diltiazem extravasation treatment
include protected health information. An incident of extravasation must be correctly documented and reported. 8th ed. MeSH Diltiazem may impair your thinking or reactions. High blood pressure may also increase the risk of heart attacks. Infusions of calcium for 24 hours or more may be required. LD = 0.25 mg/kg over 2 min. Diltiazem may be used for the treatment of high blood pressure or chronic stable angina. Regression of calcinosis associated with adult dermatomyositis following diltiazem therapy. HHS Vulnerability Disclosure, Help 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. Review/update the hb``d``f`c`P "@1vG(r8}C#7mcH`KfYtfnzv$@,BKK~x$3$shElVVp A_8{.>9UiiGK:&ALg>)tvNV-+>'(yqnSg@Em.P^''*.^. Please enable it to take advantage of the complete set of features! These doses, in some studies, have been reported to cause skeletal abnormalities. [cited 2020 Jul 10]. - Be familiar with the extravasation management standard guidelines and prepare the extravasation kit. Patients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine. 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). 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. At the first sign of extravasation, the following steps are recommended: (1) stop administration of IV fluids immediately, (2) disconnect the IV tube from the cannula, (3) aspirate any residual drug from the cannula, (4) administer a drug-specific antidote, and (5) notify the physician (Fig. Hyderabad 500032 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. Avoid concomitant use of ivabradine and diltiazem. Diltiazem hydrochloride injection rarely converts atrial fibrillation or atrial flutter to normal sinus rhythm. The combination of the two drugs was well tolerated without serious adverse effects. Sterile 25 mL Single-Dose Vial 113. 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. Management of extravasation includes nursing intervention and thermal application. The https:// ensures that you are connecting to the Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. Diltiazem may also be used for purposes not listed in this medication guide. These guidelines consist of following topics: basic knowledge about extravasation, extravasation management, and extravasation prevention. As with all drugs, care should be exercised when treating patients with multiple medications. The frequency of extravasation in adults is reported to be between 0.1% and 6%. 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 Therefore, the potential for acute hepatic injury exists following administration of intravenous diltiazem. The effect of cyclosporine on diltiazem plasma concentrations has not been evaluated. Duration of infusion longer than 24 hours and infusion rates greater than 15 mg/h have not been studied. 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. Diltiazem hydrochloride injection is for direct intravenous bolus injection and continuous intravenous infusion. 6. 2838 0 obj <>stream The sample was 18 healthy adults between 20 and 45 years. The patients normal activities, such as at home, work, school, etc., may be disrupted until the patient is fully recovered. Barton-Burke M, Wilkes GM, Ingwersen KC, Bean CK, Berg D. Cancer chemotherapy: a nursing process approach. Writingoriginal draft: JTK, JYP, HJL, YJC. (5 mg/mL) Swallow it whole. This includes AV nodal reentrant tachycardias and reciprocating tachycardias associated with an extranodal accessory pathway such as the WPW syndrome or short PR syndrome. - Check for blood backflow before injection to ensure that the catheter is positioned in the vein. - For observation, do not cover the cannula area with opaque gauze. Symptomatic hypotension occurred in 3.2% of patients. Diltiazem inhibits the influx of calcium (Ca 2+) ions during membrane depolarization of cardiac and vascular smooth muscle. The apparent volume of distribution remains unchanged (360 to 391 L). Sterile eugia 10 x 5 mL Single-Dose Vials, Rx only NDC 55150-426-01 * Irritant drugs can cause local pain and inflammation but rarely cause tissue destruction. The phase IV clinical study analyzes which people take Cardizem and have Injection site extravasation. 25 mg per 5 mL (5 mg/mL) 5 mL Single-Dose Vials 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. 332 0 obj <> endobj 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. 1Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, Korea, 2Department of Clinical Nursing, University of Ulsan, Seoul, Korea. The risk of toxic reactions to this drug may be greater in patients with impaired renal or hepatic function. 25 mL Single-Dose Vials (5 mg/mL) 0000030204 00000 n In severe cases, extravasation may cause tissue dysfunction or physical defects, resulting in a delay of attempted treatment, patients distrust, and numerous other issues. India Diltiazem hydrochloride is extensively metabolized by the liver and excreted by the kidneys and in bile. 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. Diltiazem (Cardizem ) IV Push IV infusion . While the injury is usually minor and resolves spontaneously, some cases result in serious complications, including full-thickness skin loss and muscle and tendon necrosis requiring reconstructive surgery or even amputation, leading to longer hospital stays, increased morbidity, and increased costs. Adverse events reported in controlled and uncontrolled clinical trials were generally mild and transient. Unauthorized use of these marks is strictly prohibited. Three solutions were used: 1/2 saline (154 mOsm), normal saline (308 mOsm), and 3% saline (1027 mOsm). Hypotension, if it occurs, may be similarly persistent. Because errors associated with IV administration can result in fatal or life-threatening outcomes, administration of IV fluids and medications can be a high-risk, with adverse outcomes potentially leading to malpractice claims. Avoid drinking alcohol while taking diltiazem. Diltiazem is both a substrate and an inhibitor of the cytochrome P-450 3A4 enzyme system. 0000012749 00000 n - After the injection, make sure to run a saline solution through the catheter. endstream endobj startxref 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. Give a list of all your medicines to any healthcare provider who treats you. Vesicants are inherently toxic and can cause pain, inflammation, and burn-like injury including blistering, sloughing, deep tissue damage, and necrosis. Available for Android and iOS devices. Br J Dermatol 2001; 144:894. In the same study, there was no significant change in 20 mg single dose pravastatin AUC and Cmax during diltiazem coadministration. sharing sensitive information, make sure youre on a federal The .gov means its official. Clinical studies of diltiazem did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Do not stop taking this medication without first talking to your doctor. If you are being treated for high blood pressure, keep using this medicine even if you feel well. If you stop taking diltiazem suddenly, your condition may become worse. Vesicants include several chemotherapy drugs. Take the missed dose as soon as you remember. These antiarrhythmic agents were intravenous or oral digoxin, Class 1 antiarrhythmics (e.g., quinidine, procainamide), calcium channel blockers, and oral beta-blockers. Manufactured by: Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Descriptions. Many drugs can interact with diltiazem, and your doctor may need to change your treatment plan if you use certain other medicines. If use of diltiazem hydrochloride is deemed essential, an alternative method of infant feeding should be instituted. Common Questions and Answers about Diltiazem extravasation. government site. Upon discontinuation of infusion, heart rate reduction may last from 0.5 hours to more than 10 hours (median duration 7 hours). They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. The effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose has been inconsistent. Following single intravenous injection of diltiazem hydrochloride, however, plasma concentrations of N-monodesmethyldiltiazem and desacetyldiltiazem, two principal metabolites found in plasma after oral administration, are typically not detected. E. Windsor, NJ 08520 Inclusion in an NLM database does not imply endorsement of, or agreement with, Discard Unused Portion Store Under Refrigeration Extravasation is the leakage of an injected drug out of the blood vessels, damaging the surrounding tissues. Mean plasma diltiazem concentrations of 130 ng/mL and 300 ng/mL were determined to produce reductions in heart rate of 30% and 40%. Patients taking other drugs that are substrates of CYP450 3A4, especially patients with renal and/or hepatic impairment, may require dosage adjustment when starting or stopping concomitantly administered diltiazem in order to maintain optimum therapeutic blood levels. Diltiazem (Cardizem, Tiazac, others) Felodipine; Isradipine; Nicardipine; Nifedipine (Procardia) Nisoldipine (Sular) Verapamil (Calan SR, Verelan) Sometimes, a doctor might prescribe a calcium channel blocker with other high blood pressure medications or with cholesterol-lowering drugs such as statins. privacy practices. 0 Your doctor may occasionally change your dose. Skip the missed dose if it is almost time for your next scheduled dose. - Secure the cannula during the administration of the drug. 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. Generic name: diltiazem [dil-TYE-a-zem] However, the study had only a small number of - Veins on the back of the hand can be used, and in some cases, observation is easier. 7. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. 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. 42 . Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Diltiazem hydrochloride injection is clear, colorless, sterile, nonpyrogenic solution and is supplied as follows: Hemodynamics Intravenous Infusion This relaxes the blood vessels, lowers blood pressure, and increases the supply of blood and oxygen to the heart while reducing its workload. injury. 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. There was an increased incidence of stillbirths at doses of 20 times the human oral antianginal dose or greater. Hypotension - Decreases in blood pressure associated with diltiazem hydrochloride injection therapy may occasionally result in symptomatic hypotension (3.2%). If these agents are to be administered concurrently, cyclosporine concentrations should be monitored, especially when diltiazem therapy is initiated, adjusted or discontinued. One report with oral diltiazem suggests that concentrations in breast milk may approximate serum levels. Englewood (CO): Micromedex Inc; [date unknown]. 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. - Edema around the port insertion or in the chest, or medication leakage around the catheter insertion, - Redness in the chest, collarbone, or neck where a central venous catheter is inserted. High blood pressure often has no symptoms. 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 In the event of overdosage or an exaggerated response, appropriate supportive measures should be employed. 0000003491 00000 n Available from: University of Illinois College of Pharmacy . Reproduction studies have been conducted in mice, rats, and rabbits. 2737 0 obj <> endobj Revised: April 2023, Rx only NDC 55150-425-01 Torralba TP, Li-Yu J, Navarra ST. Last updated on Mar 22, 2023. HCl Injection Sterile 10 mL Single-Dose Vial, Rx only NDC 55150-426-10