Nursing Department, Asan Medical Center . Rheumatology (Oxford) 2000; 39:333. information and will only use or disclose that information as set forth in our notice of For Direct Intravenous Bolus Injection and xref Extravasation is the leakage of an injected drug out of the blood vessels, damaging the surrounding tissues. sharing sensitive information, make sure youre on a federal Cardiac Conduction - Diltiazem prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm. the unsubscribe link in the e-mail. Diltiazem converts paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm by interrupting the reentry circuit in AV nodal reentrant tachycardias and reciprocating tachycardias, e.g., Wolff- Parkinson-White syndrome (WPW). It is soluble in water, methanol, and chloroform. The sample was 18 healthy adults between 20 and 45 years. Continuous Intravenous Infusion 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 %PDF-1.5 % Be careful if you drive or do anything that requires you to be alert. Supplement 2. Changes in heart rate, systolic blood pressure, and diastolic blood pressure did not correlate with diltiazem plasma concentrations in normal volunteers. 0 Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. IV push by TSN or MD only (in non-emergent settings). Chicago (IL): University of Illinois College of Pharmac; c2020. 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. Drug information handbook. 364 0 obj <>stream 25 mg per 5 mL (5 mg/mL) 5 mL Single-Dose Vials For continued reduction of the heart rate (up to 24 hours) in patients with atrial fibrillation or atrial flutter, an intravenous infusion of diltiazem hydrochloride injection may be administered. Vesicants include several chemotherapy drugs. 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. 332 33 5. 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. I remember the case of the complication of extravasation in my patient in 1985 when I was an intern. Available from: Lacy C, American Pharmaceutical Association . Fixed high-degree AV block should be treated with cardiac pacing. 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. Hypotension, if it occurs, may be similarly persistent. Drug classes: Calcium channel blocking agents, Group IV antiarrhythmics. When used concomitantly, anesthetics and calcium blockers should be titrated carefully. Langer SW. Extravasation of chemotherapy. 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. Only 1 of the studies of diltiazem was in children. If possible, it is recommended that diltiazem hydrochloride injection not be co-infused in the same intravenous line. Guideline for the management of extravasation of a cytotoxic agent or a monoclonal antibody used in the treatment of malignant disease: version 4.2. 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. Waltham (MA): UpToDate Inc; c2020. The mean ejection fraction and cardiac output/index remained unchanged or increased. Diltiazem may also be used for purposes not listed in this medication guide. Your doctor will tell you which of these are most important for you. Sterile eugia 10 x 10 mL Single-Dose Vials, Rx only NDC 55150-427-01 We comply with the HONcode standard for trustworthy health information. Congestive Heart Failure - Although diltiazem has a negative inotropic effect in isolated animal tissue preparations, hemodynamic studies in humans with normal ventricular function and in patients with a compromised myocardium, such as severe CHF, acute MI, and hypertrophic cardiomyopathy, have not shown a reduction in cardiac index nor consistent negative effects on contractility (dp/dt). 0 Diltiazem may impair your thinking or reactions. Patients with second- or third-degree AV block except in the presence of a functioning ventricular pacemaker. - 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. Cardiovascular: AV block (third degree), bundle branch block, ECG abnormality, palpitations, syncope, tachycardia, ventricular extrasystoles 0000002809 00000 n In patients with cardiovascular disease, diltiazem hydrochloride injection administered intravenously in single bolus doses, followed in some cases by a continuous infusion, reduced blood pressure, systemic vascular resistance, the rate-pressure product, and coronary vascular resistance and increased coronary blood flow. If we combine this information with your protected Renal insufficiency, or even end-stage renal disease, does not appear to influence diltiazem disposition following oral administration. Available from: Lacy C, American Pharmaceutical Association . Patients must be informed to report any changes in sensation, signs, or symptoms during the IV administration of any chemotherapeutic drug and to alert the healthcare professionals to early signs of extravasation. Atrial fibrillation or atrial flutter - In clinical studies with diltiazem hydrochloride injection for AF/FI, 135 of 257 patients were 65 years of age. - Directions: apply hot fomentations for 20 to 30 minutes four to 6 times per day (for 1 day or more). Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. National Library of Medicine Hot fomentations can be applied to the dilated veins to mitigate the symptoms. Monitor heart rate in patients receiving concomitant diltiazem and clonidine. Injection and Continuous Revised: April 2023, Rx only NDC 55150-425-01 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. Common symptoms and signs of extravasation include pain, stinging or burning sensations, and edema around the intravenous (IV) injection site. With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. Diltiazem is used alone or together with other medicines to treat angina (severe chest pain) or hypertension (high blood pressure). The .gov means its official. Caution should be exercised when using the drug in such patients. 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). information highlighted below and resubmit the form. - Watch for edema, inflammation, and pain around the cannula during administration. 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 - Directions: apply cold fomentations for 15 to 20 minutes four to 6 times per day (for 1 day or more). If I understood the guidelines for extravasation management, it might be possible to prevent the necrosis of her arm skin. - Regularly check the extravasation kit and refill any used medications. For Direct Intravenous Bolus Injection and 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. Similar ventricular complexes have been noted during cardioversion, other pharmacologic therapy, and during spontaneous conversion of PSVT to sinus rhythm. Cyclosporine - A pharmacokinetic interaction between diltiazem and cyclosporine has been observed during studies involving renal and cardiac transplant patients. However, if you have symptoms of low blood pressure (dizziness, fainting, weakness, or blurred vision), call your doctor and stop taking diltiazem. Diltiazem exhibits frequency (use) dependent effects on AV nodal conduction such that it may selectively reduce the heart rate during tachycardias involving the AV node with little or no effect on normal AV nodal conduction at normal heart rates. - Assess patients sensory changes, tingling or burning, and always pay attention to the words of patients. (5 mg/mL) The chemical structure is: Diltiazem hydrochloride, USP is a white crystalline powder with a bitter taste. Cardiac Failure: Administer inotropic agents (isoproterenol, dopamine, or dobutamine) and diuretics. Proceedings of the Infusion Nurses Society Annual Meeting; 1997 May; Salt Lake City, USA. Although not observed in clinical trials with diltiazem hydrochloride injection, the following events associated with oral diltiazem may occur: IV push over 10 minutes or IVPB as directed. 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. 42 . 7. Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. 125 mg per 25 mL (5 mg/mL) 1. [cited 2020 Jul 10]. privacy practices. Available from: [place unknown]: [publisher unknown]; 2018. - Be familiar with the extravasation management standard guidelines and prepare the extravasation kit. Calcium gluconate has also been administered as a continuous infusion at a rate of 2 g per hour for 10 hours. (5 mg/mL) For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. Patients with atrial fibrillation or atrial flutter associated with an accessory bypass tract such as in WPW syndrome or short PR syndrome. Last updated on Mar 22, 2023. hb``d``f`c`P "@1vG(r8}C#7mcH`KfYtfnzv$@,BKK~x$3$shElVVp A_8{.>9UiiGK:&ALg>)tvNV-+>'(yqnSg@Em.P^''*.^. Manufactured by: - Possibly no initial symptoms of extravasation, - Redness, pruritus, and edema around the injection site, - Fluid injection rate slows down or stops, - Blood backflow does not work well or there is leakage of medication around the needle, - A complaint of discomfort or pain and occasional expression of searing pain or numbness. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Extravasated drugs are classified according to their potential for causing damage as vesicant, irritant, and nonvesicant. Vesicant drugs are also classified into 2 groups: DNA binding and non-DNA binding. Patients with ventricular tachycardia. Treatment depends on the nature of the offending substance; one approach is to localise and neutralise the substance whereas another is to spread and dilute it. - Check if there is any local discomfort or swelling by running a saline solution through the catheter, and then inject the drug. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. Diltiazem hydrochloride injection is a clear, colorless, sterile, nonpyrogenic solution. Disconnect the IV tubing but DO NOT remove the catheter or needle. Statins - Diltiazem is an inhibitor of CYP3A4 and has been shown to increase significantly the AUC of some statins. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Supplement 6. Nursing Mothers 4 Hyaluronidase has been successfully used in the treatment of TPN extravasations. Paroxysmal supraventricular tachycardia - Clinical studies of diltiazem hydrochloride injection for PSVT did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Packaged in a Carton of 10 NDC 55150-426-10 Diltiazem hydrochloride injection is clear, colorless, sterile, nonpyrogenic solution and is supplied as follows: Intravenous Infusion Sodium hydroxide or hydrochloric acid is used for pH adjustment. Diltiazem may also be used for purposes not listed in this medication guide. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. You should not stop using diltiazem suddenly. Tips Extended-release diltiazem capsules should be taken on an empty stomach (this means one hour before food or two hours after food). May repeat with 2. nd 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 %%EOF Coadministration of diltiazem with rifampin or any known CYP3A4 inducer should be avoided when possible, and alternative therapy considered. 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. Carcinogenesis, Mutagenesis, Impairment of Fertility FOIA Medically reviewed by Kaci Durbin, MD. - Veins on the back of the hand can be used, and in some cases, observation is easier. 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. Unauthorized use of these marks is strictly prohibited. National Library of Medicine hbbd```b``= "ro) "5" `LBT80yLHf) 8, EA! 0000010832 00000 n LD = 0.25 mg/kg over 2 min. The usual dose range of oral diltiazem for the treatment of hypertension is 180 to 360 mg daily. Sterile 25 mL Single-Dose Vial In the event of overdosage or an exaggerated response, appropriate supportive measures should be employed. Experience in the use of antiarrhythmic agents following maintenance infusion of diltiazem hydrochloride injection is limited. Injectable forms of diltiazem are contraindicated in: 1. endstream endobj startxref 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. 0000029248 00000 n India 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Visualization: JTK, JYP, HJL, YJC. Diltiazem is excreted in human milk. Avoid concomitant use of ivabradine and diltiazem. . 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_. - 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). The frequency of extravasation in adults is reported to be between 0.1% and 6%. Patients with severe hypotension or cardiogenic shock. Many drugs can interact with diltiazem, and your doctor may need to change your treatment plan if you use certain other medicines. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. 125 mg per 25 mL If use of diltiazem hydrochloride is deemed essential, an alternative method of infant feeding should be instituted. 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. In vitro studies suggest alpha1-acid glycoprotein binds approximately 40% of the drug at clinically significant concentrations.

Flyers Draft Picks This Year, Articles D