Store diltiazem at room temperature away from moisture and heat. Federal government websites often end in .gov or .mil. As a library, NLM provides access to scientific literature. High blood pressure adds to the workload of the heart and arteries. Destroy after 1 month at room temperature. All rights reserved. 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. Diltiazem is not intended to convert atrial fib or flutter to NSR but to slow the heart rate down. Diltiazem is used alone or together with other medicines to treat angina (severe chest pain) or hypertension (high blood pressure). %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz Diltiazem is in a class of medications called calcium-channel blockers. 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. Calcium channel blockers (CCBs) are among the most commonly used cardiovascular drugs in the adult population. Use diltiazem regularly to get the most benefit. PDF Memorial Medical Center Intravenous Medication Use Guidelines Communication and trust between patients and nurses can be interfered due to extravasation. E. Windsor, NJ 08520 For Direct Intravenous Bolus Injection and 25 mg per 5 mL Patients with severe hypotension or cardiogenic shock. * 5 mg/h may be appropriate for some patients. The use of local warming is recommended for the extravasation of nonDNA-binding vesicants. Cyclosporine - A pharmacokinetic interaction between diltiazem and cyclosporine has been observed during studies involving renal and cardiac transplant patients. One report with oral diltiazem suggests that concentrations in breast milk may approximate serum levels. Only 1 of the studies of diltiazem was in children. 25 mg per 5 mL Tell your doctor about all medicines you use, and those you start or stop using. 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. Appendix A: Management of Extravasation: Chemotherapeutic and Non-chemotherapeutic Agents Figure 1: Workflow algorithm Stop infusion at first suspicion of extravasation. Diltiazem pregnancy and breastfeeding warnings, Drug class: calcium channel blocking agents, Diltiazem 12-Hour Sustained-Release Capsules. The infusion may be maintained for up to 24 hours. Would you like email updates of new search results? Worldwide experience in over 1,300 patients was similar. Generic name: diltiazem hydrochloride sharing sensitive information, make sure youre on a federal Diltiazem (Oral Route) Proper Use - Mayo Clinic Drug Information Group [Internet] [cited 2020 Jul 10]. Diltiazem hydrochloride is a calcium ion cellular influx inhibitor (slow channel blocker or calcium channel antagonist). https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. 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. Verapamil belongs to the Phenylalkylamines class of calcium channel blockers and Diltiazem belongs to a class called the Benzothiazepines. Tell your doctor if you are pregnant or plan to become pregnant. Diltia XT, Dilt-XR, Diltzac, Matzim LA, Taztia XT, Tiadylt ER, Tiazac. Pediatric Use Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. 4 Hyaluronidase has been successfully used in the treatment of TPN extravasations. The average age of the children in this study was about 3 years. If you are a Mayo Clinic patient, this could Cardiac Conduction - Diltiazem prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm. Venous shock can occur when injecting very cold medication or when medication is injected at a rapid pace. (5 mg/mL) Diltiazem hydrochloride is 70% to 80% bound to plasma proteins. Therapists will always feel nervous during the medical team-patient communication because of guilt. Portions of this document last updated: April 01, 2023. . %PDF-1.6 % 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. Writingoriginal draft: JTK, JYP, HJL, YJC. Digitalis - Intravenous diltiazem has been administered to patients receiving either intravenous or oral digitalis therapy. 8th ed. (5 mg/mL) Data curation: JTK, JYP, HJL, YJC. Subjects with increased average steady-state exposures of diltiazem showed a greater fold increase in simvastatin exposure. Some patients may respond to an initial dose of 0.15 mg/kg, although duration of action may be shorter. It is soluble in water, methanol, and chloroform. Rhinitis, headache, and constipation are commonly reported side effects. These VPBs are transient, are typically considered to be benign, and appear to have no clinical significance. National Center for Biotechnology Information 125 mg per 25 mL Pain, tightening, and skin discoloration tend to worsen. With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. Hudson (OH): Lexi-Comp Inc; 2000. Drug Interactions We comply with the HONcode standard for trustworthy health information. 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. 0000003528 00000 n 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. 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. . For Direct Intravenous Bolus Injection and Guideline Feedback - Starship The average heart rate is reduced by 20%. Alteplase Adult Assess for hemorrhage during first hour of treatment. Therefore, the potential for acute hepatic injury exists following administration of intravenous diltiazem. Bethesda, MD 20894, Web Policies MeSH Supplement 6. The apparent volume of distribution remains unchanged (360 to 391 L). - Directions: apply cold fomentations for 15 to 20 minutes four to 6 times per day (for 1 day or more). - Check if there is any local discomfort or swelling by running a saline solution through the catheter, and then inject the drug. 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. 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. 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. In dogs, oral doses of 20 mg/kg were also associated with hepatic changes; however, these changes were reversible with continued dosing. Anesthetics - The depression of cardiac contractility, conductivity, and automaticity as well as the vascular dilation associated with anesthetics may be potentiated by calcium channel blockers. These contents are derived from authors experiences and the references [1-21]. Intravenous Infusion 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. Diltiazem (Cardizem ) IV Push IV infusion . Proceedings of the Infusion Nurses Society Annual Meeting; 1997 May; Salt Lake City, USA. Diltiazem may impair your thinking or reactions. health information, we will treat all of that information as protected health Medically reviewed by Kaci Durbin, MD. 0000002293 00000 n 0000029456 00000 n PDF Vasoactive Continuous Infusions - Adult - Inpatient Guideline - UW Health %PDF-1.4 % In a ten-subject randomized, open label, 4-way crossover study, coadministration of diltiazem (120 mg bid, diltiazem SR for 2 weeks) with a single 20 mg dose of lovastatin resulted in a 3- to 4-fold increase in mean lovastatin AUC and Cmax versus lovastatin alone. Careers. Pharmacokinetics and Metabolism May repeat with 2. nd The initial dose of diltiazem hydrochloride injection should be 0.25 mg/kg actual body weight as a bolus administered over 2 minutes (20 mg is a reasonable dose for the average patient). Drugs with high osmolarity. 0000029978 00000 n Gently aspirate extravasated drug. 50 mg per 10 mL An extremely severe case of cutaneous calcinosis with juvenile dermatomyositis, and successful treatment with diltiazem. Swallow right away without chewing. Barton-Burke M, Wilkes GM, Ingwersen KC, Bean CK, Berg D. Cancer chemotherapy: a nursing process approach. 113. Before taking diltiazem, tell your doctor if you have kidney disease, liver disease, or congestive heart failure. 0000001363 00000 n 2. Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician. UpToDate Keywords: PDF Extravasation/Infiltration Management Chart - Johns Hopkins University An official website of the United States government. This relaxes the blood vessels, lowers blood pressure, and increases the supply of blood and oxygen to the heart while reducing its workload. If response is inadequate, a second dose may be administered after 15 minutes. 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. It should not be used in patients with atrial fibrillation or atrial flutter associated with an accessory bypass tract such as in Wolff-Parkinson-White (WPW) syndrome or short PR syndrome. Continuous Intravenous Infusion As with all drugs, care should be exercised when treating patients with multiple medications (see PRECAUTIONS, General and Drug Interactions). Clinical studies of diltiazem did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. 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. If coadministration of simvastatin with diltiazem is required, limit the daily doses of simvastatin to 10 mg and diltiazem to 240 mg. Swallow it whole. National Center for Biotechnology Information No potential conflict of interest relevant to this article was reported. Chemically, diltiazem hydrochloride is 1,5-benzothiazepin-4-(5H)-one,3-(Acetyloxy)-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(-4-methoxyphenyl)-, monohydrochloride, (+)-cis-. 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. 0000025065 00000 n Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. You should not stop using diltiazem suddenly. 0000006222 00000 n 8600 Rockville Pike .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 Waltham (MA): UpToDate Inc; c2020. %%EOF Impact of intravenous calcium with diltiazem for atrial fibrillation Copyright: Merative US L.P. 1973, 2023. The apparent volume of distribution of diltiazem hydrochloride is approximately 305 L. Diltiazem hydrochloride is extensively metabolized in the liver with a systemic clearance of approximately 65 L/h. In the same study, there was no significant change in 20 mg single dose pravastatin AUC and Cmax during diltiazem coadministration. Do not use this medicine in larger or smaller amounts or for longer than recommended. But it must be done carefully because this area can suffer a more severe injury due to extravasation. Antidotes, special drug management, drugs with high osmolarity, and drugs with pH are provided as supplement files (Supplements 14). Diltiazem is a calcium channel blocker. 0 It works by affecting the movement of calcium into the cells of the heart and blood vessels. We comply with the HONcode standard for trustworthy health information. aztreonam, diltiazem hydrochloride, dobutamine hydrochloride, dopamine hydrochloride, fludarabine phosphate, foscarnet sodium, idarubicin hydrochloride, . Conceptualization: JTK, JYP, HJL, YJC. include protected health information. Hadaway L. Extravasation: Issues and Controversies. %PDF-1.5 % Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Cardiovascular: Asystole, atrial flutter, AV block first degree, AV block second degree, bradycardia, chest pain, congestive heart failure, sinus pause, sinus node dysfunction, syncope, ventricular arrhythmia, ventricular fibrillation, ventricular tachycardia * Irritant drugs can cause local pain and inflammation but rarely cause tissue destruction. High intravenous dosages (4.5 mg/kg tid) administered to dogs resulted in significant bradycardia and alterations in AV conduction. Extravasation:Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Photographic documentation can be helpful for follow-up procedures. Supplement 1. Torralba TP, Li-Yu J, Navarra ST. This content does not have an Arabic version. - 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). These two medications are different than other calcium channel blockers because they have direct action on cardiac tissue at therapeutic levels. 0000002809 00000 n Calcium gluconate has also been administered as a continuous infusion at a rate of 2 g per hour for 10 hours. 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. 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. To make swallowing easier, ask your doctor or pharmacist if you can open a diltiazem capsule and sprinkle the medicine into a spoonful of applesauce. 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 IV infiltrations and extravasations occur when fluid leaks out of the vein into surrounding soft tissue. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. Intravenous Infusion 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). Available from: [place unknown]: [publisher unknown]; 2018. Diltiazem Injection Prescribing Information. Effect of warm and cold applications on the resolution of i.v
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