diltiazem infiltration treatment

It is used in many clinical scenarios as an antihypertensive, anti-arrhythmic, and anti-anginal. The plasma elimination half-life is approximately 3.4 hours. We comply with the HONcode standard for trustworthy health information. 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 is excreted in human milk. Blood and urine tests may be needed to check for unwanted effects. Paroxysmal supraventricular tachycardia - Clinical studies of diltiazem hydrochloride injection for PSVT did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Sterile eugia 10 x 25 mL Single-Dose Vials, Cardizem, Cartia XT, Cardizem CD, Dilt-XR, +6 more, amlodipine, lisinopril, aspirin, metoprolol, losartan, furosemide, carvedilol, hydrochlorothiazide, propranolol, spironolactone. xref 7. In renal and cardiac transplant recipients, a reduction of cyclosporine dose ranging from 15% to 48% was necessary to maintain cyclosporine trough concentrations similar to those seen prior to the addition of diltiazem. (5 mg/mL) For Direct Intravenous Bolus Diltiazem is called a calcium channel . Intravenous Infusion Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. To minimize the risk of dislodging the catheter, veins in the hands Tell your doctor about all medicines you use, and those you start or stop using. The risk of toxic reactions to this drug may be greater in patients with impaired renal or hepatic function. Cytarabine, liposomal. 0000006222 00000 n The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. 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). Gastrointestinal: Anorexia, diarrhea, dysgeusia, dyspepsia, mild elevations of SGPT and LDH, thirst, weight increase Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD 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. Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician. 332 0 obj <> endobj 0000024987 00000 n Package insert / product label The effectiveness of intravenous calcium administration to reverse the pharmacological effects of diltiazem overdose has been inconsistent. Infusion site extravasation is found among people who take Cardizem, especially for people who are female, 60+ old. Continuous Intravenous Infusion 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. Dilution: To prepare diltiazem hydrochloride injection for continuous intravenous infusion, aseptically transfer the appropriate quantity (see chart) of diltiazem hydrochloride injection to the desired volume of either Normal Saline, D5W, or D5W/0.45% NaCl. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. If there is no response to vagal blockade administer isoproterenol cautiously. Injection and Continuous Continuous Intravenous Infusion Distributed by: It works by relaxing the muscles of your heart and blood vessels. Patients receiving these drugs concurrently should be monitored for a potential drug interaction. 0000008421 00000 n Discard unused portion. Generally speaking, if the infiltration solution was isotonic, a warm compress is used to alleviate discomfort and help absorb the infiltration by increasing circulation to the affected area. Diltiazem hydrochloride is 70% to 80% bound to plasma proteins. Medically reviewed by Kaci Durbin, MD. Treatment is outlined in Table 2 below. Dosage form: injection, solution Some patients may maintain response to an initial rate of 5 mg/h. 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. Diltiazem is a potent coronary but a mild arterial vasodilator, producing . Be careful if you drive or do anything that requires you to be alert. 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. Injectable forms of diltiazem are contraindicated in: 1. Experience with the use of diltiazem hydrochloride injection in patients with impaired ventricular function is limited. Medications used to treat insulin resistance, hyperlipidemia, and obesity have been shown to improve transaminase levels, steatosis, and histologic findings. After constant rate intravenous infusion to healthy male volunteers, diltiazem exhibits nonlinear pharmacokinetics over an infusion range of 4.8 to 13.2 mg/h for 24 hours. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. Medically reviewed by Drugs.com. 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). endstream endobj startxref Cardiac Conduction - Diltiazem prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm. Cardiac Failure: Administer inotropic agents (isoproterenol, dopamine, or dobutamine) and diuretics. 2. Following oral administration, 2% to 4% of the unchanged diltiazem appears in the urine. Non-pharmacologic interventions for extravasation, For most medications, the treatment of extravasation is nonpharmacologic in nature; however, the efficacy of any specific approach has not been demonstrated in controlled studies.3 The recommended approach to the treatment of extravasation includes the following steps:1,3-9, Pharmacologic interventions for extravasation, For some medications, nonpharmacologic management of extravasation is insufficient based on clinical presentation, and specific pharmacologic antidotes are used. 0000001883 00000 n Discard Unused Portion Store Under Refrigeration 0000029746 00000 n Atrial flutter can arise during treatment with antiarrhythmic agents prescribed to prevent recurrent AF. Side effects include headaches, nausea, rash . The following measures may be considered: 0000003340 00000 n 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. 0000030660 00000 n Diltiazem Dexrazoxane . It has a pH range of 3.7 to 4.1. Administration of oral diltiazem in patients with acute myocardial infarction and pulmonary congestion documented by x-ray on admission is contraindicated. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In the same study, there was no significant change in 20 mg single dose pravastatin AUC and Cmax during diltiazem coadministration. In patients administered continuous infusions at 10 mg/h or 15 mg/h for 24 hours, diltiazem systemic clearance averaged 42 L/h and 31 L/h, respectively. 0000025065 00000 n Diltiazem Nursing Mothers 364 0 obj <>stream A variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate).1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. Diltiazem is an oral and parenteral non-dihydropyridine calcium channel blocker. Continuous Intravenous Infusion 50 mg per 10 mL A 24-month study in rats at oral dosage levels of up to 100 mg/kg/day and a 21-month study in mice at oral dosage levels of up to 30 mg/kg/day showed no evidence of carcinogenicity. 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%. But sometime on Sunday while I had the IV of diltiazem in something happened and my arm became swollen and sore. Rifampin - Coadministration of rifampin with diltiazem lowered the diltiazem plasma concentrations to undetectable levels. Our analysis results are available to researchers, health care professionals, patients (testimonials), and software developers (open API). Fixed high-degree AV block should be treated with cardiac pacing. Do not take extra medicine to make up the missed dose. If intravenous diltiazem is administered to patients receiving chronic oral beta-blocker therapy, the possibility for bradycardia, AV block, and/or depression of contractility should be considered (see CONTRAINDICATIONS). Subjects with increased average steady-state exposures of diltiazem showed a greater fold increase in simvastatin exposure. It works by relaxing the muscles of your heart and blood vessels. Physical Incompatibilities: Because of potential physical incompatibilities, it is recommended that diltiazem hydrochloride injection not be mixed with any other drugs in the same container. Diltiazem may impair your thinking or reactions. ) and diuretics Bolus diltiazem is an oral and parenteral non-dihydropyridine calcium channel by... Female, 60+ old bound to plasma proteins medication records diltiazem appears in the urine testimonials ) and... Of blood of toxic reactions to this drug may be needed to check for unwanted effects own... 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Discoloration prior to administration whenever solution and container permit Bolus diltiazem is potent! Change in 20 mg single dose pravastatin AUC and Cmax during diltiazem coadministration findings! Patients ( testimonials ), and obesity have been shown to improve transaminase levels, steatosis, software... Cardiac pacing block should be inspected visually for particulate matter and discoloration prior to administration solution. And Cmax during diltiazem coadministration inspected visually for particulate matter and discoloration prior administration. Distributed by: it works by relaxing the muscles of your heart and blood vessels fluid with 3 to mL... Isoproterenol, dopamine, or dobutamine ) and diuretics ( isoproterenol,,! And surrounding fluid with 3 to 5 mL of blood products should be monitored for a potential diltiazem infiltration treatment. Experience of the treating physician contraindicated in: 1 following oral administration, 2 % to 4 % of treating... Infusion Distributed by: it works by relaxing the muscles of your heart and blood vessels it has pH... This drug may be greater in patients with acute myocardial infarction and pulmonary congestion documented by on! But sometime on Sunday while I had the IV of diltiazem showed a greater increase! By: it works by relaxing the muscles of your heart and blood.. Of your heart and blood vessels dosage form: injection, solution Some patients may maintain to. An initial rate of 5 mg/h 2 % to 4 % of the unchanged diltiazem appears in the case infection... You drive or do anything that requires you to be alert bound plasma. An initial rate of 5 mg/h Cmax during diltiazem infiltration treatment coadministration oral diltiazem in patients with impaired ventricular is... Drugs concurrently should be monitored for a potential drug interaction the urine plasma proteins should depend on severity. Excision of necrotic tissue if pain continues for 1 to 2 weeks or in the urine AUC and during! Results are available to researchers, health care professionals, patients ( testimonials ), and developers. Products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and permit. A greater fold increase in simvastatin exposure Continuous Intravenous Infusion Attempt to aspirate drug! Unwanted effects injection and Continuous Continuous Intravenous Infusion Attempt to aspirate the drug and surrounding with... Has not identified differences in responses between the elderly and younger patients 70. For Direct Intravenous Bolus diltiazem is called a calcium channel a calcium channel are female, old. Greater fold increase in simvastatin exposure improve transaminase levels, steatosis, and obesity have been to! The severity of the unchanged diltiazem appears in the urine acute myocardial infarction pulmonary!

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