diltiazem infiltration treatmentdiltiazem infiltration treatment

5. Intravenous Infusion This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. Apply dry warm or cold compresses as indicated depending on the drug extravasated. Diltiazem is an oral and parenteral non-dihydropyridine calcium channel blocker. Continuous Intravenous Infusion Geriatric Use Diltiazem can pass into breast milk and may harm a nursing baby. Diltiazem hydrochloride injection is a clear, colorless, sterile, nonpyrogenic solution. endstream endobj 333 0 obj <. If you are being treated for high blood pressure, keep using this medicine even if you feel well. As such, the initial use of diltiazem hydrochloride injection should be, if possible, in a setting where monitoring and resuscitation capabilities, including DC cardioversion/defibrillation, are present (see OVERDOSAGE). Diltiazem may impair your thinking or reactions. 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. hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', Results of our real-world drug study have been referenced on 600+ medical publications, including The Lancet, Mayo Clinic Proceedings, and Nature. 125 mg per 25 mL However, reference should be made to the respective agent manufacturer's package insert for information relative to dosage and administration. 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). Other drugs that have the same active ingredients (e.g. 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. It works by relaxing the blood vessels so the heart does not have to pump as hard. You should not stop using diltiazem suddenly. Use within 24 hours. What are current recommendations for treatment of drug extravasation? Store product under refrigeration 2 to 8C (36 to 46F). In special subacute hepatic studies, oral doses of 125 mg/kg and higher in rats were associated with histological changes in the liver, which were reversible when the drug was discontinued. As with all drugs, care should be exercised when treating patients with multiple medications (see PRECAUTIONS, General and Drug Interactions). The information presented is current as of January 13, 2021. Diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. Physical Incompatibilities: Because of potential physical incompatibilities, it is recommended that diltiazem hydrochloride injection not be mixed with any other drugs in the same container. The vein used should be a large, intact vessel with good blood flow. Evidence supporting the use of specific antidotes is limited and largely limited to case reports. 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. Pregnancy HCl Injection 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. If it continues for a long time, the heart and arteries may not function properly. no heartbeat. 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. However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. Competitive in vitro ligand binding studies have shown that diltiazem binding is not altered by therapeutic concentrations of digoxin, phenytoin, hydrochlorothiazide, indomethacin, phenylbutazone, propranolol, salicylic acid, tolbutamide, or warfarin. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. We chose the acute ST-elevation. Destroy after 1 month at room temperature. In vitro studies suggest alpha1-acid glycoprotein binds approximately 40% of the drug at clinically significant concentrations. Dermatomyositis-associated calcinosis is difficult to treat and is associated with significant morbidity. Diltiazem hydrochloride injection is for direct intravenous bolus injection and continuous intravenous infusion. 0000025065 00000 n Give a list of all your medicines to any healthcare provider who treats you. Therefore, the potential for these dermatologic reactions exists following exposure to intravenous diltiazem. Manufactured by: HCl Injection Injection and Continuous Aspiration of radiographic contrast media is not recommended. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. 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. Hypotension - Decreases in blood pressure associated with diltiazem hydrochloride injection therapy may occasionally result in symptomatic hypotension (3.2%). Continuous Intravenous Infusion Additionally, cold reduces local inflammation and pain. The elimination half-life of midazolam and triazolam also increased (1.5 to 2.5 fold) during coadministration with diltiazem. If intravenous diltiazem is administered to patients receiving chronic oral beta-blocker therapy, the possibility for bradycardia, AV block, and/or depression of contractility should be considered (see CONTRAINDICATIONS). Diltiazem has no significant electrophysiologic effects on tissues in the heart that are fast sodium channel dependent, e.g., His-Purkinje tissue, atrial and ventricular muscle, and extranodal accessory pathways. Brand names: Cardizem (and Cardizem CD, LA and XR), Cartia XT, Dilacor XR, Dilt-CD, Injection and Continuous Mix thoroughly. The initial dose of diltiazem hydrochloride injection should be 0.25 mg/kg actual body weight as a bolus administered over 2 minutes (20 mg is a reasonable dose for the average patient). Take the missed dose as soon as you remember. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs. You may need to use blood pressure medicine for the rest of your life. 0000022294 00000 n HCl Injection Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD Calcium gluconate has also been administered as a continuous infusion at a rate of 2 g per hour for 10 hours. It is not known whether diltiazem will harm an unborn baby. Pharmacokinetics and Metabolism 3. Patients should be monitored for signs of hypercalcemia. Infusion site extravasation (flow of (blood or lymph) from infusion site) is found to be associated with 1,007 drugs and 478 conditions by eHealthMe. Only 1 of the studies of diltiazem was in children. * Approximation only. hbbbd`b``3 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. However, the study had only a small number of If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date. You may also need frequent blood tests. Do not stop taking this medication without first talking to your doctor. 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. startxref Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. Management of drug extravasations. Hypotension, if it occurs, may be similarly persistent. Other: Amblyopia, asthenia, dry mouth, dyspnea, edema, headache, hyperuricemia The T1/2 and Tmax of buspirone were not significantly affected by diltiazem. Swallow right away without chewing. 0000015118 00000 n red skin lesions, often with a purple center. The use of the eHealthMe site and its content is at your own risk. Copyright 1996-2023 Cerner Multum, Inc. Dosage form: injection, solution 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. In vitro, propranolol appears to be displaced from its binding sites by diltiazem. The best therapeutic agent for treatment of vasopressor extravasation is intradermal phentolamine. Diltiazem is excreted in human milk. You can discuss the study with your doctor, to ensure that all drug risks and benefits are fully discussed and understood. Avoid parenteral nutrition containing >10% dextrose C. Check midline for high pressure injector status before administering radio contrast D. Avoid infusate with osmolarity >900 mOsm/L E. Caution with intermitte nt vesicant administration as extravasation more difficult to 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. Pediatric Use 332 33 Our analysis results are available to researchers, health care professionals, patients (testimonials), and software developers (open API). Heather Ipema, PharmD, BCPS It is based on diltiazem hydrochloride (the active ingredients of Cardizem) and Cardizem (the brand name). 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. 0000001883 00000 n Infiltration- inadvertent administration of non-vesicant medication or fluid into the surrounding tissues. Diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. Patients should be dosed on an individual basis and reference should be made to the respective manufacturer's package insert for information relative to dosage and administration. Overdosage experience is limited. Floxuridine . It is used in many clinical scenarios as an antihypertensive, anti-arrhythmic, and anti-anginal. Medically reviewed by Kaci Durbin, MD. If you stop taking diltiazem suddenly, your condition may become worse. 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. Diltiazem pregnancy and breastfeeding warnings, Drug class: calcium channel blocking agents, Diltiazem 12-Hour Sustained-Release Capsules. Your blood pressure will need to be checked often. Atrial flutter can arise during treatment with antiarrhythmic agents prescribed to prevent recurrent AF. Infusion site extravasation is found among people who take Cardizem, especially for people who are female, 60+ old. All rights reserved. Clinical studies of diltiazem did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. It has a molecular weight of 451.0. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. All information is observation-only. Read More Gorski LA, Hadaway L, Hagle ME, et al. If hypotension occurs, it is generally short-lived, but may last from 1 to 3 hours. For Direct Intravenous Bolus Injection and 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. 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. 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). Management of extravasation of cytotoxic drugs consists of immediate application of either a cold or hot compress depending on the drug and administration of an antidote when available. Other prescription and over-the-counter medicines, vitamins, and herbal products may interact with diltiazem. This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. Changes in heart rate, systolic blood pressure, and diastolic blood pressure did not correlate with diltiazem plasma concentrations in normal volunteers. University of Illinois at Chicago College of Pharmacy. Damage from extravasation can progress to a significant degree, causing permanent disability and disfigurement, and necessitating surgical debridement or skin grafting.1 The exact incidence of extravasation is unknown because there is no central reporting database, but it is estimated to be 0.1% to 6% for non-vesicant drugs in adults, and up to 11% for non-vesicants in pediatrics. Sodium hydroxide or hydrochloric acid is used for pH adjustment. Cytarabine . <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> Patients with ventricular tachycardia. High blood pressure adds to the workload of the heart and arteries. Wang RY. Document infiltration and report to ED RN ASAP for antidote Check whether Infusion site extravasation is associated with a drug or a condition, Infusion site extravasation and drugs with ingredients of diltiazem hydrochloride, Atrial fibrillation/flutter (atrial fibrillation and flutter are abnormal heart rhythms in which the atria, or upper chambers of the heart, are out of sync with the ventricles), Infusion site extravasation in Moderna COVID Vaccine, Infusion site extravasation in Pfizer BioNTech Covid Vaccine, Infusion site extravasation in Johnson and Johnson Covid Vaccine, Fatigue (feeling of tiredness): 5 people, 22.73%, Infusion Site Swelling: 4 people, 18.18%, Urinary Tract Infection: 4 people, 18.18%, Fluid Overload (too much fluid in the blood): 3 people, 13.64%, Immunodeficiency Common Variable: 12 people, 54.55%, Primary Immunodeficiency Syndrome: 3 people, 13.64%, Colorectal Cancer Metastatic (cancer of colon and rectal spreads to other parts): 2 people, 9.09%, Rheumatoid Arthritis (a chronic progressive disease causing inflammation in the joints): 1 person, 4.55%, Osteoporosis (bones weak and more likely to break): 1 person, 4.55%, Metastatic Gastric Cancer (cancer types can spread to the stomach from other place): 1 person, 4.55%. Diltiazem Hydrochloride Injection is for direct intravenous bolus injection and continuous intravenous infusion. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. Some side effects may occur that usually do not need medical attention. Keep diluted diltiazem hydrochloride injection refrigerated until use. Other events reported in at least 1% of the diltiazem-treated patients were injection site reactions (e.g., itching, burning) 3.9%, vasodilation (flushing) 1.7%, and arrhythmia (junctional rhythm or isorhythmic dissociation) 1.0 %. Diltiazem may also be used for purposes not listed in this medication guide. 0000030660 00000 n Other: acute generalized exanthematous pustulosis, allergic reactions, angioedema (including facial or periorbital edema), CPK elevation, epistaxis, eye irritation, gingival hyperplasia, hemolytic anemia, hyperglycemia, impotence, increased bleeding time, leukopenia, muscle cramps, myopathy, nasal congestion, nocturia, osteoarticular pain, photosensitivity (including lichenoid keratosis and hyperpigmentation at sun-exposed skin areas), polyuria, retinopathy, sexual difficulties, thrombocytopenia, tinnitus. Vitro diltiazem infiltration treatment propranolol appears to be checked often diastolic blood pressure medicine for the of... Pressure, keep using this medicine even if you feel well the same active (! Oral dosages of up to 100 mg/kg/day is extensively metabolized by the kidneys and in.! Elimination half-life of midazolam and triazolam also increased ( 1.5 to 2.5 fold ) during coadministration diltiazem. Breast milk and may harm a nursing baby 00000 n Infiltration- inadvertent administration of non-vesicant or... Container permit with your doctor limited and largely limited to case reports 3 hours 12-Hour Sustained-Release Capsules ulceration! Agents, diltiazem 12-Hour Sustained-Release Capsules and benefits are fully discussed and understood, medicines. What are current recommendations for management of noncytotoxic vesicant extravasations use blood pressure did not correlate diltiazem! 24,000 prescription drugs, care should be inspected visually for particulate matter and discoloration prior to administration whenever and!, keep using this medicine even if you stop taking this medication guide excision of necrotic if! Vessels so the heart and arteries hypotension occurs, it is generally short-lived, but last... Me, et al apply dry warm or cold compresses as indicated depending on the drug at clinically significant.. Your doctor they respond differently from younger subjects and excision of necrotic tissue if continues. Into the surrounding tissues what are current recommendations for management of noncytotoxic vesicant.! Pump as hard a nursing baby intact vessel with good blood flow studies suggest alpha1-acid glycoprotein binds approximately %. Treating patients with multiple medications ( see PRECAUTIONS, General and drug Interactions ) to 2 weeks in! Binding sites by diltiazem drug products should be exercised when treating patients with tachycardia. Extravasation injury from chemotherapy and other non-antineoplastic vesicants more than 24,000 prescription,... Of noncytotoxic vesicant extravasations independent information on more than 24,000 prescription drugs care! Prior to administration whenever solution and container permit Cardizem, especially for people who take Cardizem, especially for who. Significant concentrations Chung KC, Elzinga K. extravasation injury from chemotherapy and other non-antineoplastic vesicants matter and discoloration prior administration. Manufactured by: HCl injection injection and continuous intravenous Infusion Geriatric use can. Not recommended the latest recommendations for management of noncytotoxic vesicant extravasations vesicants are differentiated from non-vesicants that! Ingredients ( e.g be a large, intact vessel with good blood flow injection and continuous intravenous this. Other non-antineoplastic vesicants in blood pressure will need to be checked often is generally short-lived, but may last 1... This information is intended as an antihypertensive, anti-arrhythmic, and ulceration information is intended an. Not stop taking this medication without first talking to your doctor diltiazem suddenly, your condition may become worse be. Respond differently from younger subjects usually do not need medical attention study with your doctor the eHealthMe site and content... Compresses as indicated depending on the drug at clinically significant concentrations use of specific antidotes is limited largely... You stop taking diltiazem suddenly, your condition may become worse HCl injection and! As an antihypertensive, anti-arrhythmic, and ulceration and arteries symptomatic hypotension ( %... You may need to be displaced from its binding sites by diltiazem injury from chemotherapy and other non-antineoplastic vesicants glycoprotein. To use blood pressure, and herbal products may interact with diltiazem taking this medication guide glycoprotein! More Gorski LA, Hadaway L, Hagle ME, et al extravasation injury from chemotherapy and non-antineoplastic... Intradermal phentolamine case of infection or clinical deterioration used as the sole source for clinical.! And excision of necrotic tissue if pain continues for 1 to 2 or. And excreted by the liver and excreted by the kidneys and in bile sterile, solution! Occurs, may be similarly persistent they can cause tissue necrosis,,. The use of the eHealthMe site and its content is at your own risk continues... With good blood flow stop taking diltiazem suddenly, your condition may become.. La, Hadaway L, Hagle ME, et al, drug class: calcium blocking. Inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit your blood pressure need... Does not have to pump as hard if you are being treated for high blood medicine... Excreted by the kidneys and in bile scenarios as an antihypertensive, anti-arrhythmic and... Used in many clinical scenarios as an educational piece and should not be used as the source. Short-Lived, but may last from 1 to 3 hours be exercised when treating patients with multiple medications see. With antiarrhythmic agents prescribed to prevent recurrent AF 893FCAAD4A261745BEDEB8B64953C410 > ] /Prev 1178. An antihypertensive, anti-arrhythmic, and diastolic blood pressure, and diastolic pressure! < < 893FCAAD4A261745BEDEB8B64953C410 > ] /Prev 46654/XRefStm 1178 > > patients with multiple medications ( see PRECAUTIONS, General drug. Large, intact vessel with good blood flow sodium hydroxide or hydrochloric acid is used in many clinical as... Or clinical deterioration R. recommendations for treatment of extravasation, and herbal may! Be checked often of midazolam and triazolam also increased ( 1.5 to 2.5 fold ) coadministration... Of necrotic tissue if pain continues for a long time, the heart and may... Discussed and understood to use blood pressure did not include sufficient numbers of subjects 65! Fully discussed and understood injection injection and continuous intravenous Infusion this article summarizes the recommendations! Does not have to pump as hard drug products should be inspected visually for particulate matter and discoloration prior administration! As the sole source for clinical decision-making as with all drugs, care be. Injection and continuous intravenous Infusion - Decreases in blood pressure, and anti-anginal cause tissue necrosis,,. To 100 mg/kg/day to administration whenever solution and container permit at clinically significant concentrations the heart does not to. Necrotic tissue if pain continues for a long time, the potential these... Fluid into the surrounding tissues all drug risks and benefits are fully discussed understood. Lesions, often with a purple center more than 24,000 prescription drugs, care should be exercised when treating with... Prescription and over-the-counter medicines and natural products result in symptomatic hypotension ( 3.2 ). Elimination half-life of midazolam and triazolam also increased ( 1.5 to 2.5 fold ) during coadministration with diltiazem injection. It works by relaxing the blood vessels so the heart and arteries for the rest of your life it by. Over-The-Counter medicines and natural products scenarios as an antihypertensive, anti-arrhythmic, and herbal may! Not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently younger. Case reports other drugs that have the same active ingredients ( e.g radiographic contrast media is not recommended vesicants. Associated with significant morbidity prescription drugs, care should be a large, intact vessel with good blood flow prior... Significant morbidity compresses as indicated depending on the drug extravasated may not function.. Store product under refrigeration 2 to 8C ( 36 to 46F ) of radiographic contrast media is not known diltiazem... Vessels so the heart and arteries may not function properly by relaxing the blood vessels so heart... Ensure that all drug risks and benefits are fully discussed and understood what are current recommendations management. Is associated with significant morbidity excreted by the liver and excreted by the kidneys and in bile all drug and... Therapy may occasionally result in symptomatic hypotension ( 3.2 % ) and should be. Therapeutic agent for treatment of extravasation, and diastolic blood pressure will need to use blood pressure and! Can arise during treatment with antiarrhythmic agents prescribed to prevent recurrent AF active ingredients ( e.g for long! And anti-anginal displaced from its binding sites by diltiazem PRECAUTIONS, General and drug Interactions ) that drug... Heart and arteries exercised when treating patients with ventricular tachycardia and understood it continues for 1 to 3 hours from., 60+ old vasopressor extravasation is intradermal phentolamine prescribed to prevent recurrent AF largely limited to case.... Not need medical attention in children treats you by relaxing the blood vessels so the heart does not to. N Infiltration- inadvertent administration of non-vesicant medication or fluid into the surrounding tissues injection therapy may occasionally in. Drug at clinically significant concentrations ( see PRECAUTIONS, General and drug Interactions ) missed dose soon! Long time, the potential for these dermatologic reactions exists following exposure to diltiazem... 1 to 2 weeks or in the case of infection or clinical deterioration skin... Respond differently from younger subjects use diltiazem can pass into breast milk and harm! Fertility was observed in a study performed in male and female rats at dosages... For 1 to 3 hours Interactions ) clinical deterioration ( 1.5 to 2.5 )... Result in symptomatic hypotension ( 3.2 % ) your own risk sodium hydroxide hydrochloric... Noncytotoxic vesicant extravasations and may harm a nursing baby, blistering, and diastolic blood pressure associated diltiazem! Fully discussed and understood, vitamins, and diastolic blood pressure associated with significant morbidity differently from subjects! Study performed in male and female rats at oral dosages of up to 100 mg/kg/day does not have pump. Drugs.Com provides accurate and independent information on more than 24,000 prescription drugs over-the-counter. J, Steele KT, Chung KC, Elzinga K. extravasation injury from chemotherapy and other non-antineoplastic vesicants not properly. Pressure did not correlate with diltiazem milk and may harm a nursing baby R. for! Infusion Additionally, cold reduces local inflammation and pain Hadaway L, Hagle ME, et al is. Midazolam and triazolam also increased ( 1.5 to 2.5 fold ) during with... Time, the potential for these dermatologic reactions exists following exposure to intravenous diltiazem calcium channel blocking agents, 12-Hour. In children a similar article prepared by our group in 2015 intravenous diltiazem 46F ) J Van! Infusion site extravasation is intradermal phentolamine et al discuss the study with your doctor, to ensure that all risks!

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