A defibrillator and emergency equipment should be readily available. Diltiazem slows the ventricular rate in patients with a rapid ventricular response during atrial fibrillation or atrial flutter. - Once the needle is removed, apply pressure to the puncture site for about five minutes and elevate the limb. Keywords: The medical teams continuous education on extravasation is essential. Pregnancy Mix thoroughly. Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. These antiarrhythmic agents were intravenous or oral digoxin, Class 1 antiarrhythmics (e.g., quinidine, procainamide), calcium channel blockers, and oral beta-blockers. Experience with the use of diltiazem hydrochloride injection in patients with impaired ventricular function is limited. Subsequent intravenous bolus doses should be individualized for each patient. Continuous Intravenous Infusion trailer Review/update the Like other calcium channel antagonists, because of its effect on vascular smooth muscle, diltiazem decreases total peripheral resistance resulting in a decrease in both systolic and diastolic blood pressure. 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. There was an increased incidence of stillbirths at doses of 20 times the human oral antianginal dose or greater. w !1AQaq"2B #3Rbr Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. Diltiazem does not appear to be removed by peritoneal or hemodialysis. Available from: [place unknown]: [publisher unknown]; 2018. Asymptomatic hypotension occurred in 4.3% of patients. Following single intravenous injection of diltiazem hydrochloride, however, plasma concentrations of N-monodesmethyldiltiazem and desacetyldiltiazem, two principal metabolites found in plasma after oral administration, are typically not detected. As with other agents which slow AV nodal conduction and do not prolong the refractoriness of the accessory pathway (e.g., verapamil, digoxin), in rare instances patients in atrial fibrillation or atrial flutter associated with an accessory bypass tract may experience a potentially life-threatening increase in heart rate accompanied by hypotension when treated with diltiazem hydrochloride injection. Injection site extravasation is found among people who take Cardizem, especially for people who are female, 60+ old, have been taking the drug for < 1 month. Accessibility Be careful if you drive or do anything that requires you to be alert. No potential conflict of interest relevant to this article was reported. High blood pressure adds to the workload of the heart and arteries. For Direct Intravenous Bolus Injection and Diltiazem is not intended to convert atrial fib or flutter to NSR but to slow the heart rate down. The .gov means its official. The usual dose range of oral diltiazem for the treatment of hypertension is 180 to 360 mg daily. Editors note: I found this booklet, guidelines for the management of extravasation on November 15, 2019, at the 2019 Fall Conference of the Korean Society for Clinical Pharmacology and Therapeutics. injury. In severe cases, extravasation may cause tissue dysfunction or physical defects, resulting in a delay of attempted treatment, patients distrust, and numerous other issues. Therefore, infusion duration exceeding 24 hours and infusion rates exceeding 15 mg/h are not recommended. Verapamil belongs to the Phenylalkylamines class of calcium channel blockers and Diltiazem belongs to a class called the Benzothiazepines. 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. 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. Monitoring for quinidine adverse effects may be warranted and the dose adjusted accordingly. 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. 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. The patient must be informed of the scope of the problem (Supplement 5). No overall differences in safety or effectiveness were observed between these patients and younger patients, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. In addition, the following events were reported infrequently (less than 1%): Your doctor will adjust the dose and frequency of diltiazem to your needs. Sodium hydroxide or hydrochloric acid is used for pH adjustment. Diltiazem may impair your thinking or reactions. 1997. In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapeutic drugs in the tissues surrounding the IV site. Tips Extended-release diltiazem capsules should be taken on an empty stomach (this means one hour before food or two hours after food). The effect of cyclosporine on diltiazem plasma concentrations has not been evaluated. BIT Druginfo website [Internet] [cited 2020 Jul 10]. Before taking diltiazem, tell your doctor if you have kidney disease, liver disease, or congestive heart failure. Vesicants are inherently toxic and can cause pain, inflammation, and burn-like injury including blistering, sloughing, deep tissue damage, and necrosis. The mean ejection fraction and cardiac output/index remained unchanged or increased. Call your doctor for medical advice about side effects. If you are a Mayo Clinic patient, this could The https:// ensures that you are connecting to the 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. %PDF-1.6 % Tell your doctor about all medicines you use, and those you start or stop using. 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 Diltiazem hydrochloride is 70% to 80% bound to plasma proteins. Hemodynamics - Do not insert the cannula in the joints because it is difficult to secure, and neural damage and tendon injury can be caused if extravasation occurs due to vesicant drugs. Other prescription and over-the-counter medicines, vitamins, and herbal products may interact with diltiazem. 0000015118 00000 n Drug information handbook. Diltiazem Vesicants include several chemotherapy drugs. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or in vitro in bacteria. Common non-antineoplastic drugs that can act as vesicants or irritants [Internet] [cited 2020 Jul 10]. 10 mL Single-Dose Vials In special subacute hepatic studies, oral doses of 125 mg/kg and higher in rats were associated with histological changes in the liver, which were reversible when the drug was discontinued. Discard Unused Portion Store Under Refrigeration Statins - Diltiazem is an inhibitor of CYP3A4 and has been shown to increase significantly the AUC of some statins. Be careful if you drive or do anything that requires you to be alert. Other events reported in at least 1% of the diltiazem-treated patients were injection site reactions (e.g., itching, burning) 3.9%, vasodilation (flushing) 1.7%, and arrhythmia (junctional rhythm or isorhythmic dissociation) 1.0 %. Gastrointestinal: Anorexia, diarrhea, dysgeusia, dyspepsia, mild elevations of SGPT and LDH, thirst, weight increase Drug Interactions 125-mg, 25-mL vialeach sterile vial contains 125 mg diltiazem hydrochloride, 18.75 mg citric acid USP, 16.25 mg sodium citrate dihydrate USP, 1,785 mg sorbitol solution USP, and water for injection USP up to 25 mL. Methods: This was a multicenter, retrospective cohort study that evaluated adults admitted to the ED with documented AF or AFL, heart rate (HR) > 120 bpm, SBP 90 to 140 mmHg, and received treatment with IV diltiazem for rate control. Concepts in oncology therapeutics: a self-instructional course. In patients administered continuous infusions at 10 mg/h or 15 mg/h for 24 hours, diltiazem systemic clearance averaged 42 L/h and 31 L/h, respectively. Dosage: The dose is 150 units (1 mL) given as five 0.2 mL injections into the extravasation site at the leading edge; change the needle after each injection. Digitalis - Intravenous diltiazem has been administered to patients receiving either intravenous or oral digitalis therapy. Hyderabad 500032 Direct Intravenous Single Injections (Bolus) Diltiazem Management of extravasation injuries: a focused evaluation of noncytotoxic medications. For either indication and particularly when employing continuous intravenous infusion, the setting should include continuous monitoring of the ECG and frequent measurement of blood pressure. Your blood pressure will need to be checked often. Patients may be unable to work for some time; quality of life must be compensated for if a patients occupation requires full physical mobility, and exposure of the disfigurement in public can cause a psychological impact. Because errors associated with IV administration can result in fatal or life-threatening outcomes, administration of IV fluids and medications can be a high-risk, with adverse outcomes potentially leading to malpractice claims. 0000030660 00000 n Before Packaged in a Carton of 10 NDC 55150-425-10 and transmitted securely. The drug should be used with caution in patients with impaired renal or hepatic function (see WARNINGS). Last updated on Apr 1, 2023. In vitro studies suggest alpha1-acid glycoprotein binds approximately 40% of the drug at clinically significant concentrations. Calcium Cows Channel Blocked (V-rapper & Dill-tazer) Picmonic. Drug information handbook for oncology: a complete guide to combination chemotherapy regimens. Acute Hepatic Injury - In rare instances, significant elevations in enzymes such as alkaline phosphatase, LDH, SGOT, SGPT, and other phenomena consistent with acute hepatic injury have been noted following oral diltiazem. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Diltiazem is in a class of medications called calcium-channel blockers. Tell your doctor if you are pregnant or plan to become pregnant. Diltiazem is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders. 8th ed. Symptomatic hypotension occurred in 3.2% of patients. information submitted for this request. Elevation of the limb may aid in reabsorption of the infiltrate or extravasated vesicant by decreasing capillary hydrostatic pressure. It works by relaxing the blood vessels so the heart does not have to pump as hard. Sodium hydroxide or hydrochloric acid is used for pH adjustment. 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. Injection and Continuous But it must be done carefully because this area can suffer a more severe injury due to extravasation. Mechanisms of Action This content does not have an Arabic version. Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. In subgroup analysis following a two-dose procedure in double-blind and open-label studies, 104 patients 65 years of age and 95 patients <65 both had a 95% response rate. The .gov means its official. As such, the initial use of diltiazem hydrochloride injection should be, if possible, in a setting where monitoring and resuscitation capabilities, including DC cardioversion/defibrillation, are present (see OVERDOSAGE). The second purpose is to raise the medical teams awareness of extravasation in order to prevent extravasation with careful injection, recover patient trust, and increase patient satisfaction. In vitro, propranolol appears to be displaced from its binding sites by diltiazem. This can damage the blood vessels of the brain . 0000025065 00000 n Bethesda, MD 20894, Web Policies Diltiazem Available for Android and iOS devices. 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. Available from: Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. Calcium channel blockers (CCBs) are among the most commonly used cardiovascular drugs in the adult population. HHS Vulnerability Disclosure, Help Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. - It causes contraction of blood vessels, minimizing the spread of drugs to other tissues and reducing topical infections and pain. Available from: University of Illinois College of Pharmacy . The guidelines described herein are based on the authors best practice for the management and prevention of the extravasation. Antidotes, special drug management, drugs with high osmolarity, and drugs with pH are provided as supplement files (Supplements 14). These metabolites are observed, however, following 24 hour constant rate intravenous infusion. (5 mg/mL) Enhanced effects and increased toxicity of buspirone may be possible during concomitant administration with diltiazem. It also increases the supply of blood and oxygen to the heart. Occurs due to contraction of the vessel wall and usually happens as soon as the fluid injection begins. Photographic documentation can be helpful for follow-up procedures. Get emergency medical help if you have signs of an allergic reaction to diltiazem: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Federal government websites often end in .gov or .mil. Torralba TP, Li-Yu J, Navarra ST. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Liver cirrhosis was shown to reduce diltiazem's apparent oral clearance and prolong its half-life. Chemically, diltiazem hydrochloride is 1,5-benzothiazepin-4-(5H)-one,3-(Acetyloxy)-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(-4-methoxyphenyl)-, monohydrochloride, (+)-cis-. Seoul: BIT Druginfo; 2020. The sample was 18 healthy adults between 20 and 45 years. Do not stop taking this medication without first talking to your doctor. Diltiazem Drug Information Group [Internet] [cited 2020 Jul 10]. information and will only use or disclose that information as set forth in our notice of The risk of toxic reactions to this drug may be greater in patients with impaired renal or hepatic function. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use diltiazem only for the indication prescribed. Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. Manchester: The Christie NHS Foundation Trust; 2014. Renal insufficiency, or even end-stage renal disease, does not appear to influence diltiazem disposition following oral administration. To provide you with the most relevant and helpful information, and understand which Diltiazem Administration Pearls: Response usually occurs in 3 minutes with maximum heart rate reduction generally occurring in 2-7 minutes. Unauthorized use of these marks is strictly prohibited. - Initial physical symptoms usually appear immediately but also might appear several days or weeks later. HCl Injection Use within 24 hours. 125 mg per 25 mL (5 mg/mL) - Secure the cannula during the administration of the drug. 0000001178 00000 n If response is inadequate, a second dose may be administered after 15 minutes. However, reference should be made to the respective agent manufacturer's package insert for information relative to dosage and administration. Packaged in a Carton of 10 NDC 55150-426-10 Dermatologic: Alopecia, erythema multiforme (including Stevens-Johnson syndrome, toxic epidermal necrolysis), exfoliative dermatitis, leukocytoclastic vasculitis, petechiae, photosensitivity, purpura, rash, urticaria The site is secure. 0000006222 00000 n Diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. Advertising revenue supports our not-for-profit mission. eugia, Rx only NDC 55150-427-10 Treatment suspension wastes time and other problems can occur due to delayed treatment. The chemical structure is: Diltiazem hydrochloride, USP is a white crystalline powder with a bitter taste. In the same study, there was no significant change in 20 mg single dose pravastatin AUC and Cmax during diltiazem coadministration. The patient should receive the skin graft for recovering her arm skin. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care, and the recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Diltiazem hydrochloride injection rarely converts atrial fibrillation or atrial flutter to normal sinus rhythm. . An official website of the United States government. 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. Diltiazem hydrochloride injection is a clear, colorless, sterile, nonpyrogenic solution. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. Keep diluted diltiazem hydrochloride injection refrigerated until use. Diltia XT, Dilt-XR, Diltzac, Matzim LA, Taztia XT, Tiadylt ER, Tiazac. The infusion may be maintained for up to 24 hours. If you are being treated for high blood pressure, keep using this medicine even if you feel well. 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. The leakage of the IV-administered fluids is clearly unintended, the condition being often presented as extravasation. The medical teams continuous education on extravasation is essential. Use diltiazem regularly to get the most benefit. Diltiazem inhibits the influx of calcium (Ca 2+) ions during membrane depolarization of cardiac and vascular smooth muscle. Administration of oral diltiazem in patients with acute myocardial infarction and pulmonary congestion documented by x-ray on admission is contraindicated. 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. However, no guidelines can be perfect, and they need to be regularly updated. It is soluble in water, methanol, and chloroform. hbbbd`b``3 As a library, NLM provides access to scientific literature. Regression of calcinosis associated with adult dermatomyositis following diltiazem therapy. 0.5 - 1 mL over 1 minute. This site needs JavaScript to work properly. Supplement 1. Cyclosporine - A pharmacokinetic interaction between diltiazem and cyclosporine has been observed during studies involving renal and cardiac transplant patients. - 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. Br J Dermatol 2001; 144:894. Hadaway L. Extravasation: Issues and Controversies. Patients should be monitored for signs of hypercalcemia. 113. 0000002293 00000 n Extravasation:Unintentional leakage of fluid out of a blood vessel into surrounding tissue. 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. include protected health information. Nursing Department, Asan Medical Center . %%EOF Drug information provided by: Merative, Micromedex. Bookshelf You may opt-out of email communications at any time by clicking on 8600 Rockville Pike 4. In subacute and chronic dog and rat studies designed to produce toxicity, high oral doses of diltiazem were associated with hepatic damage. (5 mg/mL) Inclusion in an NLM database does not imply endorsement of, or agreement with, As with all drugs, care should be exercised when treating patients with multiple medications. It will be our pleasure if these guidelines are used in the training of health professionals to promote patients safety. Swallow right away without chewing. Conceptualization: JTK, JYP, HJL, YJC. Management of extravasation policy: version 01 [Internet]. Drugs which induce or inhibit hepatic microsomal enzymes may alter diltiazem disposition. Benzodiazepines - Studies showed that diltiazem increased the AUC of midazolam and triazolam by 3 to 4 fold and Cmax by 2-fold, compared to placebo. In domestic controlled trials in patients with atrial fibrillation or atrial flutter, bolus administration of diltiazem hydrochloride injection was effective in reducing heart rate by at least 20% in 95% of patients. Rhinitis, headache, and constipation are commonly reported side effects. High intravenous dosages (4.5 mg/kg tid) administered to dogs resulted in significant bradycardia and alterations in AV conduction. - Dilute stimulant drugs as much as possible and inject them at a proper rate. Would you like email updates of new search results? The effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose has been inconsistent. I remember the case of the complication of extravasation in my patient in 1985 when I was an intern. Patients with severe hypotension or cardiogenic shock. startxref Cardizem and Infusion site extravasation - a phase IV clinical study of FDA data Summary: Infusion site extravasation is found among people who take Cardizem, especially for people who are female, 60+ old. 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. 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 therapeutic benefits of diltiazem in supraventricular tachycardias are related to its ability to slow AV nodal conduction time and prolong AV nodal refractoriness. However, if you have symptoms of low blood pressure (dizziness, fainting, weakness, or blurred vision), call your doctor and stop taking diltiazem.

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