diltiazem extravasation treatment
Calcium Cows Channel Blocked (V-rapper & Dill-tazer) Picmonic. 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). Follow all directions on your prescription label. 0000029746 00000 n Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Discoloration and edema do not occur. In the event of overdosage or an exaggerated response, appropriate supportive measures should be employed. 0000030705 00000 n endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream 5. High blood pressure often has no symptoms. The risk of toxic reactions to this drug may be greater in patients with impaired renal or hepatic function. It works by relaxing the blood vessels so the heart does not have to pump as hard. Rapid conversion of paroxysmal supraventricular tachycardias (PSVT) to sinus rhythm. endstream endobj startxref An extremely severe case of cutaneous calcinosis with juvenile dermatomyositis, and successful treatment with diltiazem. 0000030429 00000 n 0000001363 00000 n Discard Unused Portion Store Under Refrigeration Extravasation is a serious complication during patient care. These pharmacokinetic effects seen during diltiazem coadministration can result in increased clinical effects (e.g. Carcinogenesis, Mutagenesis, Impairment of Fertility The medical teams continuous education on extravasation is essential. The purpose of these practice guidelines is to offer and share strategies for preventing extravasation and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled experts at intravenous (IV) injection. Norwood (MA). Liver cirrhosis was shown to reduce diltiazem's apparent oral clearance and prolong its half-life. Geriatric Use Chicago (IL): University of Illinois College of Pharmac; c2020. The combination of the two drugs was well tolerated without serious adverse effects. Hudson (OH): Lexi-Comp Inc; 2000. Available from: [place unknown]: [publisher unknown]; 2018. 8th ed. Click here for an email preview. 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. (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 . Common signs include inflammation, tightness of the skin, and pain around the IV site. Phase IV trials are used to detect adverse drug outcomes and monitor drug effectiveness in the real world. Transition to Further Antiarrhythmic Therapy Diltiazem is in a class of medications called calcium-channel blockers. IV: intravenous. Discard unused portion. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Some patients may respond to an initial dose of 0.15 mg/kg, although duration of action may be shorter. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. However, the study had only a small number of $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? Therefore, the potential for acute hepatic injury exists following administration of intravenous diltiazem. Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician. @ 0000003491 00000 n - It dilates the blood vessels around the extravasation site, increases dispersion and absorption of the medicinal fluid by increasing the blood flow, and helps to quickly purge medicinal fluid that has leaked from the extravasation site. Computer-based simulations showed that at a daily dose of 480 mg of diltiazem, an 8- to 9-fold mean increase in simvastatin AUC can be expected. sharing sensitive information, make sure youre on a federal 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. Diltiazem is not intended to convert atrial fib or flutter to NSR but to slow the heart rate down. Drug Interactions 4 Hyaluronidase has been successfully used in the treatment of TPN extravasations. Mean plasma diltiazem concentrations of 130 ng/mL and 300 ng/mL were determined to produce reductions in heart rate of 30% and 40%. The usual dose range of oral diltiazem for controlling chest pain is 120 to 480 mg daily. Tips Extended-release diltiazem capsules should be taken on an empty stomach (this means one hour before food or two hours after food). For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. 1). Venous shock can occur when injecting very cold medication or when medication is injected at a rapid pace. 0 At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Injection and Continuous It works by affecting the movement of calcium into the cells of the heart and blood vessels. The use of vasopressor medications is the mainstay in management of patients with distributive shock in intensive care unit (ICU). Skip the missed dose if it is almost time for your next scheduled dose. Definition The IV infiltration can be defined as a complication of the intravenous therapy, with the administered medication infiltrating into the surrounding tissues. Patients with severe hypotension or cardiogenic shock. 0000002293 00000 n BIT Druginfo website [Internet] [cited 2020 Jul 10]. 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. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. privacy practices. official website and that any information you provide is encrypted Visualization: JTK, JYP, HJL, YJC. FOIA 0000029001 00000 n Therefore, infusion duration exceeding 24 hours and infusion rates exceeding 15 mg/h are not recommended. IV Push IV infusion . You should not breastfeed while using this medicine. This can damage the blood vessels of the brain . These two medications are different than other calcium channel blockers because they have direct action on cardiac tissue at therapeutic levels. Photographic documentation can be helpful for follow-up procedures. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Discard Unused Portion Store Under Refrigeration Portions of this document last updated: April 01, 2023. In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapeutic drugs in the tissues surrounding the IV site. hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ Copyright: Merative US L.P. 1973, 2023. Package insert / product label Nervous System: Dizziness, paresthesia The effect of cyclosporine on diltiazem plasma concentrations has not been evaluated. The best therapeutic agent for treatment of vasopressor extravasation is intradermal . Avoid concomitant use of ivabradine and diltiazem. 5. The patient should receive the skin graft for recovering her arm skin. Patients receiving these drugs concurrently should be monitored for a potential drug interaction. Clonidine - Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with the use of clonidine concurrently with diltiazem. Common diltiazem side effects may include: This is not a complete list of side effects and others may occur. Continuous Intravenous Infusion May repeat with 2. nd - Secure the cannula during the administration of the drug. When possible, use a non-CYP3A4-metabolized statin together with diltiazem; otherwise, dose adjustments for both diltiazem and the statin should be considered along with close monitoring for signs and symptoms of any statin related adverse events. Beta-blockers - Intravenous diltiazem has been administered to patients on chronic oral beta-blocker therapy. Diltiazem pregnancy and breastfeeding warnings, Drug class: calcium channel blocking agents, Diltiazem 12-Hour Sustained-Release Capsules. 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. However, in rare instances, worsening of congestive heart failure has been reported in patients with preexisting impaired ventricular function. 2 0 obj <> endobj 3 0 obj <> endobj 4 0 obj <> endobj 6 0 obj <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC]>>/Contents 14 0 R>> endobj 7 0 obj <> endobj 8 0 obj [0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1000 1000 293 343 489 818 637 1199 781 275 454 454 637 818 313 431 313 577 637 637 637 637 637 637 637 637 637 637 363 363 818 818 818 566 920 685 686 667 757 615 581 745 764 483 500 696 572 893 771 770 657 770 726 633 612 739 675 1028 685 670 623 454 577 454 818 637 546 599 632 527 629 594 382 629 640 302 363 603 302 954 640 617 629 629 434 515 416 640 579 890 604 576 526 623 637 623 818 1000 637 1000 275 637 489 1000 637 637 546 1676 633 425 1037 1000 623 1000 1000 275 275 489 489 637 637 909 546 861 515 425 985 1000 526 670 293 343 637 637 637 637 637 637 546 929 508 703 818 431 929 637 520 818 539 539 546 651 637 363 546 539 539 703 1128 1128 1128 566 685 685 685 685 685 685 989 667 615 615 615 615 483 483 483 483 774 771 770 770 770 770 770 818 770 739 739 739 739 670 659 646 599 599 599 599 599 599 937 527 594 594 594 594 302 302 302 302 620 640 617 617 617 617 617 818 617 640 640 640 640 576 629 576] endobj 9 0 obj <> endobj 10 0 obj <> endobj 11 0 obj [0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1000 1000 313 332 401 728 546 977 674 211 383 383 546 728 303 363 303 382 546 546 546 546 546 546 546 546 546 546 354 354 728 728 728 474 909 600 589 601 678 561 521 667 675 373 417 588 498 771 667 708 551 708 621 557 584 656 597 902 581 576 559 383 382 383 728 546 546 525 553 461 553 526 318 553 558 229 282 498 229 840 558 543 553 553 360 446 334 558 498 742 495 498 444 480 382 480 728 1000 546 1000 211 546 397 817 546 546 546 1391 557 383 977 1000 559 1000 1000 211 211 401 401 455 546 909 546 876 446 383 909 1000 444 576 313 332 546 546 546 546 382 546 546 929 493 573 728 363 929 546 471 728 493 493 546 568 546 354 546 493 493 573 1000 1000 1000 474 600 600 600 600 600 600 913 601 561 561 561 561 373 373 373 373 698 667 708 708 708 708 708 728 708 656 656 656 656 576 565 548 525 525 525 525 525 525 880 461 526 526 526 526 229 229 229 229 546 558 543 543 543 543 543 728 543 558 558 558 558 498 553 498] endobj 12 0 obj <> endobj 13 0 obj <>stream 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. Sterile eugia 10 x 25 mL Single-Dose Vials, Cardizem, Cartia XT, Dilt-XR, Cardizem CD, +6 more, amlodipine, lisinopril, aspirin, metoprolol, losartan, furosemide, carvedilol, hydrochlorothiazide, spironolactone, propranolol. Review/update the Other reported clinical experience has not identified differences in responses between the elderly and younger patients. IV Push IV infusion . In subacute and chronic dog and rat studies designed to produce toxicity, high oral doses of diltiazem were associated with hepatic damage. This includes AV nodal reentrant tachycardias and reciprocating tachycardias associated with an extranodal accessory pathway such as the WPW syndrome or short PR syndrome. Patients with sick sinus syndrome except in the presence of a functioning ventricular pacemaker. Therapists will always feel nervous during the medical team-patient communication because of guilt. Oral administration of diltiazem with propranolol in five normal volunteers resulted in increased propranolol levels in all subjects and bioavailability of propranolol was increased approximately 50%. If hypotension occurs, it is generally short-lived, but may last from 1 to 3 hours. Descriptions. Hadaway L. Extravasation: Issues and Controversies. Diltiazem Injection Prescribing Information. 0000006222 00000 n High blood pressure adds to the workload of the heart and arteries. You may report side effects to FDA at 1-800-FDA-1088. 1. Extravasation kit includes the following: 25G needle, 10-cc syringe, and 1-mL syringe; disinfection swabs, sterile gauze, and adhesive bandage; saline solution (1 ampule); sterile distilled water (1 ampule); dimethyl sulfoxide 99% solution; hyaluronidase 1,500 U/mL (refrigerated); hydrocortisone cream 1%; sodium thiosulfate 25% solution; and warm pack and an ice pack (frozen). If there is no response to vagal blockade administer isoproterenol cautiously. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Diltiazem prolongs the sinus cycle length. High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys . HHS Vulnerability Disclosure, Help Infusions of calcium for 24 hours or more may be required. It will be our pleasure if these guidelines are used in the training of health professionals to promote patients safety. Diltiazem hydrochloride injection was found to be physically compatible and chemically stable in the following parenteral solutions for at least 24 hours when stored in glass or polyvinylchloride (PVC) bags at controlled room temperature 15 to 30C (59 to 86F) or under refrigeration 2 to 8C (36 to 46F). 6. Calcium gluconate has also been administered as a continuous infusion at a rate of 2 g per hour for 10 hours. [cited 2020 Jul 10]. This guideline will enable health professions to manage the patients extravasation appropriately. They are used to treat a broad array of clinical conditions, including hypertension, supraventricular tachycardia, vasospasm, and migraine headaches. If you are a Mayo Clinic patient, this could Eugia Pharma Specialities Limited Sodium hydroxide or hydrochloric acid is used for pH adjustment. Therefore, the potential for these dermatologic reactions exists following exposure to intravenous diltiazem. 25 mg per 5 mL The phase IV clinical study analyzes which people take Cardizem and have Infusion site extravasation. - 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. The chemical structure is: Diltiazem hydrochloride, USP is a white crystalline powder with a bitter taste. Disconnect the IV tubing but DO NOT remove the catheter or needle. government site. All rights reserved. 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. Although not observed in clinical trials with diltiazem hydrochloride injection, the following events associated with oral diltiazem may occur: Cleanse the extravasation site gently with an alcohol sponge, insert the needle of the TB syringe into the subcutaneous tissue around the site and gently aspirate as much of the solution as possible Avoid friction or pressure to the affected area 5. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. 125 mg per 25 mL Take diltiazem exactly as prescribed by your doctor. 0000001178 00000 n Drugs with high osmolarity. The patient must be informed of the scope of the problem (Supplement 5). Supplement 3. An official website of the United States government. (5 mg/mL) Reproduction studies have been conducted in mice, rats, and rabbits. This document is only valid for the day on which it is accessed. Swallow right away without chewing. Proceedings of the Infusion Nurses Society Annual Meeting; 1997 May; Salt Lake City, USA. These doses, in some studies, have been reported to cause skeletal abnormalities. Sodium hydroxide or hydrochloric acid is used for pH adjustment. - Possibly no initial symptoms of extravasation, - Redness, pruritus, and edema around the injection site, - Fluid injection rate slows down or stops, - Blood backflow does not work well or there is leakage of medication around the needle, - A complaint of discomfort or pain and occasional expression of searing pain or numbness. Writingoriginal draft: JTK, JYP, HJL, YJC. Follow your diet, medication, and exercise routines very closely. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. 5. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. - Check for blood backflow before injection to ensure that the catheter is positioned in the vein. Experience in the use of antiarrhythmic agents following maintenance infusion of diltiazem hydrochloride injection is limited. In severe cases, extravasation may cause tissue dysfunction or physical defects, resulting in a delay of attempted treatment, patients distrust, and numerous other issues. The frequency of extravasation in adults is reported to be between 0.1% and 6%. 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 . Use diltiazem regularly to get the most benefit. %%EOF 42, 48 In two cases of TPN extravasation, 25 units of hyaluronidase were injected intradermally around the inflamed area, resulting in clinical improvement within 6-12 hours. For Direct Intravenous Bolus Injection and Alteplase Adult Assess for hemorrhage during first hour of treatment. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, GUID:367E9C1D-E270-4114-AA3D-21C537398B1B, GUID:D253D40D-77BC-48AC-A9B8-1814B76155B0, GUID:AD28B884-86A0-4E06-8641-E315D06B067F, GUID:3AC69EF7-5706-454E-AEA5-D87005B23EF4, GUID:D75BDE9D-DD6A-421F-A27E-A2A0FE0A12C1, GUID:6CED1AD4-FC08-4A32-B5E3-E0B71BFF0284, Extravasation, Antidotes, Intravenous injections, Patient care, Risk factors. Diltiazem hydrochloride is 70% to 80% bound to plasma proteins. However, if you have symptoms of low blood pressure (dizziness, fainting, weakness, or blurred vision), call your doctor and stop taking diltiazem. Spots or solid lines with blisters can be suddenly felt along the vessels injected with drugs. Antidotes, special drug management, drugs with high osmolarity, and drugs with pH are provided as supplement files (Supplements 14). Diltiazem 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). Discard Unused Portion Store Under Refrigeration If it continues for a long time, the heart and arteries may not function properly. This content does not have an English version. India For Direct Intravenous Bolus If coadministration of simvastatin with diltiazem is required, limit the daily doses of simvastatin to 10 mg and diltiazem to 240 mg. If use of diltiazem hydrochloride is deemed essential, an alternative method of infant feeding should be instituted. 0000003340 00000 n - Check if there is any local discomfort or swelling by running a saline solution through the catheter, and then inject the drug. 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. You should not stop using diltiazem suddenly. Pain, tightening, and skin discoloration tend to worsen. As with all drugs, care should be exercised when treating patients with multiple medications (see PRECAUTIONS, General and Drug Interactions). (5 mg/mL) Diltiazem (Oral Route) Your gift holds great power - donate today! The effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose has been inconsistent. It is the brilliant info like a diamond that is useful for the training of the interns, nurses, and medical laboratory technicians who routinely work for the vascular injection. The primary outcome was the change in SBP 60 min (+/- 30 min) after initial IV diltiazem administration. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Keywords: The usual dose range of oral diltiazem for the treatment of hypertension is 180 to 360 mg daily. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Diltiazem Diltiazem extravasation. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. This medicine is available only with your doctor's prescription. It is anticipated that these guidelines would help health professionals to prevent extravasation during IV and central vein injection and to promote patient safety should extravasation occur in any case. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. If possible, it is recommended that diltiazem hydrochloride injection not be co-infused in the same intravenous line. 10 mL Single-Dose Vials When treatment for hypotension was required, it generally consisted of administration of saline or placing the patient in the Trendelenburg position. The average heart rate is reduced by 20%. Advertising revenue supports our not-for-profit mission. Diltiazem is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders. The second purpose is to raise the medical teams awareness of extravasation in order to prevent extravasation with careful injection, recover patient trust, and increase patient satisfaction. Your doctor will adjust the dose and frequency of diltiazem to your needs. Cardizem, Cartia XT, Dilt-XR, Cardizem CD, +7 more. Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others.
