Diltiazem In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Experience with the use of diltiazem hydrochloride injection in patients with impaired ventricular function is limited. the contents by NLM or the National Institutes of Health. The audio recording of the abstract. The therapeutic benefits of diltiazem in supraventricular tachycardias are related to its ability to slow AV nodal conduction time and prolong AV nodal refractoriness. (5 mg/mL) Some data suggest that the incidence is decreasing probably due to improvements in the infusion procedure, early recognition of the drug leakage, and training in management techniques. Guideline for the management of extravasation of a cytotoxic agent or a monoclonal antibody used in the treatment of malignant disease: version 4.2. The use of diltiazem hydrochloride injection should be undertaken with caution when the patient is compromised hemodynamically or is taking other drugs that decrease any or all of the following: peripheral resistance, myocardial filling, myocardial contractility, or electrical impulse propagation in the myocardium. A 24 hour continuous infusion of diltiazem hydrochloride injection in the treatment of atrial fibrillation or atrial flutter maintained at least a 20% heart rate reduction during the infusion in 83% of patients. BIT Druginfo website [Internet] [cited 2020 Jul 10]. Follow all directions on your prescription label. @ The usual dose range of oral diltiazem for controlling chest pain is 120 to 480 mg daily. It will be our pleasure if these guidelines are used in the training of health professionals to promote patients safety. Supplement 6. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Use diltiazem regularly to get the most benefit. Overdosage experience is limited. 0000017632 00000 n 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. Patients with severe hypotension or cardiogenic shock. Symptomatic hypotension occurred in 3.2% of patients. Before taking diltiazem, tell your doctor if you have kidney disease, liver disease, or congestive heart failure. The patient must be informed of the scope of the problem (Supplement 5). Do NOT flush the line with normal saline or dextrose 0000030705 00000 n May be stored at room temperature for up to 1 month. Diltiazem The plasma elimination half-life is approximately 3.4 hours. Medically reviewed by Drugs.com. Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the . 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. Nursing standard for intravenous injection of Asan Medical Center. In a healthy volunteer cross-over study (N=10), coadministration of a single 20 mg dose of simvastatin at the end of a 14 day regimen with 120 mg BID diltiazem SR resulted in a 5-fold increase in mean simvastatin AUC versus simvastatin alone. Drug information: Clinical Computerized Information System: vol. 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. However, the study had only a small number of Albumin appears to bind approximately 30% of the drug, while other constituents bind the remaining bound fraction. Supplement 2. Mayo Clinic does not endorse companies or products. HCl Injection Diltiazem is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders. After oral administration, diltiazem undergoes extensive metabolism in man by deacetylation, N-demethylation, and O-demethylation via cytochrome P-450 (oxidative metabolism) in addition to conjugation. Diltiazem is used alone or together with other medicines to treat angina (severe chest pain) or hypertension (high blood pressure). w !1AQaq"2B #3Rbr (Activase) A N IV Push Coronary Artery Thrombus : Initial: 15 mg over X NOT SDU 1-2 minutes, followed (weight adjusted dosing): Y Continuous Weight greater than 67kg: 50 mg over 30 minutes, then 35 mg over 60 minutes Weight less than 67 kg: 0.75 mg/ kg (not to exceed information is beneficial, we may combine your email and website usage information with 3. Intravenous Infusion Diltiazem can pass into breast milk and may harm a nursing baby. Diltiazem hydrochloride injection is for direct intravenous bolus injection and continuous intravenous infusion. You should not breastfeed while using this medicine. and transmitted securely. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. Cardizem, Cartia XT, Dilt-XR, Cardizem CD, +7 more. The toxic dose in man is not known. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Injectable forms of diltiazem are contraindicated in: 1. Three solutions were used: 1/2 saline (154 mOsm), normal saline (308 mOsm), and 3% saline (1027 mOsm). 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. High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys . 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. Bookshelf The primary outcome was the change in SBP 60 min (+/- 30 min) after initial IV diltiazem administration. The following measures may be considered: They are used to treat a broad array of clinical conditions, including hypertension, supraventricular tachycardia, vasospasm, and migraine headaches. Take diltiazem exactly as prescribed by your doctor. Elevation of the limb may aid in reabsorption of the infiltrate or extravasated vesicant by decreasing capillary hydrostatic pressure. In subacute and chronic dog and rat studies designed to produce toxicity, high oral doses of diltiazem were associated with hepatic damage. If these agents are to be administered concurrently, cyclosporine concentrations should be monitored, especially when diltiazem therapy is initiated, adjusted or discontinued. Data files are available from Harvard Dataverse: https://doi.org/10.7910/DVN/NUWZML. Diltiazem is in a class of medications called calcium-channel blockers. tiazac. It works by affecting the movement of calcium into the cells of the heart and blood vessels. Computer-based simulations showed that at a daily dose of 480 mg of diltiazem, an 8- to 9-fold mean increase in simvastatin AUC can be expected. 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. 7. 0000024987 00000 n 332 0 obj <> endobj * Irritant drugs can cause local pain and inflammation but rarely cause tissue destruction. %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz Diltiazem hydrochloride injection is clear, colorless, sterile, nonpyrogenic solution and is supplied as follows: Avoid concomitant use of ivabradine and diltiazem. Avoid taking herbal supplements containing St. John's wort at the same time you are taking diltiazem. 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. PEI can be very effective in the treatment of larger cysts that have one significant pocket of fluid (in contrast to multiple, small pockets of fluid) -- The cyst is drained then approx half of that volume in 95% ethanol is injected back into the . Hot fomentations can dilate the veins and mitigate the symptoms. Cimetidine - A study in six healthy volunteers has shown a significant increase in peak diltiazem plasma levels (58%) and area-under-the-curve (53%) after a 1-week course of cimetidine at 1,200 mg per day and a single dose of diltiazem 60 mg. Ranitidine produced smaller, nonsignificant increases. 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. Eugia Pharma Specialities Limited Coadministration of diltiazem with rifampin or any known CYP3A4 inducer should be avoided when possible, and alternative therapy considered. For Direct Intravenous Bolus Injection and Careers, Unable to load your collection due to an error. Available from: University of Illinois College of Pharmacy . Diltiazem (Oral Route) Your gift holds great power - donate today! Diltiazem inhibits the influx of calcium (Ca2+) ions during membrane depolarization of cardiac and vascular smooth muscle. Mean plasma diltiazem concentrations of 130 ng/mL and 300 ng/mL were determined to produce reductions in heart rate of 30% and 40%. 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. General Chicago (IL): University of Illinois College of Pharmac; c2020. High blood pressure may also increase the risk of heart attacks. No report of Extravasation is found in people who take Diltiazem hydrochloride. Diltiazem may impair your thinking or reactions. 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. IV push by TSN or MD only (in non-emergent settings). Pain, tightening, and skin discoloration tend to worsen. If possible, it is recommended that diltiazem hydrochloride injection not be co-infused in the same intravenous line. It works by relaxing the blood vessels so the heart does not have to pump as hard. No evidence of impaired fertility was observed in a study performed in male and female rats at oral dosages of up to 100 mg/kg/day. Available from: Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. If coadministration of simvastatin with diltiazem is required, limit the daily doses of simvastatin to 10 mg and diltiazem to 240 mg. Narcotic analgesics may be required to reduce severe pain around widespread extensive necrosis. This site needs JavaScript to work properly. When treatment for hypotension was required, it generally consisted of administration of saline or placing the patient in the Trendelenburg position. Other drugs that are specific substrates, inhibitors, or inducers of this enzyme system may have a significant impact on the efficacy and side effect profile of diltiazem. Federal government websites often end in .gov or .mil. The use of vasopressor medications is the mainstay in management of patients with distributive shock in intensive care unit (ICU). An official website of the United States government. Some patients may respond to an initial dose of 0.15 mg/kg, although duration of action may be shorter. 2. 25 mg per 5 mL Your blood pressure will need to be checked often. In a limited number of studies of patients with compromised myocardium (severe congestive heart failure, acute myocardial infarction, hypertrophic cardiomyopathy), administration of intravenous diltiazem produced no significant effect on contractility, left ventricular end diastolic pressure, or pulmonary capillary wedge pressure. The mean ejection fraction and cardiac output/index remained unchanged or increased. Cardiac Conduction - Diltiazem prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm. Antidotes for the care of the extravasation. hb``d``f`c`P "@1vG(r8}C#7mcH`KfYtfnzv$@,BKK~x$3$shElVVp A_8{.>9UiiGK:&ALg>)tvNV-+>'(yqnSg@Em.P^''*.^. Descriptions. government site. For Direct Intravenous Bolus Injection and In vitro studies suggest alpha1-acid glycoprotein binds approximately 40% of the drug at clinically significant concentrations. We comply with the HONcode standard for trustworthy health information. These pharmacokinetic effects seen during diltiazem coadministration can result in increased clinical effects (e.g. Data curation: JTK, JYP, HJL, YJC. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or in vitro in bacteria. JFIF C C d[" Waltham (MA): UpToDate Inc; c2020. The elimination half-life of midazolam and triazolam also increased (1.5 to 2.5 fold) during coadministration with diltiazem. Seoul: BIT Druginfo; 2020. endstream endobj startxref 0000030429 00000 n 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. %%EOF With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. Calcium channel blockers (CCBs) are among the most commonly used cardiovascular drugs in the adult population. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Carcinogenesis, Mutagenesis, Impairment of Fertility This relaxes the blood vessels, lowers blood pressure, and increases the supply of blood and oxygen to the heart while reducing its workload. 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. IV Push IVPB IVPB IVPB EXTRAVASATION PRECAUTION - May be Harmful. 1). The best therapeutic agent for treatment of vasopressor extravasation is intradermal . HCl Injection Do not use this medicine in larger or smaller amounts or for longer than recommended. 0000000016 00000 n 113. Avoid drinking alcohol while taking diltiazem. Statins - Diltiazem is an inhibitor of CYP3A4 and has been shown to increase significantly the AUC of some statins. In a few reported cases, overdose with calcium channel blockers associated with hypotension and bradycardia that was initially refractory to atropine became more responsive to atropine after the patients received intravenous calcium. 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. Available from: [place unknown]: [publisher unknown]; 2018. Gastrointestinal: Constipation, elevated SGOT or alkaline phosphatase, nausea, vomiting However, if you have symptoms of low blood pressure (dizziness, fainting, weakness, or blurred vision), call your doctor and stop taking diltiazem. 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. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream Oral administration of diltiazem with propranolol in five normal volunteers resulted in increased propranolol levels in all subjects and bioavailability of propranolol was increased approximately 50%. Temporary control of rapid ventricular rate in atrial fibrillation or atrial flutter. Related/similar drugs 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. These guidelines consist of following topics: basic knowledge about extravasation, extravasation management, and extravasation prevention. The .gov means its official. 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. Packaged in a Carton of 10 NDC 55150-426-10 Revised: April 2023, Rx only NDC 55150-425-01 Monitoring for quinidine adverse effects may be warranted and the dose adjusted accordingly. The phase IV clinical study is created by eHealthMe based on reports from the FDA, and is updated regularly. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. (5 mg/mL) Subsequent dose adjustments may be necessary during coadministration, and should be based on clinical assessment. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. 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. 0000003340 00000 n - For observation, do not cover the cannula area with opaque gauze. The therapeutic benefits of diltiazem in supraventricular tachycardias are related to its ability to slow AV nodal conduction time and prolong AV nodal refractoriness. - It causes contraction of blood vessels, minimizing the spread of drugs to other tissues and reducing topical infections and pain. Alteplase Adult Assess for hemorrhage during first hour of treatment. Nervous System: Dizziness, paresthesia Delayed extravasation:Symptoms occur 48 hours, or later, after drug administration. Patients receiving these drugs concurrently should be monitored for a potential drug interaction. Diltiazem is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders. The apparent volume of distribution remains unchanged (360 to 391 L). Photographic documentation can be helpful for follow-up procedures. Vesicant extravasation:Leakage of a drug that causes pain, necrosis, or tissue sloughing. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. . Patients with atrial fibrillation or atrial flutter associated with an accessory bypass tract such as in WPW syndrome or short PR syndrome. (5 mg/mL) You may need to use blood pressure medicine for the rest of your life. Pain or tightening occurs along the vein, and it is caused mainly by drugs such as vinorelbine and dacarbazine. Pain, edema, and ulcer do not appear, and symptoms disappear within 30 to 90 minutes. 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. 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. Careers. Accessibility Changes in heart rate, systolic blood pressure, and diastolic blood pressure did not correlate with diltiazem plasma concentrations in normal volunteers. 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. 0000001694 00000 n INTRODUCTION. 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). The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. If you are being treated for high blood pressure, keep using this medicine even if you feel well. You may opt-out of email communications at any time by clicking on It is important to remember that the degree of damage is dependent on the type of the drug, the drug concentration, the localization of the extravasation, and the length of time for which the drug develops its potential for damage. Sodium hydroxide or hydrochloric acid is used for pH adjustment. Discard Unused Portion Store Under Refrigeration BIT Druginfo website [Internet] [cited 2020 Jul 10]. Diltiazem hydrochloride injection is indicated for the following: Do not save the mixture for later use. A defibrillator and emergency equipment should be readily available. Diltia XT, Dilt-XR, Diltzac, Matzim LA, Taztia XT, Tiadylt ER, Tiazac. Be careful if you drive or do anything that requires you to be alert. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. 0000010698 00000 n HCl Injection - Veins on the back of the hand can be used, and in some cases, observation is easier. Cardiovascular: AV block (third degree), bundle branch block, ECG abnormality, palpitations, syncope, tachycardia, ventricular extrasystoles 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. It is soluble in water, methanol, and chloroform. As with all drugs, care should be exercised when treating patients with multiple medications (see PRECAUTIONS, General and Drug Interactions). Nervous System: Abnormal dreams, amnesia, depression, extrapyramidal symptoms, gait abnormality, hallucinations, insomnia, nervousness, personality change, somnolence, tremor - Secure the cannula during the administration of the drug. Carbamazepine - Concomitant administration of oral diltiazem with carbamazepine has been reported to result in elevated plasma levels of carbamazepine (by 40 to 72%), resulting in toxicity in some cases. Administration of oral doses ranging from five to ten times greater (on a mg/kg basis) than the daily recommended oral antianginal therapeutic dose has resulted in embryo and fetal lethality. In patients administered bolus doses ranging from 2.5 mg to 38.5 mg, systemic clearance averaged 36 L/h. 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. * 5 mg/h may be appropriate for some patients. 1997. Definition The IV infiltration can be defined as a complication of the intravenous therapy, with the administered medication infiltrating into the surrounding tissues. 0000022294 00000 n 4. The effect of cyclosporine on diltiazem plasma concentrations has not been evaluated. Dilution: To prepare diltiazem hydrochloride injection for continuous intravenous infusion, aseptically transfer the appropriate quantity (see chart) of diltiazem hydrochloride injection to the desired volume of either Normal Saline, D5W, or D5W/0.45% NaCl. 8600 Rockville Pike High blood pressure adds to the workload of the heart and arteries. Diltiazem inhibits the influx of calcium (Ca 2+) ions during membrane depolarization of cardiac and vascular smooth muscle. - 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.