Ivabradine - Concurrent use of diltiazem increases exposure to ivabradine and may exacerbate bradycardia and conduction disturbances. 0000001694 00000 n Please read our disclaimer. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. If coadministration of simvastatin with diltiazem is required, limit the daily doses of simvastatin to 10 mg and diltiazem to 240 mg. The effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose has been inconsistent. 0000025065 00000 n Rifampin - Coadministration of rifampin with diltiazem lowered the diltiazem plasma concentrations to undetectable levels. Supplement 1. Give a list of all your medicines to any healthcare provider who treats you. Common symptoms and signs of extravasation include pain, stinging or burning sensations, and edema around the intravenous (IV) injection site. To prevent extravasation, a clinical specialist should perform the venipuncture or injection, who with relevant skills and management ability understands the properties of the injected drug. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. %%EOF 0000002809 00000 n government site. 0000010832 00000 n Spots or solid lines with blisters can be suddenly felt along the vessels injected with drugs. hb```l 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. Enhanced effects and increased toxicity of buspirone may be possible during concomitant administration with diltiazem. Available from: Lacy C, American Pharmaceutical Association . Pharmacodynamics It also increases the supply of blood and oxygen to the heart. 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. Extravasation:Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Only 1 of the studies of diltiazem was in children. All rights reserved. FOIA Drug information handbook for oncology: a complete guide to combination chemotherapy regimens. Direct Intravenous Single Injections (Bolus) Cardiac Conduction - Diltiazem prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm. Sterile 25 mL Single-Dose Vial tiazac. - Regularly check the extravasation kit and refill any used medications. 0000019842 00000 n Hemodynamics 3. DO NOT apply pressure to the area 6. Diltiazem may also be used for purposes not listed in this medication guide. The frequency of extravasation in adults is reported to be between 0.1% and 6%. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. (5 mg/mL) Revised: April 2023, Rx only NDC 55150-425-01 This content does not have an English version. HHS Vulnerability Disclosure, Help Patients who have demonstrated hypersensitivity to the drug. %%EOF The patient should receive the skin graft for recovering her arm skin. Vinen CS, Patel S, Bruckner FE. The T1/2 and Tmax of buspirone were not significantly affected by diltiazem. Transition to Further Antiarrhythmic Therapy HCl Injection (5 mg/mL) Patients with severe hypotension or cardiogenic shock. Disclaimer. Sodium hydroxide or hydrochloric acid is used for pH adjustment. 125 mg per 25 mL (5 mg/mL) This site needs JavaScript to work properly. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. The patient must be informed of the scope of the problem (Supplement 5). Chicago (IL): University of Illinois College of Pharmac; c2020. eugia, Rx only NDC 55150-427-10 Packaged in a Carton of 10 NDC 55150-426-10 You may report side effects to FDA at 1-800-FDA-1088. Packaged in a Carton of 10 NDC 55150-425-10 Medically reviewed by Drugs.com. Diltia XT, Dilt-XR, Diltzac, Matzim LA, Taztia XT, Tiadylt ER, Tiazac. Keep diluted diltiazem hydrochloride injection refrigerated until use. Asymptomatic hypotension occurred in 4.3% of patients. Occurs due to contraction of the vessel wall and usually happens as soon as the fluid injection begins. Diltiazem is not intended to convert atrial fib or flutter to NSR but to slow the heart rate down. An adjustment in the diltiazem dose may be warranted. Diltiazem inhibits the influx of calcium (Ca2+) ions during membrane depolarization of cardiac and vascular smooth muscle. Diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. For the most part, blood does not backflow. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. other information we have about you. One hundred two (102) patients <65 had a response rate of 78%. Common Questions and Answers about Diltiazem extravasation. IV Push IV infusion . 25 mg per 5 mL These contents are derived from authors experiences and the references [1-21]. Drug information: Clinical Computerized Information System: vol. It has a molecular weight of 451.0. Langer SW. Extravasation of chemotherapy. - If in doubt, re-insert the cannula and administer the drug. . 0000000016 00000 n Take diltiazem exactly as prescribed by your doctor. You may opt-out of email communications at any time by clicking on Discard Unused Portion Store Under Refrigeration Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. This medicine is available only with your doctor's prescription. These guidelines consist of following topics: basic knowledge about extravasation, extravasation management, and extravasation prevention. Manufactured by: Please enable it to take advantage of the complete set of features! Sodium hydroxide or hydrochloric acid is used for pH adjustment. If you are being treated for high blood pressure, keep using this medicine even if you feel well. Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician. The drug should be used with caution in patients with impaired renal or hepatic function (see WARNINGS). 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. In vitro, propranolol appears to be displaced from its binding sites by diltiazem. } !1AQa"q2#BR$3br Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. 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. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 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. 50-mg, 10-mL vialeach sterile vial contains 50 mg diltiazem hydrochloride, 7.5 mg citric acid USP, 6.5 mg sodium citrate dihydrate USP, 714 mg sorbitol solution USP, and water for injection USP up to 10 mL. When treatment for hypotension was required, it generally consisted of administration of saline or placing the patient in the Trendelenburg position. The .gov means its official. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. official website and that any information you provide is encrypted 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. the contents by NLM or the National Institutes of Health. Hyderabad 500032 For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. However, reference should be made to the respective agent manufacturer's package insert for information relative to dosage and administration. See this image and copyright information in PMC. %PDF-1.4 % The use of intravenous diltiazem for control of ventricular response in patients with supraventricular arrhythmias should be undertaken with caution when the patient is compromised hemodynamically. HCl Injection 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Federal government websites often end in .gov or .mil. Supplement 2. General information submitted for this request. 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. There was an increased incidence of stillbirths at doses of 20 times the human oral antianginal dose or greater. The best therapeutic agent for treatment of vasopressor extravasation is intradermal . Should a dermatologic reaction persist, the drug should be discontinued. Nursing Department, Asan Medical Center . Portions of this document last updated: April 01, 2023. Tips Extended-release diltiazem capsules should be taken on an empty stomach (this means one hour before food or two hours after food). 0 If there is no response to vagal blockade administer isoproterenol cautiously. Similar ventricular complexes have been noted during cardioversion, other pharmacologic therapy, and during spontaneous conversion of PSVT to sinus rhythm. It is soluble in water, methanol, and chloroform. Atrial fibrillation or atrial flutter - In clinical studies with diltiazem hydrochloride injection for AF/FI, 135 of 257 patients were 65 years of age. 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. 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. information is beneficial, we may combine your email and website usage information with 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. Be careful if you drive or do anything that requires you to be alert. 0000012749 00000 n Patients with ventricular tachycardia. Eugia Pharma Specialities Limited Store diltiazem at room temperature away from moisture and heat. Patients receiving these drugs concurrently should be monitored for a potential drug interaction. Use diltiazem regularly to get the most benefit. If bone marrow function decreases, anticancer treatments may be delayed due to infection caused by leukopenia. 0 Photographic documentation can be helpful for follow-up procedures. 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. 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. Sterile eugia 10 x 5 mL Single-Dose Vials, Rx only NDC 55150-426-01 Drug information handbook. Over this infusion range, as the dose is increased, systemic clearance decreases from 64 to 48 L/h while the plasma elimination half-life increases from 4.1 to 4.9 hours. Diltiazem may impair your thinking or reactions. 10 mL Single-Dose Vials Three solutions were used: 1/2 saline (154 mOsm), normal saline (308 mOsm), and 3% saline (1027 mOsm). endstream endobj startxref Copyright 1996-2023 Cerner Multum, Inc. Englewood (CO): Micromedex Inc; [date unknown]. Chemically, diltiazem hydrochloride is 1,5-benzothiazepin-4-(5H)-one,3-(Acetyloxy)-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(-4-methoxyphenyl)-, monohydrochloride, (+)-cis-. 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. Maximal hemodynamic effects usually occurred within 2 to 5 minutes of an injection. Administration of oral diltiazem in patients with acute myocardial infarction and pulmonary congestion documented by x-ray on admission is contraindicated. Pain or tightening occurs along the vein, and it is caused mainly by drugs such as vinorelbine and dacarbazine. Available from: [place unknown]: The National Extravasation Information Service; 2020. Coadministration of diltiazem with rifampin or any known CYP3A4 inducer should be avoided when possible, and alternative therapy considered. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or in vitro in bacteria. Liver cirrhosis was shown to reduce diltiazem's apparent oral clearance and prolong its half-life. Diltiazem (Oral Route) Your gift holds great power - donate today! The dose may be increased slowly over time until treatment goals are achieved. startxref Diltiazem is both a substrate and an inhibitor of the cytochrome P-450 3A4 enzyme system. Elevation of the limb may aid in reabsorption of the infiltrate or extravasated vesicant by decreasing capillary hydrostatic pressure. If you are a Mayo Clinic patient, this could Diltiazem hydrochloride injection is indicated for the following: %%EOF 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.

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