Sodium hydroxide or hydrochloric acid is used for pH adjustment. Diltiazem hydrochloride injection is clear, colorless, sterile, nonpyrogenic solution and is supplied as follows: Topical nitroglycerin for management of peripheral extravasation of Three solutions were used: 1/2 saline (154 mOsm), normal saline (308 mOsm), and 3% saline (1027 mOsm). the contents by NLM or the National Institutes of Health. Available for Android and iOS devices. UpToDate PDF Extravasation Management Reference Sheet - NACNS Dermatologic events progressing to erythema multiforme and/or exfoliative dermatitis have been infrequently reported following oral diltiazem. You may need to use blood pressure medicine for the rest of your life. Patients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine. 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. 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. It is anticipated that these guidelines would help health professionals to prevent extravasation during IV and central vein injection and to promote patient safety should extravasation occur in any case. (5 mg/mL) Store diltiazem at room temperature away from moisture and heat. Diltiazem Injection Prescribing Information. } !1AQa"q2#BR$3br Sterile eugia 10 x 5 mL Single-Dose Vials, Rx only NDC 55150-426-01 An official website of the United States government. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Your doctor may occasionally change your dose. This relaxes the blood vessels, lowers blood pressure, and increases the supply of blood and oxygen to the heart while reducing its workload. If it continues for a long time, the heart and arteries may not function properly. 0000000956 00000 n Pharmacokinetics and Metabolism This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. However, if you have symptoms of low blood pressure (dizziness, fainting, weakness, or blurred vision), call your doctor and stop taking diltiazem. Verapamil belongs to the Phenylalkylamines class of calcium channel blockers and Diltiazem belongs to a class called the Benzothiazepines. - Initial physical symptoms usually appear immediately but also might appear several days or weeks later. 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. Extravasation refers to the leakage of injected drugs from blood vessels causing damage to the surrounding tissues. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Seoul: BIT Druginfo; 2020. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Diltiazem hydrochloride is 70% to 80% bound to plasma proteins. 2838 0 obj <>stream The mean ejection fraction and cardiac output/index remained unchanged or increased. 0000000016 00000 n Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. Your blood pressure will need to be checked often. PDF Critical Care Intravenous Drug Administration Guide - SGUL * 5 mg/h may be appropriate for some patients. In vitro, propranolol appears to be displaced from its binding sites by diltiazem. These guidelines consist of following topics: basic knowledge about extravasation, extravasation management, and extravasation prevention. Photographic documentation of extravasation case. Geriatric Use Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. 4. show all 12 brands Enhanced effects and increased toxicity of buspirone may be possible during concomitant administration with diltiazem. You may need to use blood pressure medicine for the rest of your life. 1Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, Korea, 2Department of Clinical Nursing, University of Ulsan, Seoul, Korea. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. 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. While the injury is usually minor and resolves spontaneously, some cases result in serious complications, including full-thickness skin loss and muscle and tendon necrosis requiring reconstructive surgery or even amputation, leading to longer hospital stays, increased morbidity, and increased costs. The plasma elimination half-life is approximately 3.4 hours. Patients with severe hypotension or cardiogenic shock. Avoid drinking alcohol while taking diltiazem. Injection and Continuous information and will only use or disclose that information as set forth in our notice of hb``d``f`c`P "@1vG(r8}C#7mcH`KfYtfnzv$@,BKK~x$3$shElVVp A_8{.>9UiiGK:&ALg>)tvNV-+>'(yqnSg@Em.P^''*.^. Do NOT flush the line with normal saline or dextrose Diltiazem hydrochloride injection rarely converts atrial fibrillation or atrial flutter to normal sinus rhythm. 332 0 obj <> endobj <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> Disclaimer. Extravasation:Unintentional leakage of fluid out of a blood vessel into surrounding tissue. endstream endobj startxref Appendix A: Management of Extravasation: Chemotherapeutic and Non-chemotherapeutic Agents Figure 1: Workflow algorithm Stop infusion at first suspicion of extravasation. 1). Writingreview & editing: JTK, JYP, HJL, YJC. 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 combination of the two drugs was generally well tolerated without serious adverse effects. Dermatologic: Pruritus, sweating Englewood (CO): Micromedex Inc; [date unknown]. PDF Guide to Extravasation Management in Adult & Pediatric Patients For the most part, blood does not backflow. Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. The https:// ensures that you are connecting to the Concepts in oncology therapeutics: a self-instructional course. If hypotension occurs, it is generally short-lived, but may last from 1 to 3 hours. 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. The medical teams continuous education on extravasation is essential. 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. @ Supplement 6. Grapefruit and grapefruit juice may interact with diltiazem and lead to unwanted side effects. 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. 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. 0000003528 00000 n The chemical structure is: Diltiazem hydrochloride, USP is a white crystalline powder with a bitter taste. Adapted from: Saint Francis Hospital Department of Pharmacy Services Protocol With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. Intravenous diltiazem and intravenous beta-blockers should not be administered together or in close proximity (within a few hours). Do not save the mixture for later use. Torralba TP, Li-Yu J, Navarra ST. sharing sensitive information, make sure youre on a federal Definition The IV infiltration can be defined as a complication of the intravenous therapy, with the administered medication infiltrating into the surrounding tissues. Hypotension: Vasopressors (e.g., dopamine or norepinephrine). Your doctor will adjust the dose and frequency of diltiazem to your needs. BIT Druginfo website [Internet] [cited 2020 Jul 10]. If you are being treated for high blood pressure, keep using this medicine even if you feel well. 549 0 obj <>stream 4 Hyaluronidase has been successfully used in the treatment of TPN extravasations. Paroxysmal Supraventricular Tachycardia What are current recommendations for treatment of drug extravasation - Even if there is an existing IV route, secure a new route when administering vesicant drugs. Tell your doctor about all medicines you use, and those you start or stop using. 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). Accessibility 5. Hemodynamics 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. If bone marrow function decreases, anticancer treatments may be delayed due to infection caused by leukopenia. This can damage the blood vessels of the brain . Diltiazem does not appear to be removed by peritoneal or hemodialysis. Diltiazem Injection: Package Insert - Drugs.com The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Bradycardia: Administer atropine (0.6 to 1.0 mg). %PDF-1.5 % Skip the missed dose if it is almost time for your next scheduled dose. 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. Please read our disclaimer. Rifampin - Coadministration of rifampin with diltiazem lowered the diltiazem plasma concentrations to undetectable levels. However, the study had only a small number of 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. 125 mg per 25 mL 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. 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. PMC If possible, it is recommended that diltiazem hydrochloride injection not be co-infused in the same intravenous line. In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapeutic drugs in the tissues surrounding the IV site. Management of Extravasation Injuries: A Focused Evaluation of They are used to treat a broad array of clinical conditions, including hypertension, supraventricular tachycardia, vasospasm, and migraine headaches. prolonged sedation) of both midazolam and triazolam. High blood pressure adds to the workload of the heart and arteries. Diltiazem hydrochloride injection is a clear, colorless, sterile, nonpyrogenic solution.
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