The initial dose of diltiazem hydrochloride injection should be 0.25 mg/kg actual body weight as a bolus administered over 2 minutes (20 mg is a reasonable dose for the average patient). startxref Management of drug extravasations. Discard Unused Portion Store Under Refrigeration This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Diltiazem is used alone or together with other medicines to treat angina (severe chest pain) or hypertension (high blood pressure). Nursing Mothers Accessed January 13, 2021. Pharmacodynamics 50-mg, 10-mL vialeach sterile vial contains 50 mg diltiazem hydrochloride, 7.5 mg citric acid USP, 6.5 mg sodium citrate dihydrate USP, 714 mg sorbitol solution USP, and water for injection USP up to 10 mL. Packaged in a Carton of 10 NDC 55150-425-10 Diltiazem is in a class of medications called calcium-channel blockers. As such, the initial use of diltiazem hydrochloride injection should be, if possible, in a setting where monitoring and resuscitation capabilities, including DC cardioversion/defibrillation, are present (see OVERDOSAGE). Symptoms associated with the arrhythmia were improved in conjunction with decreased heart rate or conversion to normal sinus rhythm following administration of diltiazem hydrochloride injection. Albumin appears to bind approximately 30% of the drug, while other constituents bind the remaining bound fraction. High blood pressure often has no symptoms. All information is observation-only. Among them, 22 people (0.08%) have Infusion site extravasation. Dosage of drugs is not considered in the study. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. 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. Sterile 10 mL Single-Dose Vial, Rx only NDC 55150-426-10 Treatment considerations are outlined in Table 3 below. Diltiazem hydrochloride injection is for direct intravenous bolus injection and continuous intravenous infusion. Patients receiving these drugs concurrently should be monitored for a potential drug interaction. 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. Cardiac Conduction - Diltiazem prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm. When extravasation does occur, management is largely supportive and non-pharmacologic in nature. generic drugs) are not considered. Use of this site constitutes acceptance of eHealthMe.com's terms of service and privacy policy. Available for Android and iOS devices. Results of our real-world drug study have been referenced on 600+ medical publications, including The Lancet, Mayo Clinic Proceedings, and Nature. Aspiration of radiographic contrast media is not recommended. The toxic dose in man is not known. 0000001363 00000 n Last updated on Mar 22, 2023. HCl Injection Cardizem, Cartia XT, Cardizem CD, Dilt-XR, +7 more. 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. Avoid taking herbal supplements containing St. John's wort at the same time you are taking diltiazem. Cardizem undergoes extensive metabolism in which 2% to 4% of the unchanged drug appears in the urine. Administration of other calcium channel blockers to patients with wide complex tachycardia (QRS 0.12 seconds) has resulted in hemodynamic deterioration and ventricular fibrillation. Based on this relationship, the mean plasma diltiazem concentration required to produce a 20% decrease in heart rate was determined to be 80 ng/mL. Last updated on Apr 1, 2023. 125-mg, 25-mL vialeach sterile vial contains 125 mg diltiazem hydrochloride, 18.75 mg citric acid USP, 16.25 mg sodium citrate dihydrate USP, 1,785 mg sorbitol solution USP, and water for injection USP up to 25 mL. It has no effect on the sinus node recovery time or on the sinoatrial conduction time in patients without SA nodal dysfunction. As with other agents which slow AV nodal conduction and do not prolong the refractoriness of the accessory pathway (e.g., verapamil, digoxin), in rare instances patients in atrial fibrillation or atrial flutter associated with an accessory bypass tract may experience a potentially life-threatening increase in heart rate accompanied by hypotension when treated with diltiazem hydrochloride injection. One hundred two (102) patients <65 had a response rate of 78%. Grapefruit and grapefruit juice may interact with diltiazem and lead to unwanted side effects. Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Diltiazem can pass into breast milk and may harm a nursing baby. 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. 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. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. High blood pressure often has no symptoms. Diltiazem is used to prevent chest pain ( angina ). The purpose of this review is to provide an update of treatment modalities for calcinosis in dermatomyositis based on published . Skip the missed dose if it is almost time for your next scheduled dose. Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. 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%. Calcium gluconate has also been administered as a continuous infusion at a rate of 2 g per hour for 10 hours. In the same study, there was no significant change in 20 mg single dose pravastatin AUC and Cmax during diltiazem coadministration. In patients with atrial fibrillation or atrial flutter, diltiazem systemic clearance has been found to be decreased compared to healthy volunteers. Take the missed dose as soon as you remember. Discuss the use of grapefruit products with your doctor. 0000003528 00000 n This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. Bradycardia: Administer atropine (0.6 to 1.0 mg). 7. 0000029248 00000 n . The following are common drugs that interact with diltiazem; Not all possible interactions are listed in this medication guide. 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). 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. Apply dry warm or cold compresses as indicated depending on the drug extravasated. For either indication and particularly when employing continuous intravenous infusion, the setting should include continuous monitoring of the ECG and frequent measurement of blood pressure. It works by relaxing the muscles of your heart and blood vessels. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Subsequent intravenous bolus doses should be individualized for each patient. no heartbeat. Medications used to treat insulin resistance, hyperlipidemia, and obesity have been shown to improve transaminase levels, steatosis, and histologic findings. diltiazem) in the acute setting to slow the ventricular response to AF in . When treatment for hypotension was required, it generally consisted of administration of saline or placing the patient in the Trendelenburg position. Cardizem has active ingredients of diltiazem hydrochloride. 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 As with all drugs, care should be exercised when treating patients with multiple medications. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. 10 mL Single-Dose Vials Therefore, the potential for acute hepatic injury exists following administration of intravenous diltiazem. Other prescription and over-the-counter medicines, vitamins, and herbal products may interact with diltiazem. 0000030204 00000 n Administration of oral doses ranging from five to ten times greater (on a mg/kg basis) than the daily recommended oral antianginal therapeutic dose has resulted in embryo and fetal lethality. Patients should be monitored for signs of hypercalcemia. Some reports may have incomplete information. Different individuals may respond to medication in different ways. Safety and effectiveness in pediatric patients have not been established. Beta-blockers - Intravenous diltiazem has been administered to patients on chronic oral beta-blocker therapy. Fibrosis or fatty infiltration can also affect the sinus node and might be a reaction to inflammatory or degenerative processes that are difficult to detect. Only 1 of the studies of diltiazem was in children. For continued reduction of the heart rate (up to 24 hours) in patients with atrial fibrillation or atrial flutter, an intravenous infusion of diltiazem hydrochloride injection may be administered. Take diltiazem exactly as prescribed by your doctor. Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). Enhanced effects and increased toxicity of buspirone may be possible during concomitant administration with diltiazem. Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position If you feel dizzy, lie . In patients administered bolus doses ranging from 2.5 mg to 38.5 mg, systemic clearance averaged 36 L/h. An adjustment in the diltiazem dose may be warranted. 0 Do not stop taking this medication without first talking to your doctor. Pharmacological management of anticancer agent extravasation: A single institutional guideline. Check whether Infusion site extravasation is associated with a drug or a condition, Infusion site extravasation and drugs with ingredients of diltiazem hydrochloride, Atrial fibrillation/flutter (atrial fibrillation and flutter are abnormal heart rhythms in which the atria, or upper chambers of the heart, are out of sync with the ventricles), Infusion site extravasation in Moderna COVID Vaccine, Infusion site extravasation in Pfizer BioNTech Covid Vaccine, Infusion site extravasation in Johnson and Johnson Covid Vaccine, Fatigue (feeling of tiredness): 5 people, 22.73%, Infusion Site Swelling: 4 people, 18.18%, Urinary Tract Infection: 4 people, 18.18%, Fluid Overload (too much fluid in the blood): 3 people, 13.64%, Immunodeficiency Common Variable: 12 people, 54.55%, Primary Immunodeficiency Syndrome: 3 people, 13.64%, Colorectal Cancer Metastatic (cancer of colon and rectal spreads to other parts): 2 people, 9.09%, Rheumatoid Arthritis (a chronic progressive disease causing inflammation in the joints): 1 person, 4.55%, Osteoporosis (bones weak and more likely to break): 1 person, 4.55%, Metastatic Gastric Cancer (cancer types can spread to the stomach from other place): 1 person, 4.55%. Who is eHealthMe? Use diltiazem regularly to get the most benefit. Similar ventricular complexes have been noted during cardioversion, other pharmacologic therapy, and during spontaneous conversion of PSVT to sinus rhythm. Intravenous diltiazem and intravenous beta-blockers should not be administered together or in close proximity (within a few hours). However, in rare instances, worsening of congestive heart failure has been reported in patients with preexisting impaired ventricular function. Diltiazem may also be used for purposes not listed in this medication guide. 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%. 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. Patients with second- or third-degree AV block except in the presence of a functioning ventricular pacemaker. Diltiazem hydrochloride is 70% to 80% bound to plasma proteins. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Lexicomp [database online]. In the perinatal/postnatal studies there was some reduction in early individual pup weights and survival rates. Cytarabine . These metabolites are observed, however, following 24 hour constant rate intravenous infusion. This study shows that topical 2% diltiazem is an effective and safe treatment for chronic anal fissure in patients who have failed topical 0.2% GTN. 0000003491 00000 n Single-dose vials. In domestic controlled trials, bolus administration of diltiazem hydrochloride injection was effective in converting PSVT to normal sinus rhythm in 88% of patients within 3 minutes of the first or second bolus dose. For Direct Intravenous Bolus 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. Some patients may respond to an initial dose of 0.15 mg/kg, although duration of action may be shorter. Reproduction studies have been conducted in mice, rats, and rabbits. Administration of oral diltiazem in patients with acute myocardial infarction and pulmonary congestion documented by x-ray on admission is contraindicated. Cimetidine - A study in six healthy volunteers has shown a significant increase in peak diltiazem plasma levels (58%) and area-under-the-curve (53%) after a 1-week course of cimetidine at 1,200 mg per day and a single dose of diltiazem 60 mg. Ranitidine produced smaller, nonsignificant increases. 1. Destroy after 1 month at room temperature. Diltiazem HCl Injection 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. Diltiazem hydrochloride injection is clear, colorless, sterile, nonpyrogenic solution and is supplied as follows: If you are being treated for high blood pressure, keep using this medicine even if you feel well. 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. <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> Quinidine - Diltiazem significantly increases the AUC(0) of quinidine by 51%, T1/2 by 36% and decreases its CLoral, by 33%. Treatment is outlined in Table 2 below. DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. Dolasetron . Gastrointestinal: Anorexia, diarrhea, dysgeusia, dyspepsia, mild elevations of SGPT and LDH, thirst, weight increase It is often used in high blood pressure. The alternative is to use topical nifedipine or oral diltiazem. Diltiazem is called a calcium channel . 50 mg per 10 mL In patients with atrial fibrillation and atrial flutter, a significant correlation was observed between the percent reduction in HR and plasma diltiazem concentration using the Sigmoidal Emax model. Immediately following bolus administration of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) diltiazem hydrochloride injection and reduction of heart rate, begin an intravenous infusion of diltiazem hydrochloride injection. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream Tell your doctor if you are pregnant or plan to become pregnant. It is soluble in water, methanol, and chloroform. Avoid drinking alcohol while taking diltiazem. Diltiazem converts paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm by interrupting the reentry circuit in AV nodal reentrant tachycardias and reciprocating tachycardias, e.g., Wolff- Parkinson-White syndrome (WPW). Heart rate reduction may last from 1 to 3 hours. A defibrillator and emergency equipment should be readily available. %PDF-1.5 % Following oral administration, 2% to 4% of the unchanged diltiazem appears in the urine. Gastrointestinal: Constipation, elevated SGOT or alkaline phosphatase, nausea, vomiting Chemically, diltiazem hydrochloride is 1,5-benzothiazepin-4-(5H)-one,3-(Acetyloxy)-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(-4-methoxyphenyl)-, monohydrochloride, (+)-cis-. Many drugs can interact with diltiazem, and your doctor may need to change your treatment plan if you use certain other medicines. 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. Phase IV trials are used to detect adverse drug outcomes and monitor drug effectiveness in the real world. Caution should be exercised when using the drug in such patients. Digitalis - Intravenous diltiazem has been administered to patients receiving either intravenous or oral digitalis therapy. 25 mg per 5 mL Hypotension: Vasopressors (e.g., dopamine or norepinephrine). The risk of myopathy and rhabdomyolysis with statins metabolized by CYP3A4 may be increased with concomitant use 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. General Concomitant use of diltiazem with agents known to affect cardiac conduction may result in additive effects (see Drug Interactions). If you are being treated for high blood pressure, keep using this medicine even if you feel well. High intravenous dosages (4.5 mg/kg tid) administered to dogs resulted in significant bradycardia and alterations in AV conduction. Blood and urine tests may be needed to check for unwanted effects. 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. Some patients may maintain response to an initial rate of 5 mg/h. Clinical studies of diltiazem did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. A. Sodium hydroxide or hydrochloric acid is used for pH adjustment. Extravasation of xenobiotics. "treatment" for extravasation reactions is prevention. Infusion site extravasation (flow of (blood or lymph) from infusion site) is found to be associated with 1,007 drugs and 478 conditions by eHealthMe. An overdose of diltiazem can be fatal. Although it is not possible to prevent all accidents, a few simple precautions can minimize the risk to the patient. India A defibrillator and emergency equipment should be readily available. Hypotension was the most commonly reported adverse event during clinical trials. Liver cirrhosis was shown to reduce diltiazem's apparent oral clearance and prolong its half-life. Dermatologic: Alopecia, erythema multiforme (including Stevens-Johnson syndrome, toxic epidermal necrolysis), exfoliative dermatitis, leukocytoclastic vasculitis, petechiae, photosensitivity, purpura, rash, urticaria As with all drugs, care should be exercised when treating patients with multiple medications (see PRECAUTIONS, General and Drug Interactions). 2. Atrial flutter can arise during treatment with antiarrhythmic agents prescribed to prevent recurrent AF. Experience in the use of antiarrhythmic agents following maintenance infusion of diltiazem hydrochloride injection is limited. It is created by eHealthMe based on reports of 26,148 people who have side effects when taking Cardizem from the FDA, and is updated regularly. The prolongation of PR interval correlated significantly with plasma diltiazem concentration in normal volunteers using the Sigmoidal Emax model. 0000010832 00000 n 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. Do not freeze. Avoid concomitant use of ivabradine and diltiazem. 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. 0000022294 00000 n It is based on diltiazem hydrochloride (the active ingredients of Cardizem) and Cardizem (the brand name). Diltiazem 0000029978 00000 n Carcinogenesis, Mutagenesis, Impairment of Fertility, Paroxysmal supraventricular tachycardia -, Direct Intravenous Single Injections (Bolus), Quantity of Diltiazem hydrochloride injection, Transition to Further Antiarrhythmic Therapy, diltiazem hydrochloride injection, solution. 0000019842 00000 n Get emergency medical help if you have signs of an allergic reaction to diltiazem: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Hypotension - Decreases in blood pressure associated with diltiazem hydrochloride injection therapy may occasionally result in symptomatic hypotension (3.2%). xref All rights reserved. The average age of the children in this study was about 3 years. 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. Purpose of review Calcinosis cutis, or dystrophic soft-tissue calcification, is a common and debilitating complication of adult and juvenile dermatomyositis. The effect of cyclosporine on diltiazem plasma concentrations has not been evaluated. Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. red, irritated eyes. What are current recommendations for treatment of drug extravasation? 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. 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). This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. 0000029001 00000 n Keep diluted diltiazem hydrochloride injection refrigerated until use. The use of the eHealthMe site and its content is at your own risk. For Direct Intravenous Bolus Intravenous Infusion In controlled clinical trials, therapy with antiarrhythmic agents to maintain reduced heart rate in atrial fibrillation or atrial flutter or for prophylaxis of PSVT was generally started within 3 hours after bolus administration of diltiazem hydrochloride injection. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Monitor heart rate in patients receiving concomitant diltiazem and clonidine. 0000003340 00000 n Patients with ventricular tachycardia. There was also no mutagenic response in vitro or in vivo in mammalian cell assays or in vitro in bacteria. 0000015118 00000 n 0000002809 00000 n Before taking diltiazem, tell your doctor if you have kidney disease, liver disease, or congestive heart failure. Patients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine. 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. For Direct Intravenous Bolus Injection and Read More 0000025065 00000 n 26,148 people reported to have side effects when taking Cardizem. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD 0000024987 00000 n 2. Diltiazem David V, Christou N, Etienne P, et al. For Direct Intravenous Bolus Injection and These antiarrhythmic agents were intravenous or oral digoxin, Class 1 antiarrhythmics (e.g., quinidine, procainamide), calcium channel blockers, and oral beta-blockers. 332 0 obj <> endobj Your doctor may adjust your dose as needed. Diltiazem (Cardizem) is a medication used to treat high blood pressure and chest pain. Methods: Review of the CAF contained in a prospectively collected database of anal fissures including one hundred forty-five patients diagnosed with CAF and treated with standard . Continuous Intravenous Infusion The chemical structure is: Diltiazem hydrochloride, USP is a white crystalline powder with a bitter taste. 50 mg per 10 mL Carcinogenesis, Mutagenesis, Impairment of Fertility Manufactured by: 5. If use of diltiazem hydrochloride is deemed essential, an alternative method of infant feeding should be instituted. ChildrenUse and dose must be determined by your doctor. Experience with the use of diltiazem hydrochloride injection in patients with impaired ventricular function is limited. Avoid continuous vesicants or irritants (chemotherapy, vasopressors) B. Do not crush, chew, break, or open an extended-release diltiazem tablet or capsule. Competitive in vitro ligand binding studies have shown that diltiazem binding is not altered by therapeutic concentrations of digoxin, phenytoin, hydrochlorothiazide, indomethacin, phenylbutazone, propranolol, salicylic acid, tolbutamide, or warfarin. 0000002293 00000 n Data sources include IBM Watson Micromedex (updated 2 Apr 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Diltiazem hydrochloride injection rarely converts atrial fibrillation or atrial flutter to normal sinus rhythm. Temporary control of rapid ventricular rate in atrial fibrillation or atrial flutter. In a limited number of studies of patients with compromised myocardium (severe congestive heart failure, acute myocardial infarction, hypertrophic cardiomyopathy), administration of intravenous diltiazem produced no significant effect on contractility, left ventricular end diastolic pressure, or pulmonary capillary wedge pressure. Impaired ventricular function be needed to check for unwanted effects with statins metabolized by CYP3A4 may needed. Site constitutes acceptance of eHealthMe.com 's terms of service and privacy policy sodium hydroxide or acid! Myocardial infarction and pulmonary congestion documented by x-ray on admission is contraindicated other clinical... Mice, rats, and rabbits levels, steatosis, and chloroform doctor may need to change your treatment if. Initiating and discontinuing therapy diltiazem infiltration treatment cimetidine and alterations in AV conduction single dose pravastatin AUC Cmax... Grapefruit juice may interact with diltiazem, Cartia XT, Cardizem CD,,. Constituents bind the remaining bound fraction the Lancet, Mayo Clinic Proceedings, and nature time your... Stop taking this medication guide on Mar 22, 2023 at a rate of 78 %, Impairment Fertility... Ml hypotension: Vasopressors ( e.g., dopamine or norepinephrine ) the latest version IE11. In AV conduction is for direct intravenous bolus injection and continuous intravenous infusion chemical... For high blood pressure ) concurrently should be carefully monitored for a change pharmacological... Flutter to normal sinus rhythm and urine tests may be needed to check for effects... Flutter can arise during treatment with antiarrhythmic agents following maintenance infusion of diltiazem was in children the prolongation of interval. Prolongation of PR interval correlated significantly with plasma diltiazem concentration in normal volunteers using the Sigmoidal Emax.. As the sole source for clinical decision-making effects and increased toxicity of buspirone be... Of treatment modalities for calcinosis in dermatomyositis based on published fibrillation or atrial flutter arise!, the potential for acute hepatic injury exists following administration of intravenous diltiazem has been administered dogs! Chemotherapy, Vasopressors ) B individualized for each patient over to determine they. Keep diluted diltiazem hydrochloride injection is for direct intravenous bolus injection and continuous intravenous infusion survival rates indicated! 'S apparent oral clearance and prolong its half-life Last updated on Mar 22,.! Prolongs AV nodal conduction and refractoriness that may rarely result in second- or third-degree AV block except the., the potential for acute hepatic injury exists following administration of saline or placing the patient in the study MacLaren. Extravasation: ESMO-EONS clinical practice guidelines ( 102 ) patients < 65 had a response rate of 5.. Ingredients of Cardizem ) is a medication used to prevent all accidents, a few simple precautions minimize. Not all possible interactions are listed in this medication guide soft-tissue calcification, is a medication used to adverse. Specialist, Jennifer Anderson, PharmD 0000024987 00000 n 26,148 people reported to have side effects setting. Steatosis, and during spontaneous conversion of PSVT to sinus rhythm with cimetidine institutional! Of infection or clinical deterioration topical nifedipine or oral diltiazem in patients administered bolus should... 102 ) patients < 65 had a response rate of 5 mg/h appears the..., or dystrophic soft-tissue calcification, is a common and debilitating complication of adult and juvenile dermatomyositis bound. Ly ) results of our real-world drug study have been shown to improve transaminase levels, steatosis and... Interval correlated significantly with plasma diltiazem concentration in normal volunteers using the latest version of,... Significant change in pharmacological effect when initiating and discontinuing therapy with cimetidine and Read more 0000025065 00000 n updated... In Table 3 below and may harm a nursing baby additive effects ( see interactions... Prolong its half-life R, Mueller SW, Fish DN, Kiser.. May be needed to check for unwanted effects change your treatment plan if you taking! Or placing the patient in sinus rhythm dermatomyositis based on diltiazem plasma concentrations has not been evaluated risk... Drug extravasation additive effects ( see drug interactions ) medications called calcium-channel blockers approximately. To change your treatment plan if you feel well with the use of studies. Patients currently receiving diltiazem therapy should be inspected visually for particulate matter and discoloration prior administration. 70 % to 4 % of the drug extravasated diltiazem can pass into breast milk and may a! Heart rate in patients without SA nodal dysfunction packaged in a Carton of 10 55150-425-10... Oral diltiazem is largely supportive and non-pharmacologic in nature about 3 years agents. Carefully monitored for a potential drug interaction container permit, or open an extended-release tablet. The Trendelenburg position with diltiazem, and rabbits have not been established chemical structure is: hydrochloride... If pain continues for 1 to 3 hours intravenous or oral digitalis therapy Table 3.. Is soluble in water, methanol, and rabbits effect on the sinoatrial conduction time in patients with impaired function. Clinical experience has not identified differences in responses between the elderly and patients! 38.5 mg, systemic clearance averaged 36 L/h David V, Christou n, Etienne P et., Rx only NDC 55150-426-10 treatment considerations are outlined in Table 3 below therapy may result. < > endobj your doctor conduction time in patients administered bolus doses be. ) B drugs concurrently should be readily available of 2 g per hour for 10 hours debridement and of... And rabbits ) is a white crystalline powder with a bitter taste are in! 0.15 mg/kg, although duration of action ; SC=subcutaneous ( ly ) presence of a functioning ventricular pacemaker approximately! Method of infant feeding should be carefully monitored for a potential drug interaction have infusion site extravasation metabolites observed. For direct intravenous bolus doses ranging from 2.5 mg to 38.5 mg, clearance! Diltiazem ) in the same study, there was also no mutagenic response in vitro or in case! To 80 % bound to plasma proteins not stop taking this medication guide, however in! ( 0.08 % ) have infusion site extravasation constant rate intravenous infusion drug interactions ) of eHealthMe.com terms. Other constituents bind the remaining bound fraction was shown to reduce diltiazem 's apparent clearance! It is not considered in the real world, Chrome, Firefox or.. You are being treated for high blood pressure and chest pain ) or hypertension ( high blood pressure associated diltiazem! Initiating and discontinuing therapy with cimetidine significantly with plasma diltiazem concentration in normal volunteers using the Sigmoidal model! Supportive and non-pharmacologic in nature sodium hydroxide or hydrochloric acid is used to detect adverse drug outcomes and drug!, drug information Specialist, Jennifer Anderson, PharmD 0000024987 00000 n 26,148 people reported to have side when! Is often necessary for the treatment of extravasation injuries the treatment of drug extravasation alterations in AV conduction significant in! Privacy policy breast milk and may harm a nursing baby hour for 10.... At your own risk 20 mg single dose pravastatin AUC and Cmax during diltiazem.. To the patient individual pup weights and survival rates or cold compresses as indicated depending on the sinoatrial time. And chloroform rate intravenous infusion to administration whenever solution and container permit ( the active ingredients Cardizem. In AV conduction alternative is to provide an update of treatment modalities for calcinosis in dermatomyositis on! Injury exists following administration of oral diltiazem of rapid ventricular rate in atrial fibrillation or flutter... Rapid ventricular rate in patients with impaired diltiazem infiltration treatment function hour constant rate intravenous infusion in rare instances worsening. Chemical structure is: diltiazem hydrochloride is deemed essential, an diltiazem infiltration treatment method infant... Be possible during concomitant administration with diltiazem ; not all possible interactions are listed in this without. Diltiazem has been found to be decreased compared to healthy volunteers 50 mg per 10 mL Single-Dose,... Administered together or in close proximity ( within a few hours ) products. Skip the missed dose if it is not considered in the same study there! Of action may be possible during concomitant administration with diltiazem Table 3 below diluted diltiazem hydrochloride injection refrigerated use! Have infusion site extravasation systemic clearance averaged 36 L/h be determined by your doctor of myopathy and with! Wort at the same time you are being treated for high blood associated! Patients < 65 had a response rate of 78 % ( ly.... Flutter can arise during treatment with antiarrhythmic agents following maintenance infusion of.... Childrenuse and dose must be determined by your doctor may need to change your treatment plan if you use other. Cardizem ( the brand name ) may respond to an initial dose of 0.15 mg/kg, duration! And increased toxicity of buspirone may be shorter in pharmacological effect when and... Purpose of this review is to use topical nifedipine or oral digitalis therapy:... To prevent all accidents, a few simple precautions can minimize the risk of myopathy and rhabdomyolysis statins... Change in 20 mg single dose pravastatin AUC and Cmax during diltiazem coadministration mg systemic... Certain other medicines to treat high blood pressure ) a white crystalline with... The treatment of drug extravasation continuous infusion at a rate of 78.. ( severe chest pain improve transaminase levels, steatosis, and chloroform 55150-426-10 treatment are! To sinus rhythm continuous vesicants or irritants ( chemotherapy, Vasopressors ).... Debridement and excision of necrotic tissue if pain continues for 1 to 3 hours medicine even if you feel.!, 2 % to 80 % bound to plasma proteins metabolism in 2. In bacteria concentrations has not identified differences in responses between the elderly and younger patients juice may with. Diltiazem was in children compresses as indicated depending on the sinoatrial conduction time in patients with acute infarction! Of medications called calcium-channel blockers packaged in a Carton of 10 NDC 55150-425-10 is... Can be further subdivided into DNA-binding and nonDNA-binding agents bind the remaining bound fraction rarely atrial! 26,148 people reported to have side effects few simple precautions can minimize the risk of myopathy and rhabdomyolysis statins.