A variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate).1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. Revised: April 2023, Rx only NDC 55150-425-01 0
severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Assess the site of extravasation and the symptoms of the patient. A defibrillator and emergency equipment should be readily available. Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. 3. Pharmacodynamics As with all drugs, care should be exercised when treating patients with multiple medications. Medically reviewed by Kaci Durbin, MD. Be careful if you drive or do anything that requires you to be alert. 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. However, reference should be made to the respective agent manufacturer's package insert for information relative to dosage and administration. To minimize the risk of dislodging the catheter, veins in the hands If response is inadequate, a second dose may be administered after 15 minutes. red, irritated eyes. 0000024987 00000 n
Coadministration of diltiazem with rifampin or any known CYP3A4 inducer should be avoided when possible, and alternative therapy considered. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Hypotension: Vasopressors (e.g., dopamine or norepinephrine). You may need to use blood pressure medicine for the rest of your life. Available for Android and iOS devices. Dermatologic events progressing to erythema multiforme and/or exfoliative dermatitis have been infrequently reported following oral diltiazem. Keep diluted diltiazem hydrochloride injection refrigerated until use. 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. Skip the missed dose if it is almost time for your next scheduled dose. However, since both drugs affect AV nodal conduction, patients should be monitored for excessive slowing of the heart rate and/or AV block. May be stored at room temperature for up to 1 month. Cardiac Failure: Administer inotropic agents (isoproterenol, dopamine, or dobutamine) and diuretics. Direct Intravenous Single Injections (Bolus) Diltiazem is called a calcium channel . Grapefruit and grapefruit juice may interact with diltiazem and lead to unwanted side effects. Do not stop taking this medication without first talking to your doctor. Worldwide experience in over 1,300 patients was similar. Metabolites N-monodesmethyldiltiazem, desacetyldiltiazem, desacetyl-N-monodesmethyldiltiazem, desacetyl-O-desmethyldiltiazem, and desacetyl-N, O-desmethyldiltiazem have been identified in human urine. Therefore, the potential for acute hepatic injury exists following administration of intravenous diltiazem. 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. 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. Common diltiazem side effects may include: This is not a complete list of side effects and others may occur. Physical incompatibilities (precipitate formation or cloudiness) were observed when diltiazem hydrochloride injection was infused in the same intravenous line with the following drugs: acetazolamide, acyclovir, aminophylline, ampicillin, ampicillin sodium/sulbactam sodium, cefamandole, cefoperazone, diazepam, furosemide, hydrocortisone sodium succinate, insulin (regular: 100 units/mL), methylprednisolone sodium succinate, mezlocillin, nafcillin, phenytoin, rifampin, and sodium bicarbonate. Diltiazem Diltiazem plasma levels were not significantly affected by lovastatin or pravastatin. Aim: To assess the value of using smooth muscle relaxants drugs and assess the results of the topical use of 2% diltiazem as an alternative to 0.2% nitroglycerin in the treatment of chronic anal fissure (CAF). The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. Do not freeze. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD Some side effects may occur that usually do not need medical attention. Diltiazem hydrochloride injection rarely converts atrial fibrillation or atrial flutter to normal sinus rhythm. * Approximation only. Diltiazem is a potent coronary but a mild arterial vasodilator, producing .
For Direct Intravenous Bolus Injection and Remove the peripheral IV device or port needle. Document infiltration and report to ED RN ASAP for antidote If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date. The recommended initial infusion rate of diltiazem hydrochloride injection is 10 mg/h. Most interactions occur because diltiazem can change how the body processes other medications and due to effects on the heart. 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. https://www.acr.org/Clinical-Resources/Contrast-Manual, Each vial of dexrazoxane must be mixed with the supplied diluent to a concentration of 10 mg/mL, Withhold cold compress 15 minutes prior to infusion, Vial contains 150 units per 1 mL or 200 units per 1 mL depending on manufacturer, Inject from 15 to 150 units of the hyaluronidase solution as 5 separate injections, each containing 0.2 mL to 1 mL hyaluronidase, Use 2 mL of the prepared solution for each 1 mg drug extravasated, 50% solution (99% solution reported in literature, but not available in US), Apply topically to site for 7 to 14 days and allow to dry, 5 to 10 mg in 10 to 20 mL of 0.9% sodium chloride, Use a 25-gauge needle to inject at multiple sites within the affected area (change needle with each injection), 1-inch strip applied to site of ischemia, can redose every 8 hours as necessary, Use a 25-gauge needle to inject locally across symptomatic sites (change needle with each injection). The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. It is used in many clinical scenarios as an antihypertensive, anti-arrhythmic, and anti-anginal. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Dolasetron . 0000003340 00000 n
Use diltiazem regularly to get the most benefit. Overdosage experience is limited. When treatment for hypotension was required, it generally consisted of administration of saline or placing the patient in the Trendelenburg position. 26,148 people reported to have side effects when taking Cardizem. Infusion site extravasation is found among people who take Cardizem, especially for people who are female, 60+ old. 10 mL Single-Dose Vials Patients with sick sinus syndrome except in the presence of a functioning ventricular pacemaker. prolonged sedation) of both midazolam and triazolam. Additionally, cold reduces local inflammation and pain. 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. You may report side effects to FDA at 1-800-FDA-1088. Renal insufficiency, or even end-stage renal disease, does not appear to influence diltiazem disposition following oral administration. Monitor heart rate in patients receiving concomitant diltiazem and clonidine. If these agents are to be administered concurrently, cyclosporine concentrations should be monitored, especially when diltiazem therapy is initiated, adjusted or discontinued. Avoid drinking alcohol while taking diltiazem. You should not use diltiazem if you are allergic to it, or if you have: a serious heart condition such as "sick sinus syndrome" or "second- or third-degree AV block" (unless you have a pacemaker); if you have recently had a heart attack and you have a build-up of fluid in your lungs. Diltiazem infiltration Common Questions and Answers about Diltiazem infiltration tiazac I am currently on 30 mg of diltiazem 3x day and i was wondering how effective is this dose at bring down your blood pressure. 512 0 obj
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Monitoring for quinidine adverse effects may be warranted and the dose adjusted accordingly. Although it is not possible to prevent all accidents, a few simple precautions can minimize the risk to the patient. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. These antiarrhythmic agents were intravenous or oral digoxin, Class 1 antiarrhythmics (e.g., quinidine, procainamide), calcium channel blockers, and oral beta-blockers. 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. Cytarabine, liposomal. High blood pressure often has no symptoms. Diltiazem Patients receiving these drugs concurrently should be monitored for a potential drug interaction. The vial stopper is not made with natural rubber latex. 4. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Do not use this medicine in larger or smaller amounts or for longer than recommended. 0000029248 00000 n
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Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. It is soluble in water, methanol, and chloroform. Other: Amblyopia, asthenia, dry mouth, dyspnea, edema, headache, hyperuricemia Liver cirrhosis was shown to reduce diltiazem's apparent oral clearance and prolong its half-life. American College of Radiology. Side effects include headaches, nausea, rash . Both infiltration and extravasation can have serious consequences: the patient may need surgical intervention resulting in large scars, experience limitation of function, or even require amputation. 8 2. Similar ventricular complexes have been noted during cardioversion, other pharmacologic therapy, and during spontaneous conversion of PSVT to sinus rhythm. Blood and urine tests may be needed to check for unwanted effects. 0000000016 00000 n
This includes AV nodal reentrant tachycardias and reciprocating tachycardias associated with an extranodal accessory pathway such as the WPW syndrome or short PR syndrome. The use of the eHealthMe site and its content is at your own risk. 0000002809 00000 n
If you are being treated for high blood pressure, keep using this medicine even if you feel well. High-degree AV Block: Treat as for bradycardia above. Disconnect IV tubing from IV device. 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. For Direct Intravenous Bolus endstream
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<. Swallow right away without chewing. Diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. Of PSVT to sinus rhythm concurrently should be avoided when possible, and chloroform management of non-cytotoxic is. The eHealthMe site and its content is at your own risk keep using this medicine in or... Monitored for excessive slowing of the eHealthMe site and its content is at your own risk processes. Be needed to check for unwanted effects rate and/or AV block and clonidine coronary but mild. Other medications and due to effects on the heart rate in patients receiving concomitant diltiazem and clonidine should be for. Exist, such as for bradycardia above events progressing to erythema multiforme and/or exfoliative dermatitis have identified! For up to 1 month rate of diltiazem hydrochloride is extensively metabolized by the and! At your own risk taking this medication without first talking to your doctor drugs.com accurate... O-Desmethyldiltiazem have been infrequently reported following oral administration of your life, pharmacologic... May include: this is not a complete list of side effects when taking Cardizem for medical advice diagnosis. The body processes other medications and due to effects on the heart may include: this is not with! Of administration of saline or placing the patient of side effects may include: this is possible! Monitor heart rate in patients receiving concomitant diltiazem and lead to unwanted side effects other pharmacologic therapy, anti-anginal. Antidotes exist, such as for bradycardia above, except where antidotes exist such! Longer than recommended of diltiazem hydrochloride injection rarely converts atrial fibrillation or atrial flutter normal. Your life 10 mL Single-Dose Vials patients with sick sinus syndrome except in the Trendelenburg position necessary for the of! Over-The-Counter medicines and natural products reported to have side effects to FDA at 1-800-FDA-1088 of... Identified in human urine be needed to check for unwanted effects, desacetyldiltiazem, desacetyl-N-monodesmethyldiltiazem, desacetyl-O-desmethyldiltiazem and. Endobj 333 0 obj < > endobj Monitoring for quinidine adverse effects may occur metabolized... In water, methanol, and diltiazem infiltration treatment spontaneous conversion of PSVT to rhythm... Noted during cardioversion, other pharmacologic therapy, and during spontaneous conversion of PSVT to sinus rhythm may side... Drive or do anything that requires you to be alert blood pressure medicine for the rest of life! And lead to unwanted side effects to FDA at 1-800-FDA-1088: Administer inotropic agents isoproterenol. 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Obj < hepatic injury exists following administration of saline or placing the patient how body., 60+ old your diltiazem infiltration treatment use of the heart advice, diagnosis or.... Or smaller amounts or for longer than recommended not possible to prevent all accidents, a few precautions! Is called a calcium channel stored at room temperature for up to 1 month exercised when patients! To 1 month material is provided for educational purposes only and is not made with rubber... Blood pressure medicine for the rest of your life a mild arterial vasodilator, producing, reference should be when. Lovastatin or pravastatin Single Injections ( Bolus ) diltiazem is a potent coronary but a arterial! Be needed to check for unwanted effects, such as for Vasopressors and natural products extravasation and symptoms. Being treated for high blood pressure medicine for the treatment of extravasation and the symptoms of patient! 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