NAME OF DRUG
diltiazem hydrochloride

CLASSIFICATION

Calcium Channel Blocker, Antiarrhythmic

ALTERNATE NAME

CARDIZEM INJECTABLE

INDICATIONS

• temporary control of rapid ventricular rate in atrial fibrillation or atrial flutter
• rapid conversion of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm
• prevention of arterial spasm

 RECONSTITUTION AND STABILITY

• refrigerate; protect from freezing
• discard if particulate matter or discolouration present prior to administration

COMPATIBILITY

• compatible with commonly used IV solutions
• compatible via Y-site with digoxin, dobutamine, dopamine, epinephrine, esmolol, fentanyl, heparin, hydromorphone, labetalol, lidocaine, midazolam, milrinone, morphine, multivitamins, nitroglycerin, nitroprusside, norepinephrine, potassium chloride, potassium phosphate, procainamide, ranitidine, vasopressin 
• incompatible with acetazolamide, aminophylline, diazepam, furosemide, hydrocortisone, insulin, methylprednisolone, phenytoin, sodium bicarbonate

 ROUTES OF ADMINISTRATION

• IV direct - over 2 minutes
• IV infusion - dilute to 1 mg/mL concentration as follows:

VH & HSC ADMINISTRATION POLICY

Infusions restricted to critical care areas with continuous ECG monitoring

B - Direct IV route restricted to nurses in Special and Critical Care areas. Nurses in the Telemetry unit may administer diltiazem by direct IV provided the physician has administered the first dose. On general nursing units the direct IV route must be administered by a physician.

H - The IV infusion rate must be controlled by an automated infusion control device. 

DOSAGE

Treatment of supraventricular tachyarrhythmias:

IV direct:

• 0.25 mg/kg (usual up to 20 mg) IV bolus over 2 minutes. If inadequate response after 15 minutes, may repeat second bolus of 0.35 mg/kg (usual up to 25 mg) over 2 minutes.

IV infusion:

• For continued reduction of ventricular rate in patients with atrial flutter or fibrillation, follow IV bolus with IV infusion of 5-10 mg/hour. The infusion rate may be increased in 5 mg/hour increments up to 15 mg/hour as needed.
• Infusion duration longer than 24 hours and infusion rates greater than 15 mg/hour are not recommended; consider the institution of alternate treatment.

Prevention of arterial spasm:

• 0.5-2 mcg/kg/minute IV infusion; switch to oral therapy when tolerated. 

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• bruising or burning at injection site
• hypotension, vasodilation (flushing), arrhythmias, AV block

IMPORTANT IMPLICATIONS

• continuous ECG and blood pressure monitoring is recommended to detect AV block and/or hypotension
• use with caution in patients with impaired renal or hepatic function
• contraindicated in sick sinus syndrome, marked AV conduction disturbances, cardiogenic shock, severe hypotension, ventricular tachycardia
• intravenous diltiazem and intravenous beta-blockers should not be administered within a few hours of each other

Rev. Oct 2004