Palmer Lutheran Health Center

Pharmacy Department "De f

DILTIAZEIVI PROTOCOL BOLUS AND INFUSION (-7 e.s- I v ii

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Indication: Treatment of paroxysmal supraventricular tachycardia, atrial fibrillation, or atrial flutter.

Supplied as: 5mg/mL in 5mL or 10mL vials.

Vials are stored in the REFRIGERATOR.

Patient placed on monitored bed status

Dosage and administration:

A. Initial IV Bolus
Inject 0.25mg/kg given over 2 minutes with continuous EKG and blood pressure monitoring.
If after 15 minutes, HR >100 bpm, give an additional 0.35mg/kg given over 2 minutes.

LBS 90 100 110 120 130 140 150 160 170 180 190 200

KG 41 45 50 55 59 64 68 73 77 82 86 90

0.25mG/Ko 10 11 12.5 13.5 14.5 16 17 18 19.5 20.5 21.5 22

BOLUS DOSE mg mg mg mg mg mg mg mg mg mg mg hic

0.35mG/Ko 14.5 16 17.5 19 20.5 22 24 25.5 27 28.5 30 31.5

BOLUS DOSE mg mg mg mg mg mg mg mg mg mg mg FAG

3. Maintenance IV Infusion
Begin IV infusion if HR >100 bpm and BP >90/60 mmHg 15 minutes after 0.35rng/kg IV bolus dose.

Adequate Response Adequate Response Inadequate Response

(HR 60-80 bpm) (HR 81-100 bpm) (HR >100 bpm)

15 minutes after start of Discontinue infusion Continue infusion at 5mg/hr Increase infusion to 10mg/hr
Infusion at 5mg/hr

After 15 minutes of infusion Decrease infusion to 5mg/hr Continue infusion at 10mg/hr Increase infusion to 15mg/hr
at 10mg/hr

After 15 minutes of infusion Decrease infusion to 10mg/hr Continue infusion at 15mg/hr Call physician for additional
at 15mg/hr order

If HR is < 60 bpm or BP < 90/60 mmHg, stop infusion and contact physician.
Continuous IV therapy via infusion pump should be used no longer than 24 hours.

C. Monitoring
With patient on monitored bed status, monitor patient's BP and HR with initiation of drip and each infusion rate change as follows:
1.Every 5 minutes x3
2.Every 15 minutes x3
3. Every 30 minutes x2
4. Every 1 hour until drip is discontinued
 D. Dilution
Mix as directed for continuous infusion at 10mg/hr. Mixture is compatible with D5W, dobutamine, dopamine, lidocaine, and
nitroglycerin. Mixture is incompatible when mixed directly with furosemide.

DILUENT VOLUME QUANTITY OF FINAL ADMINISTRATION

DILTIAZEM INJ CONCENTRATION . DOSE INFUSION RATE

100 ml NS 125mg (25m1) 1 mg/ ml iomg/hr loml/h

E.Guidelines for IV to Oral Conversion

The oral dose in mg/day is approximately equal to [(rate (mg/hr) x 3) + 3) x 10
3 mg/hour = 120 mg/day oral
5 mg/hour = 180 mg/day oral
7 mg/hour = 240 mg/day oral
11mg/hour = 360 mg/day oral
15 mg/hour = 480 mg/day oral

• Once heart rate is controlled, the infusion may be discontinued. Oral diltiazem should be started immediately after IV
discontinuation.
• Initiate with immediate release product at discontinuation of the infusion then start a long-acting product at the next
scheduled dose time.

References

1. Lexi-comp Online. Diltiazem, Updated 4/13/12.

2. GObel E, Hautvast R, Lie K, et al. Randomised, double-blind trial of intravenous diltiazem versus glyceryl trinitrate
for unstable angina pectoris. Lancet. December 23, 1995;346(8991-8992):1653-1657

PLHC: 7/14/98 PT Committee, Revised 4/2010, Revised 4/2012