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Humongous Insurance

MANFAAT KLINIS DILTIAZEM INTRAVENA DALAM


PENANGANAN HIPERTENSI EMERGENCY
PT TANABE INDONESIA
HYPERTENSIVE CRISIS
Suatu keadaan hipertensi berat, umumnya ditandai dengan SBP > 220
mm Hg dan/atau DBP > 120 mm Hg. (JNC-VII, 2003)

1. HYPERTENSIVE EMERGENCIES
Hipertensi berat disertai dengan disfungsi organ target
yang akut, seperti iskemik di koroner, stroke, perdarahan
intraserebral, udema di pulmoner, atau gagal ginjal akut.

2. HYPERTENSIVE URGENCIES
Hipertensi berat tanpa disertai adanya kerusakan organ target.
Colhum DA. Oparil S, New Engl. J. Med, 323 : 1177, 1990
- Accelerated malignant hypertension
- Hypertensive encephalopathy
- Intracerebral / Subarachnoid hemorrhage
- Acute aortic dissection
- Acute left ventricular failure
- Acute myocardial infarction
- Acute glomerulonephritis
- Eclampsia
- Severe epistaxis
- Perioperative hypertension, etc
DBP >120 mmHg
URGENCY
TD dalam waktu < 24 hours
EMERGENCY
TD dalam waktu < 1 hours
( PARENTERAL / ORAL ) ( PARENTERAL )
1. KAPLAN NM., Lancet 344:1335,1994
2. KAPLAN NM., 8
th
edition., 2002 p : 339-40
Hypertensive Crisis
Pasien harus dirawat inap di Rumah Sakit
Tekanan darah harus diturunkan:
- Secara cepat
- Gradual
- Obat yang diberikan harus I.V.

Mampu mengendalikan dan mengontrol
penurunan tekanan darah
Minimal resiko akan timbulnya hipotensi
Cepat dan dapat diprediksi dalam menurunkan
tekanan darah
Efek samping yang minimal
DILTIAZEM I.V. ( HERBESSER Injection )
Bermanfaat untuk pasien hypertensive emergency dan
urgency.
Termasuk ke dalam golongan Non-dihydropyridine
calcium channel blockers.
Dose-dependent :
Onset kerja dapat diprediksi
Menurunkan TD dengan cepat.
Tidak ada efek rebound pada saat penghentian
Adverse effect : hypotension, headache, flushing.
Memiliki kelebihan sebagai antiischemic dan antiarrhythmic

OBAT YANG UMUM DIGUNAKAN PADA
HYPERTENSIVE EMERGENCY
Calcium Channel Blockers
Nicardipine
(dihydropyridine)
Diltiazem
(benzothiazepine)
Peripheral
Vasodilation
1
+++++ +++
Coronary
Vasodilation
2
+++++ +++
Suppression
of SA Node
2
+ +++++
Suppression
of AV Node
2
0 ++++
Suppression
of Cardiac Contractility
2
0 ++
1. Frishman WH, et al. Med Clin North Am. 1988;72:523-547.
2. Adapted from Goodman and Gilmans: The Pharmacologic Basis of Therapeutics. 9th ed. 2001.
NICARDIPINE and DILTIAZEM

NICARDIPINE DILTIAZEM

Target organ Arteriole (ca
Channel)
Arteriole (ca
Channel)
Clinical effect Vasodilatation :
BP decreased
Vasodilatation :
BP decreased
Heart Rate
Diltiazem and Nicardipine on HR of
Hypertensive emergency patients
Nicardivine I.V.
Diltiazem
I.V
< 60 60 - 80 > 80
Heart Rate (beat/minute)
JNC VII
Recommendation:
The Initial Goal of Therapy in Hypertensive
Emergency Is to Reduce MABP by No More
Than 25% (within minute to 1 hour), then if
stable, to 160/100-110 within the next 2-6
hours.
MABP
MABP
50
70
90
110
130
150
170
29 Severe Hypertensive Patients
After 1 hr time evaluation
Average infussion Rate: 11 g/kg/mnt.
Result:

MABP
MABP
50
60
70
80
90
100
110
120
130
140
150
22
%

After treatment:
SBP: 154.0
DBP: 83.3
MABP: 113.4

Pretreatment:
SBP: 205.6-
DBP:115.8
MABP: 145.7

Onoyama K., et al., Current Therapeutic Research, Vol. 43, No. 3. March 1988.
27
%
11 Hypertensive Crisis Patients
Average time evaluation 3.5 hr
Infussion Dossage: 5-40 g/kg/mnt.
Result:


After treatment:
Avg: SBP: 170-
DBP: 95
MABP: 120

Pretreatment:
Avg: SBP: 224-
DBP:136
MABP: 165.7

Onoyama K., et al., Current Therapeutic Research, Vol. 42, No. 6. December 1987.
Herbesser Inj. Drip I.V. Fulfill the
JNC VII Recommendation:
Di Indonesia Herbesser Injeksi
direkomendasikan dalam:
Konsensus Penanggulangan Krisis
Hipertensi (InaSH 2008).

Penatalaksanaan Hipertensi pada Stroke
Akut. (Guideline Stroke PERDOSSI 2007, BAB VI hal 47)

Guideline Management of
Hypertension Emergency

Japan Society of Hypertension (JSH) 2009
Di Jepang Herbesser Injeksi
direkomendasikan dalam

Respon Pasien Diltiazem I.V.


1. Tachyarrhythmia / PSVT / AF 85% success

2. Unstable angina, 80% success
diawali 5-15 mcg/kg/min drip

3. Hypertensive emergency 94-100% success
diawali dosis 10 mg iv dilanjutkan dengan drip
infus 5-15 mcg/kg/min untuk mencapai target TD

Drug insert
DESCRIPTION
HERBESSER

Injection 50 mg merupakan sediaan injeksi yang


dilarutkan dengan larutan fisiologis atau glukosa sebelum
digunakan.

INDICATION
1. Tachyarrhythmia ( Supraventricular )
2. Perioperative Hypertension
3. Hypertensive emergency
4. Unstable Angina
HERBESSER

Injection


The Intravenous Ca-blocker
To Lower Blood Pressure
Faster
HERBESSER-Injection
(Diltiazem HCl)
HERBESSER

Injection


CONTRAINDICATION
1. Patients with severe hypotension
Patients with 2
nd
or 3
rd
degree of AV-block or sick sinus
syndrome ( sinus bradycardia less than 50 beats / minute )
2. Patients with severe congestive heart failure
3. Patients with severe cardiomyopathy
4. Patients with history of Hypersensitivity to diltiazem
5. Pregnant women or woman who may possibly be pregnant.

ADVERSE REACTION
Bradycardia 1.1 % 1
st
degree AV block 0.4 %
Hypotension 0.7 % 2
nd
degree AV block 0.3 %

PRESENTATION
HERBESSER

Injection 50 mg Boxes of 50 mg x 10 ampoules
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