Infusion-related reactions concentrate

A further multicenter, randomized study comparing amphotericin B lipid complex with conventional amphotericin B (AmB) as empiric therapy for febrile neutropenic patients, found a similar incidence of nephrotoxicity (defined as a doubling of the baseline serum creatinine concentration) and infusion-related reactions (fever and chills) in both treatment arms [147]. 

Select azole antifungals (e.g., itraconazole, voriconazole, and posaconazole) and the echinocandins are available for IA treatment. For initial therapy of IA, voriconazole had higher response and survival rates than c-AMB.102 An advantage of voriconazole is its 96% oral bioavailability, making use of this oral drug an attractive and less expensive alternative. The dose of voriconazole was 6 mg/kg IV every 12 hours for two doses, followed by 4 mg/kg IV every 12 hours for at least 7 days, at which time oral voriconazole 200 mg every 12 hours could be administered. Common toxicities reported with voriconazole include infusion-related, transient visual disturbances (i.e., blurred vision, altered color perception, photophobia, and visual hallucinations), skin reactions (i.e., rash, pruritus, and photosensitivity), elevations in hepatic transaminases and alkaline phosphatase, nausea, and headache.102 In addition, voriconazole increases the serum concentrations of medications cleared by cytochrome P-450 2C9, 2C19, and 3A4 (e.g., cyclophosphamide and calcineurin inhibitors) concomitant voriconazole-sirolimus should be avoided.103... 

Risks associated with infusion of blood products include transfusion-related reactions, virus transmission (rare), hypocalcemia resulting from added citrate, elevations in serum potassium and phosphorus concentrations from use of stored blood that has hemolyzed, increased blood viscosity from supranormal hematocrit elevations, and hypothermia from failure to appropriately warm solutions before administration. 

THERAPEUTIC USES Vancomycin (vancocin, others) is marketed for intravenous use as a sterile powder. It should be diluted and infused over at least 60 minutes to avoid infusion-related adverse reactions. The usual dose of vancomycin for adults is 30 mg/kg/day in 2-3 divided doses. A trough serum concentration of 5-15 (Xg/mL (10-20 (Xg/mL for serious infections such as endocarditis or meningitis) is recommended. Doses above 30 mg/kg/day may be required to achieve these trough concentrations, and up to 60 mg/kg/day has been suggested for meningitis. The peak concentration is not monitored routinely but should generally remain below 60 (Xg/mL to avoid ototoxicity. 

It is important to monitor peak and trough plasma levels (see p. 20) of gentamicin, tobramycin, netilmicin, and amikacin to avoid concentrations that cause dose-related toxicities (Figure 31.7). [Note Peak levels are defined as those obtained 1/2 to 1 hour after infusion. Trough levels are obtained immediately before the next dose.] Patient factors, such as old age, previous exposure to aminoglycosides, gender, and liver disease, tend to predispose patients to adverse reactions. The elderly are particularly susceptible to nephrotoxicity and ototoxicity. 

The side effects observed in the clinic with the early 100% and 90% w/v concentrated PFOB formula-tions and with Oxyfluor consisted of early effects, during or shortly after infusion, including headache and occasional lower backache, and delayed effects (2-12 h), referred to as flu-like symptoms e.g., fever, occasional chills and nausea.These reactions, generally categorized as mild, were transient and fully reversible within 4-12 h. A transient, moderate drop (about 15%) in platelet count was seen about 3 days after dosing. Similar effects have been documented for parenteral fat emulsions and liposomes, indicating that these effects were likely related to the particulate nature of the emulsion. 

The clinical significance of antibodies to infliximab has also been explored in 125 patients with Crohn s disease who were given infliximab, of whom 61% had antibodies after the fifth infusion however, there was no further increase in incidence after subsequent treatment (21). The presence of antibodies was associated with a 2.4-fold increase in the risk of infusion reactions, lower serum infliximab concentrations, and a shorter duration of clinical response, compared with patients with no infliximab antibodies. Patients who received concomitant immunosuppressive therapy had a lower incidence of infliximab antibodies, higher infliximab serum concentrations, and a longer duration of clinical response. Pretreatment with glucocorticoids may reduce the risk of antibody formation, but it is not known whether a pretreatment test for human antichimeric antibodies has a predictive value for adverse reactions (22). However, there were technical issues relating to the antibody assay and definition of clinically relevant antibody titers in this study. 

Adverse reactions to alphai-antitrypsin concentrate as replacement therapy are rare. In an international randomized clinical trial, 29% of the patients had adverse reactions (0.004 drug-related adverse events per infusion) of which more than 90% were classified as mild or moderate there was one case of psoriasis [25 "]. 

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