Available from: [place unknown]: [publisher unknown]; 2018. 0000022294 00000 n 0000000016 00000 n PDF Diltiazem (Cardizem) - Advocate Health What are current recommendations for treatment of drug extravasation Hadaway L. Extravasation: Issues and Controversies. 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. Descriptions. The dose may be increased slowly over time until treatment goals are achieved. 0000001178 00000 n Disclaimer. It is not known whether diltiazem will harm an unborn baby. Diltiazem shows dose-dependent, non-linear pharmacokinetics. 0 privacy practices. 0000029001 00000 n Pediatric Use The average heart rate is reduced by 20%. Inject phentolamine 0.5 mg/mL by subcutaneous or intradermal route using a 25 gauge needle in 5 aliquots of 0.2 mL each into the area of the extravasation; change the needle after each injection Give immediately but may be used up to 12 hours after the extravasation occurs IV Push IV infusion . Version: 15.01. Eugia Pharma Specialities Limited 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. Should a dermatologic reaction persist, the drug should be discontinued. Patients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine. 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. 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. 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. Generic name: diltiazem [dil-TYE-a-zem] Therefore, infusion duration exceeding 24 hours and infusion rates exceeding 15 mg/h are not recommended. Diltiazem: 7 things you should know - Drugs.com 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. It works by affecting the movement of calcium into the cells of the heart and blood vessels. The combination of the two drugs was well tolerated without serious adverse effects. Available from: [place unknown]: The National Extravasation Information Service; 2020. If there is no response to vagal blockade administer isoproterenol cautiously. 4. Cyclosporine - A pharmacokinetic interaction between diltiazem and cyclosporine has been observed during studies involving renal and cardiac transplant patients. 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. Due to concern of potential extravasation and local tissue injury, central venous catheter (CVC) is the preferred route for vasopressor administration [].Despite this concern, vasopressors are administered via peripheral lines, often in resource . - 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. 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. Supplement 5. Be careful if you drive or do anything that requires you to be alert. (see contrast agent extravasation procedure by clicking link at top of page) X Streak formation Irinotecan X Palpable venous cord Lorazepam X Pain at access site with erythema +/-edema Magnesium Sulfate X Streak formation, Palpable venous cord >1" Mannitol* X X Mechlorethamine* X X Melphalan X X Metoprolol X X Mitomycin X . Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or in vitro in bacteria. Injection and Continuous Patients who have demonstrated hypersensitivity to the drug. (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 This can damage the blood vessels of the brain . 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. You may need to use blood pressure medicine for the rest of your life. Three solutions were used: 1/2 saline (154 mOsm), normal saline (308 mOsm), and 3% saline (1027 mOsm). Keywords: Coadministration of diltiazem with rifampin or any known CYP3A4 inducer should be avoided when possible, and alternative therapy considered. Packaged in a Carton of 10 NDC 55150-427-10 Occurs due to contraction of the vessel wall and usually happens as soon as the fluid injection begins. PDF Management of Extravasation of Non-Chemotherapeutic Agents Adult 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. HCl Injection Nursing standard for intravenous injection of Asan Medical Center. Diltiazem does not appear to be removed by peritoneal or hemodialysis. Documentation procedure may differ between treatment centers (documentation form); however, certain items are mandatory for patient safety and legal purposes: (1) patient name and number, (2) date and time of the extravasation, (3) name of the drug extravasated and the diluent used (if applicable), (4) signs and symptoms (also reported by the patient), (5) description of the IV access, (6) extravasation area (and the approximate amount of the drug extravasated), and (7) management steps with time and date. 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. Available from: Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. These two medications are different than other calcium channel blockers because they have direct action on cardiac tissue at therapeutic levels. Monitoring for quinidine adverse effects may be warranted and the dose adjusted accordingly. Intravenous Infusion 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. Bradycardia: Administer atropine (0.6 to 1.0 mg). 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. 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. Your doctor will tell you which of these are most important for you. Total radioactivity measurement following short intravenous administration in healthy volunteers suggests the presence of other unidentified metabolites which attain higher concentrations than those of diltiazem and are more slowly eliminated; half-life of total radioactivity is about 20 hours compared to 2 to 5 hours for diltiazem. Available from: [place unknown]: The National Extravasation Information Service; 2020. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. Destroy after 1 month at room temperature. Sauerland C, Engelking C, Wickham R, Corbi D. Vesicant extravasation part I: mechanisms, pathogenesis, and nursing care to reduce risk. 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. An official website of the United States government. High blood pressure often has no symptoms. Sodium hydroxide or hydrochloric acid is used for pH adjustment. Diltia XT, Dilt-XR, Diltzac, Matzim LA, Taztia XT, Tiadylt ER, Tiazac. The site is secure. Injection and Continuous Immediately following bolus administration of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) diltiazem hydrochloride injection and reduction of heart rate, begin an intravenous infusion of diltiazem hydrochloride injection. Copyright 1996-2023 Cerner Multum, Inc. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. You may need to use blood pressure medicine for the rest of your life. Hyderabad 500032 If it continues for a long time, the heart and arteries may not function properly. Antidotes, special drug management, drugs with high osmolarity, and drugs with pH are provided as supplement files (Supplements 14). The second bolus dose of diltiazem hydrochloride injection should be 0.35 mg/kg actual body weight administered over 2 minutes (25 mg is a reasonable dose for the average patient). Journal of Educational Evaluation for Health Professions, http://creativecommons.org/licenses/by/4.0/, https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Policy_V5.0_June_18.pdf, http://www.uic.edu/pharmacy/centers/drug_information_center/faq/extravasation.php, https://manchestercancer.files.wordpress.com/2014/09/extravasation_sept20131.pdf, Tissue loss exposing muscle/bone with a deep crater or necrosis.