Management of extravasation includes nursing intervention and thermal application. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Vesicants include several chemotherapy drugs. 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. It also increases the supply of blood and oxygen to the heart. The https:// ensures that you are connecting to the Heart rate reduction may last from 1 to 3 hours. If we combine this information with your protected 0000002293 00000 n Diltiazem inhibits the influx of calcium (Ca2+) ions during membrane depolarization of cardiac and vascular smooth muscle. Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician. Should a dermatologic reaction persist, the drug should be discontinued. Discard Unused Portion Store Under Refrigeration Cardiac Conduction - Diltiazem prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm. Use diltiazem as a continuous IV infusion for rate control in supraventricular tachycardiain patients without concomitant LV systolic dysfunction.33-35 (Class II, Level B) 14.2. 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. Before 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. The following are common drugs that interact with diltiazem; Not all possible interactions are listed in this medication guide. Treatment suspension wastes time and other problems can occur due to delayed treatment. Mix thoroughly. The use of local warming is recommended for the extravasation of nonDNA-binding vesicants. Diltiazem (Oral Route) Your gift holds great power - donate today! The patients normal activities, such as at home, work, school, etc., may be disrupted until the patient is fully recovered. High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys . 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. Chicago (IL): University of Illinois College of Pharmac; c2020. As with all drugs, care should be exercised when treating patients with multiple medications (see PRECAUTIONS, General and Drug Interactions). 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%. Barton-Burke M, Wilkes GM, Ingwersen KC, Bean CK, Berg D. Cancer chemotherapy: a nursing process approach. prolonged sedation) of both midazolam and triazolam. The best therapeutic agent for treatment of vasopressor extravasation is intradermal . Diltiazem is used alone or together with other medicines to treat angina (severe chest pain) or hypertension (high blood pressure). Overdose symptoms may include slow heartbeat, weakness, chest pain, shortness of breath, or fainting. 42 . Diltiazem hydrochloride is 70% to 80% bound to plasma proteins. Common non-antineoplastic drugs that can act as vesicants or irritants [Internet] [cited 2020 Jul 10]. include protected health information. the unsubscribe link in the e-mail. Received 2020 Jul 16; Accepted 2020 Jul 16. DO NOT apply pressure to the area 6. 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. 0000002809 00000 n 6. Hypotension was the most commonly reported adverse event during clinical trials. Discard Unused Portion Store Under Refrigeration Cardiovascular: Asystole, atrial flutter, AV block first degree, AV block second degree, bradycardia, chest pain, congestive heart failure, sinus pause, sinus node dysfunction, syncope, ventricular arrhythmia, ventricular fibrillation, ventricular tachycardia Eugia Pharma Specialities Limited Buspirone - In nine healthy subjects, diltiazem significantly increased the mean buspirone AUC 5.5 fold and Cmax 4.1 fold compared to placebo. Use diltiazem cautiously in treatment of patients with concomitant LV systolic dysfunction because the negative inotropic effect can cause hypotension. - Once the needle is removed, apply pressure to the puncture site for about five minutes and elevate the limb. Bradycardia: Administer atropine (0.6 to 1.0 mg). Take the missed dose as soon as you remember. The risk of myopathy and rhabdomyolysis with statins metabolized by CYP3A4 may be increased with concomitant use of diltiazem. Sodium hydroxide or hydrochloric acid is used for pH adjustment. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream E. Windsor, NJ 08520 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 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. Coadministration of diltiazem with rifampin or any known CYP3A4 inducer should be avoided when possible, and alternative therapy considered. 533 0 obj <>/Filter/FlateDecode/ID[<5163DCD1F2812548B2C0DA027F0BBFFB>]/Index[512 38]/Info 511 0 R/Length 98/Prev 107501/Root 513 0 R/Size 550/Type/XRef/W[1 2 1]>>stream Common Questions and Answers about Diltiazem extravasation. You may need to use blood pressure medicine for the rest of your life. Appendix A: Management of Extravasation: Chemotherapeutic and Non-chemotherapeutic Agents Figure 1: Workflow algorithm Stop infusion at first suspicion of extravasation. NHS. 0000006002 00000 n Similar ventricular complexes have been noted during cardioversion, other pharmacologic therapy, and during spontaneous conversion of PSVT to sinus rhythm. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. INTRODUCTION. Available from: Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. 549 0 obj <>stream Events such as myocardial infarction have been observed which are not readily distinguishable from the natural history of the disease for the patient. Diltiazem may be used for the treatment of high blood pressure or chronic stable angina. Available from: Lacy C, American Pharmaceutical Association . 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. We comply with the HONcode standard for trustworthy health information. An adjustment in the diltiazem dose may be warranted. An incident of extravasation must be correctly documented and reported. You may opt-out of email communications at any time by clicking on These two medications are different than other calcium channel blockers because they have direct action on cardiac tissue at therapeutic levels. 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. Data curation: JTK, JYP, HJL, YJC. This medicine is available only with your doctor's prescription. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Visualization: JTK, JYP, HJL, YJC. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Differences in volume were determined by magnetic resonance imaging (MRI) at three intervals postinfiltration. The heart rate reduction may last from 1 - 3 hours. Particular information must be given when a vesicant drug is administered. Sauerland C, Engelking C, Wickham R, Corbi D. Vesicant extravasation part I: mechanisms, pathogenesis, and nursing care to reduce risk. 0000000016 00000 n Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. 332 0 obj <> endobj Eugia US LLC Disclaimer. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. May repeat with 2. nd IV Push IV infusion . Other reported clinical experience has not identified differences in responses between the elderly and younger patients. 332 33 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. Diltiazem hydrochloride injection rarely converts atrial fibrillation or atrial flutter to normal sinus rhythm. Pharmacodynamics Drugs with high osmolarity. 10 mL Single-Dose Vials - Regularly check the extravasation kit and refill any used medications. Supplement 1. Do not crush, chew, break, or open an extended-release diltiazem tablet or capsule. 2. Diltiazem shows dose-dependent, non-linear pharmacokinetics. 0000008421 00000 n Supplement 3. Renal insufficiency, or even end-stage renal disease, does not appear to influence diltiazem disposition following oral administration. In the perinatal/postnatal studies there was some reduction in early individual pup weights and survival rates. 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. f8.5$_t_ htt_t_ htu 8|?f|o_xR}A)xcw{|YwO]oz46Qm` QOSi p"e3b9Ez1xr&(^L{/s<<1XW^YQIN2MZ_t_ htt_t_ htu?D_sunm5]BZ>,t vncs; xF,~kjM+`}h_. 25 mg per 5 mL FOIA 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. health information, we will treat all of that information as protected health Diltiazem pregnancy and breastfeeding warnings, Drug class: calcium channel blocking agents, Diltiazem 12-Hour Sustained-Release Capsules. If there is no response to vagal blockade administer isoproterenol cautiously. In the controlled clinical trials, 3.2% of patients required some form of intervention (typically, use of intravenous fluids or the Trendelenburg position) for blood pressure support following diltiazem hydrochloride injection. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Diltiazem hydrochloride injection is indicated for the following: Gastrointestinal: Constipation, elevated SGOT or alkaline phosphatase, nausea, vomiting Patients with ventricular tachycardia. 2737 0 obj <> endobj This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. General The effect may be mediated by cimetidine's known inhibition of hepatic cytochrome P-450, the enzyme system responsible for the first-pass metabolism of diltiazem. The effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose has been inconsistent. 0000029248 00000 n The .gov means its official. 8600 Rockville Pike Pharmacokinetics and Metabolism Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Occurs due to contraction of the vessel wall and usually happens as soon as the fluid injection begins. 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. The plasma elimination half-life is approximately 3.4 hours. Diltiazem show all 12 brands National Library of Medicine 113. The sample was 18 healthy adults between 20 and 45 years. 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. 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. In some cases intravenous calcium has been administered (1 g calcium chloride or 3 g calcium gluconate) over 5 minutes, and repeated every 10 to 20 minutes as necessary. 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. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. 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. (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 Diltiazem can pass into breast milk and may harm a nursing baby. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. 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. Continuous Intravenous Infusion 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). Some patients may maintain response to an initial rate of 5 mg/h. Pregnancy Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Hudson (OH): Lexi-Comp Inc; 2000. Waltham (MA): UpToDate Inc; c2020. The T1/2 and Tmax of buspirone were not significantly affected by diltiazem. (5 mg/mL) %PDF-1.6 % Hot fomentations can dilate the veins and mitigate the symptoms. Use within 24 hours. 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. 1. Cardizem, Cartia XT, Dilt-XR, Cardizem CD, +7 more. Accessibility R7:@Io;X(^0)&c3EA$w `Yl RL`5w0$(22p9]8JIg4@ !v Diltiazem hydrochloride is a calcium ion cellular influx inhibitor (slow channel blocker or calcium channel antagonist). 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. Unauthorized use of these marks is strictly prohibited. HCl Injection Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Calcium Cows Channel Blocked (V-rapper & Dill-tazer) Picmonic. Guideline for the management of extravasation of a cytotoxic agent or a monoclonal antibody used in the treatment of malignant disease: version 4.2. Diltia XT, Dilt-XR, Diltzac, Matzim LA, Taztia XT, Tiadylt ER, Tiazac. We comply with the HONcode standard for trustworthy health information. Bethesda, MD 20894, Web Policies In a ten-subject randomized, open label, 4-way crossover study, coadministration of diltiazem (120 mg bid, diltiazem SR for 2 weeks) with a single 20 mg dose of lovastatin resulted in a 3- to 4-fold increase in mean lovastatin AUC and Cmax versus lovastatin alone. Bookshelf Ventricular Premature Beats (VPBs) - VPBs may be present on conversion of PSVT to sinus rhythm with diltiazem hydrochloride injection. Extravasation:Unintentional leakage of fluid out of a blood vessel into surrounding tissue. The toxic dose in man is not known. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. These VPBs are transient, are typically considered to be benign, and appear to have no clinical significance. Temporary control of rapid ventricular rate in atrial fibrillation or atrial flutter. In vitro studies suggest alpha1-acid glycoprotein binds approximately 40% of the drug at clinically significant concentrations. . Donate. Gently aspirate extravasated drug. Duration of infusion longer than 24 hours and infusion rates greater than 15 mg/h have not been studied. Continuous Intravenous Infusion The drug prevents the recurrence of life-threatening ventricular arrhythmias and. - Watch for edema, inflammation, and pain around the cannula during administration. Diltiazem inhibits the influx of calcium (Ca 2+) ions during membrane depolarization of cardiac and vascular smooth muscle. This site needs JavaScript to work properly. 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. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. However, in rare instances, worsening of congestive heart failure has been reported in patients with preexisting impaired ventricular function. Communication and trust between patients and nurses can be interfered due to extravasation. Reproduction studies have been conducted in mice, rats, and rabbits. Hypotension, if it occurs, may be similarly persistent. However, reference should be made to the respective agent manufacturer's package insert for information relative to dosage and administration. (5 mg/mL) Your blood pressure will need to be checked often. Available from: De Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, Mayer-Steinacker R, Bokemeyer C, Jordan K. Management of cytotoxic extravasation: ASORS expert opinion for diagnosis, prevention and treatment. 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. Skip the missed dose if it is almost time for your next scheduled dose. Available from: University of Illinois College of Pharmacy . pounding heartbeats or fluttering in your chest; a light-headed feeling, like you might pass out; shortness of breath (even with mild activity), swelling, rapid weight gain; nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or. Monitoring for quinidine adverse effects may be warranted and the dose adjusted accordingly. One report with oral diltiazem suggests that concentrations in breast milk may approximate serum levels. Do not take extra medicine to make up the missed dose. Metabolites N-monodesmethyldiltiazem, desacetyldiltiazem, desacetyl-N-monodesmethyldiltiazem, desacetyl-O-desmethyldiltiazem, and desacetyl-N, O-desmethyldiltiazem have been identified in human urine. Subjects with increased average steady-state exposures of diltiazem showed a greater fold increase in simvastatin exposure. This includes AV nodal reentrant tachycardias and reciprocating tachycardias associated with an extranodal accessory pathway such as the WPW syndrome or short PR syndrome. Injection site extravasation is found among people who take Cardizem, especially for people who are female, 60+ old, have been taking the drug for < 1 month. Please enable it to take advantage of the complete set of features! Project administration: JTK, JYP, HJL, YJC. High blood pressure adds to the workload of the heart and arteries. Do not stop taking this medication without first talking to your doctor. Beta-blockers - Intravenous diltiazem has been administered to patients on chronic oral beta-blocker therapy. The therapeutic benefits of diltiazem in supraventricular tachycardias are related to its ability to slow AV nodal conduction time and prolong AV nodal refractoriness. Diltiazem may be only part of a complete program of treatment that also includes diet, exercise, and other medications. Other: Amblyopia, asthenia, dry mouth, dyspnea, edema, headache, hyperuricemia - Even if there is an existing IV route, secure a new route when administering vesicant drugs. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. 0 Anti-anxiety medications called benzodiazepines (such as midazolam, triazolam, and others) as well as busipirone; Beta-blockers (such as atenolol, carvedilol, metoprolol, propranolol, sotalol, and others); Cholesterol medication called statins (such as atorvastatin, lovastatin, simvastatin, rosuvastatin, and others).

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