Albumin appears to bind approximately 30% of the drug, while other constituents bind the remaining bound fraction. 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). prolonged sedation) of both midazolam and triazolam. These antiarrhythmic agents were intravenous or oral digoxin, Class 1 antiarrhythmics (e.g., quinidine, procainamide), calcium channel blockers, and oral beta-blockers. 50 mg per 10 mL One hundred two (102) patients <65 had a response rate of 78%. In dogs, oral doses of 20 mg/kg were also associated with hepatic changes; however, these changes were reversible with continued dosing. hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', Concomitant use of diltiazem with agents known to affect cardiac conduction may result in additive effects (see Drug Interactions). 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. Patients with low body weights should be dosed on a mg/kg basis. Avoid continuous vesicants or irritants (chemotherapy, vasopressors) B. Brand names: Cardizem (and Cardizem CD, LA and XR), Cartia XT, Dilacor XR, Dilt-CD, 0000024987 00000 n Other prescription and over-the-counter medicines, vitamins, and herbal products may interact with diltiazem. 50 mg per 10 mL Give a list of all your medicines to any healthcare provider who treats you. In patients with atrial fibrillation or atrial flutter, diltiazem systemic clearance has been found to be decreased compared to healthy volunteers. Our original studies have been referenced on 600+ medical publications including The Lancet, Mayo Clinic Proceedings, and Nature. What are current recommendations for treatment of drug extravasation? We comply with the HONcode standard for trustworthy health information. 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. The alternative is to use topical nifedipine or oral diltiazem. Mix thoroughly. 5. 549 0 obj <>stream Generic name: diltiazem hydrochloride 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. Diltiazem 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. Additionally, administration factors, including the experience of personnel administering the injection, the injection technique, and the number of venipuncture attempts to establish a line, contribute to the risk of extravasation, as does the fragility of the patients veins. (5 mg/mL) Anal fissure: Medical management. However, since both drugs affect AV nodal conduction, patients should be monitored for excessive slowing of the heart rate and/or AV block. 125 mg per 25 mL Following administration of one or two intravenous bolus doses of diltiazem hydrochloride injection, response usually occurs within 3 minutes and maximal heart rate reduction generally occurs in 2 to 7 minutes. 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. Dermatologic events progressing to erythema multiforme and/or exfoliative dermatitis have been infrequently reported following oral diltiazem. Disconnect IV tubing from IV device. 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. Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. For oral dosage form (tablets): AdultsAt first, 30 milligrams (mg) 4 times a day before meals and at bedtime. generic drugs) are not considered. The following are common drugs that interact with diltiazem; Not all possible interactions are listed in this medication guide. Medically reviewed by Drugs.com. Lexicomp [database online]. Wang RY. Continuous Intravenous Infusion 0000010832 00000 n Dermatomyositis-associated calcinosis is difficult to treat and is associated with significant morbidity. Discard Unused Portion Store Under Refrigeration Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. Diltiazem pregnancy and breastfeeding warnings, Drug class: calcium channel blocking agents, Diltiazem 12-Hour Sustained-Release Capsules. Diltiazem is used alone or together with other medicines to treat angina (severe chest pain) or hypertension (high blood pressure). Management of drug extravasations. In the event of overdosage or an exaggerated response, appropriate supportive measures should be employed. Dosage of drugs is not considered in the study. Sterile eugia 10 x 5 mL Single-Dose Vials, Rx only NDC 55150-426-01 4. Angiotensin-converting enzyme inhibitors (ACEi) appear to be ideal agents for antihypertensive therapy in athletes. If there is no response to vagal blockade administer isoproterenol cautiously. Document infiltration and report to ED RN ASAP for antidote 0000006002 00000 n Cardizem has active ingredients of diltiazem hydrochloride. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or in vitro in bacteria. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Ventricular Premature Beats (VPBs) - VPBs may be present on conversion of PSVT to sinus rhythm with diltiazem hydrochloride injection. Discard unused portion. We comply with the HONcode standard for trustworthy health information. Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. Diltiazem prolongs the sinus cycle length. Infiltration- inadvertent administration of non-vesicant medication or fluid into the surrounding tissues. Limited data suggest that plasmapheresis or charcoal hemoperfusion may hasten diltiazem elimination following overdose. Dermatologic: Pruritus, sweating Gastrointestinal: Constipation, elevated SGOT or alkaline phosphatase, nausea, vomiting Diltiazem hydrochloride is a calcium ion cellular influx inhibitor (slow channel blocker or calcium channel antagonist). Nervous System: Abnormal dreams, amnesia, depression, extrapyramidal symptoms, gait abnormality, hallucinations, insomnia, nervousness, personality change, somnolence, tremor Our analysis results are available to researchers, health care professionals, patients (testimonials), and software developers (open API). 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%. General Clinical studies of diltiazem did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution.2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. Medications used to treat insulin resistance, hyperlipidemia, and obesity have been shown to improve transaminase levels, steatosis, and histologic findings. 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. Heart rate reduction may last from 1 to 3 hours. However, if you have symptoms of low blood pressure (dizziness, fainting, weakness, or blurred vision), call your doctor and stop taking diltiazem. red skin lesions, often with a purple center. 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. All rights reserved. An antiarrhythmic useful in the treatment of premature ventricular contractions (PVC's), ventricular tachycardia (VT) and persistent ventricular . Be careful if you drive or do anything that requires you to be alert. Remove the peripheral IV device or port needle. Sterile 5 mL Single-Dose Vial, Rx only NDC 55150-425-10 Diltiazem In vitro, propranolol appears to be displaced from its binding sites by diltiazem. You should not use diltiazem if you have very low blood pressure, a serious heart condition such as "sick sinus syndrome" or "second- or third-degree AV block" (unless you have a pacemaker), or if you have recently had a heart attack and you have a build-up of fluid in your lungs. Phase IV trials are used to detect adverse drug outcomes and monitor drug effectiveness in the real world. The combination of the two drugs was generally well tolerated without serious adverse effects. xref Skip the missed dose if it is almost time for your next scheduled dose. Each mL contains 5 mg of diltiazem hydrochloride, 0.75 mg citric acid (hydrous) USP, 0.65 mg sodium citrate dihydrate USP, 71.4 mg sorbitol solution USP, and water for injection USP. 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. 0 Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate). 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