Vials, Cardizem, Cartia XT, Dilt-XR, Cardizem CD, +6 more, amlodipine, lisinopril, aspirin, metoprolol, losartan, furosemide, carvedilol, hydrochlorothiazide, spironolactone, propranolol. Continuous Intravenous Infusion 0 Photographic documentation can be helpful for follow-up procedures. 50-mg, 10-mL vialeach sterile vial contains 50 mg diltiazem hydrochloride, 7.5 mg citric acid USP, 6.5 mg sodium citrate dihydrate USP, 714 mg sorbitol solution USP, and water for injection USP up to 10 mL. Discoloration and edema do not occur. Regression of calcinosis associated with adult dermatomyositis following diltiazem therapy. Elevate the affected extremity 0000002293 00000 n Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota. These pharmacokinetic effects seen during diltiazem coadministration can result in increased clinical effects (e.g. In addition, caution should be used in patients taking other drugs that decrease peripheral resistance, intravascular volume, myocardial contractility or conduction. Calcium channel blockers - Mayo Clinic It is soluble in water, methanol, and chloroform. 7. PDF Diltiazem (Cardizem) - Advocate Health 0000029746 00000 n At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Gently aspirate extravasated drug. Writingreview & editing: JTK, JYP, HJL, YJC. Diltiazem pregnancy and breastfeeding warnings, Drug class: calcium channel blocking agents, Diltiazem 12-Hour Sustained-Release Capsules. You may need to use blood pressure medicine for the rest of your life. The leakage of the IV-administered fluids is clearly unintended, the condition being often presented as extravasation. However, if you have symptoms of low blood pressure (dizziness, fainting, weakness, or blurred vision), call your doctor and stop taking diltiazem. For Direct Intravenous Bolus Buspirone - In nine healthy subjects, diltiazem significantly increased the mean buspirone AUC 5.5 fold and Cmax 4.1 fold compared to placebo. Hudson (OH): Lexi-Comp Inc; 2000. Quinidine - Diltiazem significantly increases the AUC(0) of quinidine by 51%, T1/2 by 36% and decreases its CLoral, by 33%. The vial stopper is not made with natural rubber latex. Guideline for the management of extravasation of a cytotoxic agent or a monoclonal antibody used in the treatment of malignant disease: version 4.2. 5. You should not use diltiazem if you are allergic to it, or if you have: a serious heart condition such as "sick sinus syndrome" or "second- or third-degree AV block" (unless you have a pacemaker); if you have recently had a heart attack and you have a build-up of fluid in your lungs. The effect may be mediated by cimetidine's known inhibition of hepatic cytochrome P-450, the enzyme system responsible for the first-pass metabolism of diltiazem. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. - Directions: apply cold fomentations for 15 to 20 minutes four to 6 times per day (for 1 day or more). Pain, edema, and ulcer do not appear, and symptoms disappear within 30 to 90 minutes. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Before Skip the missed dose if it is almost time for your next scheduled dose. 0000001694 00000 n Apply sterile dressing over the area of extravasation, regularly assess the extravasation site during every shift, and take medical photographs and consult the department of cosmetic surgery if necessary. @ 5. 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. Conceptualization: JTK, JYP, HJL, YJC. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 0000029001 00000 n Cyclosporine - A pharmacokinetic interaction between diltiazem and cyclosporine has been observed during studies involving renal and cardiac transplant patients. Dermatologic: Pruritus, sweating Administration of other calcium channel blockers to patients with wide complex tachycardia (QRS 0.12 seconds) has resulted in hemodynamic deterioration and ventricular fibrillation. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.