Infusion-related reactions

In patients receiving infliximab, monitor for infusion-related reactions such as hypotension, dyspnea, fever, chills, or chest pain when administering intravenous doses. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Correct timing of antibiotic administration is imperative to preventing SSI. The National Surgical Infection Prevention Project recommends infusing antimicrobials for surgical prophylaxis within 60 minutes of the first incision. Exceptions to this rule are fluoroquinolones and vancomycin, which can be infused 120 minutes prior to avoid infusion-related reactions.1 No consensus has been reached on whether the infusion should be complete prior to the first incision. However, if a proximal tourniquet is used, antibiotic administration should be complete prior to inflation. 

Trastuzumab 4 mg/kg IV over 90 minutes on day 1 followed by 2 mg/kg over 90 minutes (30 minutes if no infusion-related reactions) once weekly or 8 mg/kg IV over 90 minutes on day 1 followed by 6 mg/kg IV over 90 minutes every 3 weeks Infusion reactions (fever, chills, rigors), nausea, vomiting, pain at tumor sites, headaches, dizziness, dyspnea, hypotension, heart failure... 

A limitation of rituximab treatment is the severe and potentially fatal infusion-related reactions. To date, eight deaths have... 

Campath) hypotension prolonged immunosuppression (resulting in infectious complications) during treatment. Premedicate with acetaminophen, diphenhydramine, with or without a steroid to alleviate infusion-related reactions. Subcutaneous dosing may lessen acute toxicity. Initially 3 mg/day as a 2-hour infusion, increase to 1 0 mg/day, then 30 mg/day as tolerated. 

Rituxan) hypotension with or without a steroid to alleviate infusion-related reactions. Rate of infusion should be increased gradually to minimize reactions. 

Advantages Simplified regimen for patient Increased patient compliance at home Decreased labor Decreased costs Decreased risk of contamination (due to less manipulation) Minimize infusion-related reactions from intravenous lipid emulsions Decreased vein irritation (especially with PPN) Improved stability compared to TNA Increased number of compatible medications Decreased bacterial growth compared to TNA Easier visual inspection Can use 0.22-micron bacterial retention filter Cost savings if unused (i.e. not spiked) intravenous lipid emulsion can be reused... 

Radioimmunotherapy is generally well tolerated. Toxicities include infusion-related reactions, myelosuppression, and possibly myelodysplastic syndrome or AML. 131I-tositumomab can cause thyroid dysfunction. 

The most common reasons for discontinuation of treatment were infusion-related reactions (ie, dyspnea, flushing, headache, rash). Adverse events have been reported in a higher proportion of RA patients receiving the 10 mg/kg dose than the 3 mg/kg dose however, no differences were observed in the frequency of adverse events between the 5 and 10 mg/kg doses in patients with Crohn disease. 

There is a slightly increased risk of infection (as with other biologic DMARDs), predominantly of the upper respiratory tract. Concomitant use with TNF-a antagonists is not recommended due to the increased incidence of serious infection with this combination. Infusion-related reactions and hypersensitivity reactions, including anaphylaxis, have been reported but are rare. Anti-abatacept antibody formation is infrequent (< 5%) and has no effect on clinical outcomes. The incidence of malignancies is similar to placebo with the exception of a possible increase in lymphomas. The role of abatacept in this increase is unknown. 

Treatment with available anti-TN F-a inhibitors can be associated with the development of antibodies to the administered biologies [10]. The incidence is reported to be higher in patients receiving infliximab (13 to 60%), the chimeric monoclonal antibody containing a murine variable region, compared with the incidences reported for the fusion protein etanercept (<5 %) or the fully human antibody, adalimumab (-12% as monotherapy). The observed incidence of antibody formation is reduced by concomitant immunosuppressive therapies, such as methotrexate. Lower efficacy and higher incidences of infusion-related reactions have been reported in antibody-positive patients receiving infliximab [80]. 

In the clinical studies the most common adverse events observed with lar-onidase treatment were upper respiratory tract infection, rash, and injection site reaction. The most common adverse reactions requiring intervention were infusion-related reactions (IRRs), particularly flushing. Those requiring intervention were offset by slowing the infusion rate, temporarily stopping the infusion, and/or administering additional antipyretics and/or antihistamines. 

Docetaxel should be administered the day after trastuzumab for the first cycle because of the potential for infusion-related reactions to trastuzumab, particularly during or after the first administration. Serious adverse reactions to trastuzumab infusion that have been reported infrequently include dyspnoea (shortness of breath), hypotension, wheezing, hypertension, bronchospasm, supraventricular tachyarrhythmia, reduced oxygen saturation, anaphylaxis, respiratory distress and urticaria (itching). The majority of these events occur during or within 2.5 hours of the start of the first infusion. Should an infusion reaction occur, the infusion should be discontinued and the patient monitored until resolution of any observed symptoms - the infusion may be resumed when symptoms abate. If the first cycle is well tolerated then dosing of the drugs in future cycles may occur on the same day. 

Infusion-related reactions (see answer to Question 5 a). The most common adverse reactions are infusion-related symptoms, such as fever and chills, usually following the first infusion. 

Amphotericin deoxycholate in glucose versus amphotericin in nutritional fat emulsion The safety of DAMB prepared in nutritional fat emulsion (a non-approved mode of amphotericin administration) has been reviewed (SEDA-21, 282) (SEDA-22, 285). It is not clear whether it has a better therapeutic index than other formulations, and methods of preparing it have not been standardized. The adverse effects of amphotericin prepared in nutritional fat emulsion have been compared with those of amphotericin prepared in 5% dextrose in two studies. While one of the studies showed a significantly lower frequency of infusion-related reactions and hypokalemia in patients receiving the fat emulsion (49), there were no differences in safety and tolerance between the two formulations in the other study (50). The safety of amphotericin prepared in nutritional fat emulsions has been reviewed (SEDA-21, 282) (SEDA-22, 285). Because of stability concerns and lack of systematic safety data, this form of amphotericin cannot be recommended. 

Data on the safety of amphotericin deoxycholate have been reported for 50 therapeutic courses in 44 children and adolescents with cancer and a median age of 6.8 years (range 9 months to 18 years) (50). Amphotericin deoxycholate was given in a dose of 1 mg/kg over 2 hours for a mean duration of 7.8 days. Most of the patients received the drug as empirical antifungal therapy in the setting of persistent fever and neutropenia. Nephrotoxicity, defined as a 100% increase in the serum creatinine from baseline, was observed in only one patient. Infusion-related reactions (fevers and/or rigors) occurred in 24% of treatment courses. Thus, amphotericin deoxycholate was relatively well tolerated in this population, although the mean duration of therapy was comparatively short. 

Amphotericin B 0.5-1.5 mg/kg/ day <1% No renal adjustment required Nephrotoxic may cause infusion-related reactions give 250 ml normal saline before each dose q. 24hr q. 24 hr q. 24-36 hr... 

Most common side effects include diarrhea, nausea, vomiting, headache, rash, and infusion-related reactions. Frequency and potential risk of seizures with imipenem appear to be greater in comparison with the other carbapenems and beta-lactam antibiotics. Seizures have occurred most commonly in patients with CNS disorders or bacterial meningitis and/or compromised renal function. May be prevented by dose adjusting for renal insufficency. Pseudomembranous colitis. 

Alemtuzumab has been associated with significant infusion-related reactions (almost 90% of patients will experience fever and rigors during the infusion) and premedication is recommended. In addition, patients treated with this agent may become profoundly immunocompromised and are at... 

---