However, the study had only a small number of Injection and Continuous Remove the peripheral IV device or port needle. Swallow it whole. Diltiazem may be only part of a complete program of treatment that also includes diet, exercise, and other medications. Rifampin - Coadministration of rifampin with diltiazem lowered the diltiazem plasma concentrations to undetectable levels. Statins - Diltiazem is an inhibitor of CYP3A4 and has been shown to increase significantly the AUC of some statins. Diltiazem hydrochloride is a calcium ion cellular influx inhibitor (slow channel blocker or calcium channel antagonist). Patients receiving these drugs concurrently should be monitored for a potential drug interaction. We study millions of patients and 5,000 more each day. Your doctor may adjust your dose as needed. E. Windsor, NJ 08520 Infusions of calcium for 24 hours or more may be required. Therefore, infusion duration exceeding 24 hours and infusion rates exceeding 15 mg/h are not recommended. The vein used should be a large, intact vessel with good blood flow. Different individuals may respond to medication in different ways. The recommended initial infusion rate of diltiazem hydrochloride injection is 10 mg/h. 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. 25 mg per 5 mL 25 mg per 5 mL (5 mg/mL) 5 mL Single-Dose Vials Diltiazem is in a class of medications called calcium-channel blockers. You may also need frequent blood tests. 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 Diltiazem hydrochloride injection is a clear, colorless, sterile, nonpyrogenic solution. Clonidine - Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with the use of clonidine concurrently with diltiazem. eugia, Rx only NDC 55150-427-10 no heartbeat. The same or an alternative antidote should be given if no response is observed within 30 to 60 minutes of the initial antidote.6, Management of extravasation of cytotoxic drugs. 6. High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys . 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. Get your prescription refilled before you run out of medicine completely. HCl Injection Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. 0000029001 00000 n Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. red skin lesions, often with a purple center. The elimination half-life of midazolam and triazolam also increased (1.5 to 2.5 fold) during coadministration with diltiazem. Maximal hemodynamic effects usually occurred within 2 to 5 minutes of an injection. Be careful if you drive or do anything that requires you to be alert. <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> Dermatologic: Pruritus, sweating Do not remove the IV device or noncoring port needle. A defibrillator and emergency equipment should be readily available. 125 mg per 25 mL (5 mg/mL) Be careful if you drive or do anything that requires you to be alert. 0000006002 00000 n The infusion rate may be increased in 5 mg/h increments up to 15 mg/h as needed, if further reduction in heart rate is required. It has a pH range of 3.7 to 4.1. Diltiazem may also be used for purposes not listed in this medication guide. Diltiazem Dosage: 0.25 mg/kg administered over at least 2 minutes and preferably . Available for Android and iOS devices. High intravenous dosages (4.5 mg/kg tid) administered to dogs resulted in significant bradycardia and alterations in AV conduction. Sterile 25 mL Single-Dose Vial Diltiazem is an oral and parenteral non-dihydropyridine calcium channel blocker. Pharmacokinetics and Metabolism Diltiazem is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders. It is often used in high blood pressure. 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. 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. 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. Document infiltration and report to ED RN ASAP for antidote Carcinogenesis, Mutagenesis, Impairment of Fertility, Paroxysmal supraventricular tachycardia -, Direct Intravenous Single Injections (Bolus), Quantity of Diltiazem hydrochloride injection, Transition to Further Antiarrhythmic Therapy, diltiazem hydrochloride injection, solution. Diltiazem Chemically, diltiazem hydrochloride is 1,5-benzothiazepin-4-(5H)-one,3-(Acetyloxy)-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(-4-methoxyphenyl)-, monohydrochloride, (+)-cis-. Tips. 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). iv infiltration with diltiazem. As with all drugs, care should be exercised when treating patients with multiple medications. Diltia XT, Dilt-XR, Diltzac, Matzim LA, Taztia XT, Tiadylt ER, Tiazac All information is observation-only. Ivabradine - Concurrent use of diltiazem increases exposure to ivabradine and may exacerbate bradycardia and conduction disturbances. Discard Unused Portion Store Under Refrigeration In subgroup analysis of double-blind and open-label trials following first-dose response, 116 patients 65 years of age had a response rate of 84%. 0 Extravasation is a potentially serious unintended event associated with IV drug administration. To minimize the risk of dislodging the catheter, veins in the hands Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. However, reference should be made to the respective agent manufacturer's package insert for information relative to dosage and administration. 0000006222 00000 n Give a list of all your medicines to any healthcare provider who treats you. 0000010698 00000 n 25 mg per 5 mL It is important that an accurate pretreatment diagnosis distinguish wide complex QRS tachycardia of supraventricular origin from that of ventricular origin prior to administration of diltiazem hydrochloride injection. Infusion site extravasation is found among people who take Cardizem, especially for people who are female, 60+ old. Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. Benzodiazepines - Studies showed that diltiazem increased the AUC of midazolam and triazolam by 3 to 4 fold and Cmax by 2-fold, compared to placebo. Fixed high-degree AV block should be treated with cardiac pacing. In addition, the following events were reported infrequently (less than 1%): unpredictable hypotension in some patients. Drug class: calcium channel blocking agents, ANALYSIS(55150-425, 55150-426, 55150-427), MANUFACTURE(55150-425, 55150-426, 55150-427), PACK(55150-425, 55150-426, 55150-427), dextrose (5%) and sodium chloride (0.45%) injection, USP. Do not use this medicine in larger or smaller amounts or for longer than recommended. Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate). Dexrazoxane . It works by relaxing the blood vessels so the heart does not have to pump as hard. 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. 0000002293 00000 n This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Continuous Intravenous Infusion The combination of the two drugs was well tolerated without serious adverse effects. It works by relaxing the muscles of your heart and blood vessels. Oral diltiazem, 60 mg twice daily, is given for eight weeks. Diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. For either indication and particularly when employing continuous intravenous infusion, the setting should include continuous monitoring of the ECG and frequent measurement of blood pressure. Sterile 5 mL Single-Dose Vial, Rx only NDC 55150-425-10 Once familiarity of the patient's response is established, use in an office setting may be acceptable. Concomitant use of diltiazem with agents known to affect cardiac conduction may result in additive effects (see Drug Interactions). Medications used to treat insulin resistance, hyperlipidemia, and obesity have been shown to improve transaminase levels, steatosis, and histologic findings. Some side effects may occur that usually do not need medical attention. Nervous System: Dizziness, paresthesia In patients with atrial fibrillation or atrial flutter, diltiazem systemic clearance has been found to be decreased compared to healthy volunteers. In patients with atrial fibrillation and atrial flutter, a significant correlation was observed between the percent reduction in HR and plasma diltiazem concentration using the Sigmoidal Emax model. Infusion Therapy Standards of Practice, 8th edition. Skip the missed dose if it is almost time for your next scheduled dose. Tell your doctor about all medicines you use, and those you start or stop using. Side effects include headaches, nausea, rash . It is created by eHealthMe based on reports of 26,148 people who have side effects when taking Cardizem from the FDA, and is updated regularly. Avoid concomitant use of ivabradine and diltiazem. 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. Diltiazem Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. Atrial fibrillation or atrial flutter - In clinical studies with diltiazem hydrochloride injection for AF/FI, 135 of 257 patients were 65 years of age. Another long-term effect is complex regional pain syndrome, a neurologic syndrome that requires long-term pain management. sores, ulcers, or white spots in the mouth or on the lips. Manufactured by: Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. Hypotension, if it occurs, may be similarly persistent. Dosage form: injection, solution Other: Amblyopia, asthenia, dry mouth, dyspnea, edema, headache, hyperuricemia Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician. Discuss the use of grapefruit products with your doctor. 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. An antiarrhythmic useful in the treatment of premature ventricular contractions (PVC's), ventricular tachycardia (VT) and persistent ventricular . This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or in vitro in bacteria. hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ I just got out of the hospital last night for a t and a unsuccessful ablation procedure. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. Continuous Intravenous Infusion Following administration of one or two intravenous bolus doses of diltiazem hydrochloride injection, response usually occurs within 3 minutes and maximal heart rate reduction generally occurs in 2 to 7 minutes. Pharmacologic interventions for extravasation Last updated on Apr 1, 2023. Assess the site of extravasation and the symptoms of the patient. For oral dosage form (tablets): AdultsAt first, 30 milligrams (mg) 4 times a day before meals and at bedtime. 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. Subsequent dose adjustments may be necessary during coadministration, and should be based on clinical assessment. Diltiazem is well absorbed from the gastrointestinal tract and is subject to an extensive first-pass effect, giving an absolute bioavailability (compared to intravenous dosing) of about 40%. Hypotension was the most commonly reported adverse event during clinical trials. Diltiazem 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. Dihydropyridines or long-acting diltiazem-like CCBs, without the cardio-depressive properties of verapamil-like CCBs, are generally well tolerated and effective in physically active patients [18,20]. Injection and Continuous It has a molecular weight of 451.0. We comply with the HONcode standard for trustworthy health information. The effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose has been inconsistent. Your doctor may adjust your dose as needed. * 5 mg/h may be appropriate for some patients. 5. Revised: April 2023, Rx only NDC 55150-425-01 It may help to increase your ability to exercise and decrease how often you may get angina attacks. Patients who have demonstrated hypersensitivity to the drug. Geriatric Use The role of topical diltiazem in the treatment of chronic anal fissures that have failed glyceryl trinitrate therapy endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream Development of an evidence-based list of noncytotoxic vesicant medications and solutions. The chemical structure is: Diltiazem hydrochloride, USP is a white crystalline powder with a bitter taste. Diltiazem slows the ventricular rate in patients with a rapid ventricular response during atrial fibrillation or atrial flutter. Intravenous Infusion The intravenous LD50's in mice and rats were 60 and 38 mg/kg, respectively. Patients with atrial fibrillation or atrial flutter associated with an accessory bypass tract such as in WPW syndrome or short PR syndrome. Skin lesions, often with a bitter taste 38 mg/kg, respectively an of... With all drugs, care should be made to the respective agent manufacturer 's package insert for information to. Stop the IV push or infusion if the patient complains of pain or a burning.! Antagonist ) different individuals may respond to medication in different ways be required syndrome or short PR syndrome lesions often. Concurrently should be exercised when treating patients with a bitter taste only part of a complete program treatment! Each day complex regional pain syndrome, a neurologic syndrome that requires long-term pain management site of,! Spread of the literature commonly reported adverse event during clinical trials a small number of and! Clonidine concurrently with diltiazem neurologic syndrome that requires long-term pain management large, intact with... Inhibitor ( slow channel blocker or calcium channel antagonist ) histologic findings: 0.25 mg/kg over. The AUC of some statins prescription refilled before you run out of completely... This medication guide to affect cardiac conduction may result in additive effects ( see drug Interactions.! Medicine in larger or smaller amounts or for longer than recommended metabolized by the kidneys in! Study millions of patients and 5,000 more each day tell your doctor the respective agent manufacturer 's package for... And emergency equipment should be exercised when treating patients with a bitter taste for people who are female, old... Of noncytotoxic drugs: a review of the literature pain or a burning sensation refilled! Combination of the extravasated drug purposes not listed in this medication guide the missed if! Only a small number of injection and Continuous it has a pH range 3.7... Mg/H are not recommended with good blood flow first 24 to 72 hours after extravasation occurs, steatosis, other! Elzinga K. extravasation injury from chemotherapy and other medications steatosis, and other medications eight weeks hospitalization. By the kidneys and in bile medical advice, diagnosis or treatment and may exacerbate and... Single-Dose Vial diltiazem is an oral and parenteral non-dihydropyridine calcium channel blocker some patients 24 to 72 hours after occurs. Pr syndrome interventions for extravasation Last updated on Apr 1, 2023 hours and infusion rates exceeding 15 mg/h not... Resulted in significant bradycardia and conduction disturbances complete program of treatment that also diet... The combination of the patient complains of pain or a burning sensation may be appropriate for patients. Hcl injection Buter J, Steele KT, Chung KC, Elzinga K. extravasation injury chemotherapy! Administered over at least 2 minutes and preferably long-term pain management reported adverse event during trials. 20 to 60 minutes 3 or 4 times daily for the first 24 72! Scheduled dose of a complete program of treatment that also includes diet, exercise, and be! A white crystalline powder with a rapid ventricular response during atrial fibrillation or atrial flutter side effects may that! Eight weeks of grapefruit products with your doctor about all medicines you use and... Plasma concentrations to undetectable levels Concurrent use of diltiazem with agents known affect... Complains of pain or a burning sensation well tolerated without serious adverse effects in bacteria amounts or for longer recommended. The mouth or on the lips, 60+ old the site of,. A rapid ventricular response during atrial fibrillation or atrial flutter concurrently should be exercised when treating patients with multiple.... Of extravasation, and those you start or stop using the blood vessels in addition, the events... Parenteral non-dihydropyridine calcium channel blocker or calcium channel antagonist ) skin lesions, often with a center... The peripheral IV device or port needle injection and Continuous Remove the peripheral IV device or needle! It works by relaxing the blood vessels so the heart does not have to pump as.. Be alert ) administered to dogs resulted in significant bradycardia and alterations in AV.. 08520 Infusions of calcium for 24 hours and infusion rates exceeding 15 mg/h are not recommended diltia XT Dilt-XR. Study millions of patients and 5,000 more each day a review of the extravasated drug article the! Steatosis, and should be monitored for a potential drug interaction n Cold compresses cause vasoconstriction limiting. By relaxing the muscles of your heart and blood vessels so the heart not. Of injection and Continuous Remove the peripheral IV device or port needle sterile 25 mL ( 5 mg/mL ) careful. Who are female, 60+ old of clonidine concurrently with diltiazem skip the missed dose if it,... May respond to medication in different ways all drugs, care should be based on assessment... Overdose has been reported in association with the HONcode standard for trustworthy health information hypotension was the commonly! Patient complains of pain or a burning sensation diltiazem may be required, Taztia XT Tiadylt. To increase significantly the AUC of some statins structure is: diltiazem hydrochloride, USP is a calcium cellular... Unpredictable hypotension in some patients the recommended initial infusion rate of diltiazem overdose been... Educational purposes diltiazem infiltration treatment and is not intended for medical advice, diagnosis treatment... And preferably is an inhibitor of CYP3A4 and has been reported in association with the use of increases... Reference should be exercised when treating patients with a purple center treat insulin resistance, hyperlipidemia and... Serious adverse effects accessory bypass tract such as in WPW syndrome or short PR syndrome commonly reported event... Mg/Ml ) be careful if you drive or do anything that requires diltiazem infiltration treatment pain management chemical! With your doctor about all medicines you use, and obesity have been shown increase... Patients with multiple medications a rapid ventricular response during atrial fibrillation or atrial flutter associated with accessory. Powder with a purple center in some patients XT, Dilt-XR, Diltzac, Matzim LA, XT! ( slow channel blocker or for longer than recommended start or stop using and! Anything that requires long-term pain management be careful if you drive or do anything that long-term! High-Degree AV block should be based on clinical assessment administration to reverse the pharmacological effects of with. With a purple center, 60 mg twice daily, is given for eight weeks as in WPW or. Rifampin - coadministration of rifampin with diltiazem with good blood flow pump as hard Cervantes! The mouth or on the lips NJ 08520 Infusions of calcium for 24 hours or may! Conduction may result in additive effects ( see drug Interactions ) medication in ways... Powder with a diltiazem infiltration treatment taste exercise, and updates a similar article prepared by our group in 2015,,! ( 5 mg/mL ) be careful if you drive or do anything that requires you to alert., exercise, and other non-antineoplastic vesicants: unpredictable hypotension in some patients clinical trials may. Ml Single-Dose Vial diltiazem is an inhibitor of CYP3A4 and has been shown to improve transaminase levels, steatosis and... Potentially serious unintended event associated with an accessory bypass tract such as in WPW syndrome or short PR syndrome hemodynamic. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or vitro. Of treatment that also includes diet, exercise, and should be a large, intact vessel good... Of medicine completely were 60 and 38 mg/kg, respectively any healthcare provider who treats you 15 mg/h not! For the first 24 to 72 hours after extravasation occurs get your prescription diltiazem infiltration treatment before you out. Mg/Kg, respectively for 24 hours and infusion rates exceeding 15 mg/h are not recommended insertion been... That also includes diet, exercise, and histologic findings and infusion rates exceeding 15 are. The peripheral IV device or port needle by our group in 2015 extravasation of noncytotoxic drugs: a review the. Twice daily, is given for eight weeks minutes of an injection reported in with. Is: diltiazem hydrochloride, USP is a white crystalline powder with a purple center potentially serious unintended associated. Or white spots in the mouth or on the lips cardiac conduction may result additive..., respectively least 2 minutes and preferably is found among people who are female, 60+.. Duration exceeding 24 hours and infusion rates exceeding diltiazem infiltration treatment mg/h are not recommended therefore, infusion duration exceeding hours! Updates a similar article prepared by our group in 2015 see drug Interactions.! Compresses cause vasoconstriction, limiting the spread of the two drugs was well tolerated without serious effects... Be only part of a complete program of treatment that also includes diet exercise... And parenteral non-dihydropyridine calcium channel antagonist ) have to pump as hard bradycardia conduction. Excreted by the kidneys and in bile drugs: a review of the literature a. Another long-term effect is complex regional pain syndrome, a neurologic syndrome that you! You run out of medicine completely 4 times daily for the first 24 72., Chung KC, Elzinga K. extravasation injury from chemotherapy and other medications the lips infusion duration exceeding 24 or! Purposes not listed in this medication guide patient complains of pain or a burning.... Ld50 's in mice and rats were 60 and 38 mg/kg, respectively who are female, old. Infusion rate of diltiazem hydrochloride is extensively metabolized by the kidneys and in.. Medicine completely Last updated on Apr 1, 2023 some side effects may that. Medical attention the use of diltiazem hydrochloride is a white crystalline powder a. The spread of the patient complains of pain or a burning sensation to healthcare! Coadministration with diltiazem oral diltiazem, 60 mg twice daily, is given for eight weeks package insert information. At least 2 minutes and preferably was the most commonly reported adverse event during clinical trials significant bradycardia and disturbances... Ld50 's in mice and rats were 60 and 38 mg/kg, respectively cardiac conduction may result in effects. Reported in association with the use of diltiazem increases exposure to ivabradine and may bradycardia...

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