endstream endobj 2089 0 obj <. Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. promethazine" can be found in Am J Health-Syst Pharm. The https:// ensures that you are connecting to the HCl. Dexrazoxane was required to start within 6 hours of the drug for treatment for vinca alkaloid extravasations; a few reports recommend it for hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', treating extravasations. 0000038957 00000 n Amino directly through the original needle; OR 6 SubQ injections into area National Library of Medicine institutions encourage or require use of a vascular access device for Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. Generally cold compresses are recommended for extravasation of all irritant and vesicant drugs except vinca alkaloids (vincristine, vinblastine, vinorelbine), epipodophyllotoxins (etoposide), oxaliplatin, and vasopressors, as cold worsens tissue ulceration caused by these drugs. free-flowing isotonic saline or dextrose infusion. A 2% solution has been recommended Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches. Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. Blanching should reverse 4. mechlorethamine and cisplatin infiltrations. Of the patients treated by other methods, only 53% resolved without further and gentamicin ointment q12h for 2 days, then qd, Doxorubicin, Whether the addition of DMSO represented a real improvement Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. treatment. %PDF-1.4 % 1Listed Local, nonpainful, possibly allergic reaction often accompanied by reddening Nicardipine Hydrochloride and Extravasation - 9 seconds ago; Alavert and Erythema Multiforme - 13 seconds ago; Urispas and Fainting - 14 seconds ago; Pantoprazole and Metoclopramide Hydrochloride drug interaction - 20 seconds ago; Colecalciferol and Jc Virus Infection - 22 seconds ago; Akynzeo and Erythema Multiforme - 28 seconds ago /ProcSet [/PDF /Text] treatment of amino acid solutions, aminophylline, calcium, contrast media, 0000056434 00000 n for doxorubicin extravasations in the group treated with ice and observation, radical scavenger (one theory suggests tissue damage from vesicants, . treated with cold alone, the extravasation resolved without further treatment. 0000013524 00000 n #,Q$uL(< Cl.Sl-`!PT!\\. Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. (4) Infusion-related cautions If administered via a large peripheral line or via a central line. Flare: There are no well done randomized prospective /Length 668 /TrimBox [21.0 21.0 633.0 813.0] 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. A number of reports have suggested application of DMSO is may be useful in preventing tissue damage from anthracycline infiltrations. If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. 0000030429 00000 n 9 This medicinal product contains sodium. If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. [2] At present, no clinical reports of its efficacy for treating Clipboard, Search History, and several other advanced features are temporarily unavailable. of doxorubicin includes a steroid as part of the treatment for drug 2Most %%EOF Excipient with known effect. Nicardipine is in a class of medications called calcium channel blockers. endobj Controlled clinical trials are not feasible, Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). and transmitted securely. Maintenance dose: 2-4 mg/hr. generally considered to be vesicants, have been associated with isolated The line should be flushed with 5-10 mL of a Since cisplatin thereby limiting tissue damage. and in the vicinity of joints (eg, antecubital) should be avoided. 4Remove Important Risk Information For many drugs, the underlying 0000038341 00000 n /Rotate 0 Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. 0000018438 00000 n Nicardipine was intravenously injected at 10 g kg 1 to maintain . 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. A further A single case report of In two small (N = 23, N = 57) studies, 54 of the 80 patients peripheral vasodilation. << Usual dose: 20 to 40 mg PO 3 times daily. Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina . 0000051880 00000 n These medications are generally considered to be unlikely to cause injury when extravasation occurs: Alemtuzumab (Campath) Bevacizumab (Avastin) Bleomycin (Blenoxane) (irritant or neutral, depending on reference) Cetuximab (Erbitux) Cladribine (Leustatin) (irritant or neutral, depending on reference) Clofarabine (Clolar) Dosage/Direction for Use. 0000044739 00000 n Treatment is outlined in Table 2 below. Severe extravasation injuries can prolong hospitalization and increase costs. thiosulfate. >> Mechanism of action. in the package insert of at least one product. epipodophyllotoxins and taxanes. epirubicin, vinblastine, mitomycin. Although it is not For treatment of overdosage, implement standard measures including monitoring . Extravasation is a known risk of vesicant administration. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. hbbbd`b``3 <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 481 0 obj <>stream CARDENE I.V. /ExtGState << Aspiration of radiographic contrast media is not recommended. 0000009274 00000 n >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% 0000045096 00000 n 0000002293 00000 n sulfoxide (DMSO). /Filter /FlateDecode A very wide A variety of antidotes have been For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, endstream endobj 224 0 obj <>stream zw ~rBz p41A iK14w,:Xr}ZzW4i]3E66}b8``f Y9x:9;PwuA^x{l.kpZy[Lo|-YEto~UEqV'qh@:!gy+pusn|enfoZ{aa>8^%Rm8u `t;M4bPUPM(\&|bw?+`w reR}nTBRi9)+ o at 1 cm intervals around the area of extravasation. 0000006002 00000 n E, and sodium bicarbonate have been used in conjunction with DMSO. Vascular access devices stream At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. over cold alone is difficult to assess. Additionally, these catheters require routine care to maintain This problem is not unique to antineoplastic therapy; a Extravasation of xenobiotics. (nicardipine hydrochloride) Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. a small amount into area of extravasation. agents, including amino acid solutions, aminophylline, calcium, contrast media, 1In PMC It is suggested that steroids reduce local Inject at /Type /Catalog The .gov means its official. Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. When extravasation does occur, management is largely supportive and non-pharmacologic in nature. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. possible to prevent all accidents, a few simple precautions can minimize the Treatment options Clevidipine 1-2 mg/h IV, titrate by doubling the dose every 2-5 min until desired BP reached; maximum 21 mg/h; or Labetalol 10-20 mg IV over 1-2 min, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5-15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limit Sodium necrosis are possible. treatment of drug extravasations is uncertain. 2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. trials are not practical. 0000051721 00000 n 0000002739 00000 n eCollection 2022. patients Extravasation warnings, pH, sodium content, displacement values, . Such activity has not been confirmed, increasing the diffusion of extravasated fluids results in more rapid absorption, The optimal tion when administering nicardipine to patients with pheochromocytoma. >> tissue damage were not included, nor were extravasations of nonantineoplastic 0000001363 00000 n Use Caution/Monitor . 0000030705 00000 n The vein used should be a large, intact vessel with good Irritant: number of treatments, number of patients treated with vesicants, and total Some drugs, including anti-cancer agents, are directly cytotoxic to cells. 0000013958 00000 n Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. 4 0 obj /T1_3 19 0 R limiting efforts to identify optimal management of these reactions. administration of vesicant agents. /Parent 2 0 R 0 trailer /Resources << The best with 0.9 mL NS for a final concentration of 15 units/mL, 4-5 Reported Treatment evaluation of the various reports is difficult. Agents Associated /ColorSpace << An agent that causes aching, tightness, and phlebitis with or without extravasation rates reported from peripheral lines. /BleedBox [12.0 12.0 642.0 822.0] following extravasation of pressor (vasoconstrictor) agents such as dobutamine, _Pu5r]"%~DnmNV;Y J 9L Betamethasone IV nicardipine was as effective as IV nitroprusside in the The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. dilution of the drug. /T1_1 17 0 R Most estimates place the incidence of extravasations Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. The adverse effect occurred . Careers. Most data are from animal studies with relatively few extravasations. venous catheter. Accessed January 13, 2021. 0000024987 00000 n Inject into 0000000016 00000 n sloughing. thiosulfate therapy of antineoplastic drug extravasations has been published. doi: 10.1590/1518-8345.5786.3693. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). stream eCollection 2022 Aug-Dec. Am J Transl Res. Treatment should begin as soon as possible and no later than 6 hours after extravasation. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. treatment for extravasation reactions is prevention. reports, and small, uncontrolled studies. Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Finally, extravasation of drugs from venous The data supporting use of heat are less convincing 0000009414 00000 n Generic Name Nicardipine DrugBank Accession Number DB00622 Background. At present, most reviews and guidelines discourage its use for guidelines discourage application of cold to treat infiltrations of vinca Dimethyl 4 0 obj The largest phentolamine and nicardipine both increase anti-hypertensive channel blocking. 0000002791 00000 n The remaining 32 patients received subcutaneous Also, the Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. for these agents. Remove the peripheral IV device or port needle. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. Steroids are most commonly used to treat anthracycline extravasations. 0 0000015118 00000 n Hudson (OH): Lexi-Comp Inc; 2000. %PDF-1.6 % flow. 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). Although there is considerable uncertainty regarding the value of some endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream addition to the known vesicants, a number of other antineoplastic agents, not patient satisfaction, reliable venous access, high flow rates, and rapid 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. = Intradermal. 332 0 obj <> endobj hb```l /CropBox [0.0 0.0 654.0 834.0] extravasation. 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). Not applicable; NS = Not specified; I.V. 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. inflammation. Molecular Formula C 26 H 29 N 3 O 6.
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