Febrile reactions

The adverse reactions associated with the menotropins include ovarian enlargement, hemoperitoneum (blood in the peritoneal cavity), abdominal discomfort, and febrile reactions. Urofollitropin administration may result in mild to moderate ovarian enlargement, abdominal discomfort, nausea, vomiting, breast tenderness, and irritation at the injection site Multiple births and birth defects have been reported with the use of both menotropins and urofollitropin. 

Ovarian enlargement, hemoperitoneum, febrile reactions, multiple pregnancies, hypersensitivity Failure to respond to therapy due to development of antibodies, hypothyroidism, insulin resistance, swelling of the joints, joint and/or muscle pain Same as somatropin... 

Bleomycin—give test dose of 1 -2 units because of possible acute pulmonary, anaphylactoid, or severe febrile reactions must dose adjust for renal insufficiency total lifetime dose should not exceed 400 units avoid high Fi02 as it can exacerbate pulmonary toxicity... 

The United States Pharmacopeia describes a pyrogen test using rabbits as a model (USP, 1995b). This test, which is the standard for limiting risks of a febrile reaction to an acceptable level, involves measuring the rise in body temperature in a group of three rabbits for 3 h after injection of 10 ml of test solution. 

Hypersensitivity or idiosyncrasy to quinidine or other cinchona derivatives manifested by thrombocytopenia, skin eruption or febrile reactions myasthenia gravis history of thrombocytopenic purpura associated with quinidine administration digitalis intoxication manifested by arrhythmias or AV conduction disorders complete heart block left bundle branch block or other severe intraventricular conduction defects exhibiting marked QRS widening or bizarre complexes complete AV block with an AV nodal or idioventricular pacemaker aberrant ectopic impulses and abnormal rhythms due to escape mechanisms history of drug-induced torsade de pointes history of long QT syndrome. 

Massive diffuse hemorrhage due to cyclophosphamide-induced or radiation cystitis has been treated successfully with intravesicular PGE1 PGEj, and carboprost. Febrile reactions and severe bladder spasm are dose-dependent (63-65). 

Aspirin, paracetamol, and hydrocortisone are used to control febrile reactions of amphotericin. Patients with a history of adverse effects with amphotericin should be prophylactically treated with antipyretics and hydrocortisone. Antiemetics and pethidine also are used for the treatment of adverse effects of amphotericin. With sodium supplements and hydration therapy, damage to the kidney can be reduced. If conventional amphotericin is not well tolerated by the patient, colloidal carriers can be used as alternative options. Administration of amphotericin with a nephrotoxic drug, such as cyclosporin, may further increase toxicity. Diuretics and anticancer drugs should be avoided with amphotericin. 

SAFETY PROFILE Inhalation of the fumes can produce a febrile reaction and leucocytosis in humans. Questionable carcinogen with experimental tumorigenic data. Violent reaction or ignition in contact with interhalogens (e.g., bromine pentafluoride, chlorine trifluoride). Incandescent reaction with phosphorus pentachloride. See also MAGNESIUM COMPOUNDS. 

In a series of about 500 patients treated with large doses of atropine, with about 10,000 individual inductions of coma, there was one death (21). This fatality was attributed to the replacement, without notification of the physician, of the specially trained nursing and technical personnel on the treatment ward with persons who were not thoroughly familiar with the procedures for caring for comatose patients, and particularly the procedures for controlling febrile reactions. The patient died of uncontrolled hyperthermia. 

Seibert, F.B. The cause of many febrile reactions following intravenous injections. Am. J. Physiol. 1925, 71, 621-651. 

Albumin has been used to prevent the ovarian hyperstimulation syndrome (OHSS) associated with ovulation stimulation. In 98 women albumin had no positive effect on OHSS (3). Because of adverse effects, such as exacerbation of ascites in OHSS, nausea, vomiting, febrile reactions, allergic reactions, anaphylaxis, and the risk of... 

Febrile reactions after intrathecal baclofen stopped a patient from receiving this treatment for spinal spasticity (14). 

Wu SS, Dolan KA, Michael Ferrante F. Febrile reaction to subarachnoid baclofen administration. Anesthesiology 2002 96(5) 1270-2. 

Complications after granulocyte transfusions occur in about 15-20% of the recipients (38), most frequently in patients given granulocytes prepared by filtration leukapheresis. The complications are predominantly severe febrile reactions, the transmission of cytomegalovirus infection, and graft-versus-host disease. Of particular importance are respiratory reactions with pulmonary edema, which mostly occur in allo-immunized recipients. Leukocjrte aggregation may be the cause, with sequestration microemboli and fluid overflow, but other causes have also been suspected. Reactions appear to be more common in patients with sepsis. 

The major risks associated with platelet transfusion are aUo-immunization and infection. Platelets rarely cause graft-versus-host disease (108,109). Allo-antibodies, especially anti-HLA antibodies, appear to be the major source of complications in patients given repeated platelet transfusions. These antibodies cause febrile reactions, but they can also be responsible for partial or complete... 

Verapamil, nifedipine, and diltiazem have all been associated with allergic reactions, including skin eruptions and effects on liver and kidney function. Nifedipine has also been reported to cause a febrile reaction (116), and diltiazem was associated with fever, lymphadenopathy, hepatosplenomegaly, an erythematous maculopapular rash, and eosinophilia in a 50-year-old man (117). 

Carraway RD. Febrile reaction following nifedipine therapy. Am Heart J 1984 108(3 Pt 1) 611. 

Febrile reactions occurred in two patients after the initial bolus administration of porcine factor VIII C in a retrospective study of 29 treatments with porcine factor VIII C in 18 patients with hemophilia A with inhibitors (13). 

The current status of adjuvanted influenza vaccines has been reviewed (26). The authors concluded that the vaccine produces a higher titer of antibodies than non-adjuvanted or virosomal vaccines. Local reactions occur more often, but are mild and transient. The results of a trial with two doses of an intranasally administered inactivated virosome-formulated influenza vaccine containing Escherichia coli heat-labile toxin as a mucosal adjuvant in 106 volunteers aged 33-63 years have been reported (27). About 50% of vaccinees had local adverse reactions (44% after the first dose and 54% after the second dose) or systemic adverse reactions (48 and 46%) after administration of the vaccine. Rhinorrhea, sneezing, and headache were the most common reactions they were mild and transient and resolved within 24-48 hours. No febrile reactions were associated with immunization. Between 77 and 92% of vaccinees developed protective hemagglutination inhibition antibody titers against the two influenzae A strains of the vaccine, whereas protective antibody titers against the B strain of the vaccine were achieved in only 49-58%. 

During the first days of treatment, virtually all patients have a flu-hke sjmdrome with fever, chills, tachycardia, malaise, headache, arthralgias and myalgias, but tachyphylaxis usually develops after 1-2 weeks of treatment (20). Late febrile reactions are rarely noted (21). Although the severity increases with the dose, the flu-hke syndrome is rarely treatment-limiting and it can be partly prevented by the prophylactic administration of paracetamol (acetaminophen). The acute release of fever-promoting factors, for example the eicosanoids, IL-1, and TNF alfa, secondary to interferon alfa is the suggested mechanism. 

Scott GM, Ward RJ, Wright DJ, Robinson JA, Onwubalili JK, Gauci CL. Effects of cloned interferon alpha 2 in normal volunteers febrile reactions and changes in circulating corticosteroids and trace metals. Antimicrob Agents Chemother 1983 23(4) 589-92. 

Antibodies to the Ro(SSA) cellular antigen (244,397) and circulating cryoglobulins (244) are risk factors for adverse reactions to penicillamine. AntiRo (SSA) antibodies characterize a distinct group of patients with rheumatoid arthritis who are almost exclusively female, express more activated B cell function, have a high prevalence of Sjogren s features, and commonly develop adverse reactions to penicillamine. Rashes and febrile reactions were especially associated with anti-Ro(SSA) antibodies, and renal pathology was more frequent in men (244). 

Febrile reactions are common in patients taking thahdo-mide. In one study of 56 patients with HIV infection who took thalidomide for 14-21 days, 24 discontinued therapy owing to adverse reactions. Cutaneous and/or febrile reactions, which occurred in 20 patients, were the most frequent adverse effects (96). 

---