Intramuscular injection adverse effects

The well-known adverse reaction formerly often observed after intramuscular injection of clemizol penicilUn in the treatment of syphilis with anaphylaxis-like symptoms plus CNS involvement in the absence of immimological sensitization to penicillin was called the Hoigne syndrome or embolic-toxic reaction, and might be explained by intravasal appUcation of LA with subsequent toxic effects [8]. 

The most common adverse effects in adults include injection site reactions (e.g., tenderness, pain, and warmth), headaches within 5 days after vaccination, and fatigue. Local reactions may be minimized by using an appropriate needle length based on the person s age and size and by administering the injection intramuscularly in the deltoid muscle. Children may also have feeding disturbances. Hepatitis A vaccine given... 

Alefacept (Amevive) is a dimeric fusion protein that binds to CD2 on T cells to inhibit cutaneous T-cell activation and proliferation. It also produces a dose-dependent decrease in circulating total lymphocytes. Alefacept is approved for treatment of moderate to severe plaque psoriasis and is also effective for treatment of psoriatic arthritis. Significant response is usually achieved after about 3 months of therapy. The recommended dose is 15 mg intramuscularly once weekly for 12 weeks. Adverse effects are mild and include pharyngitis, flu-like symptoms, chills, dizziness, nausea, headache, injection site pain and inflammation, and nonspecific infection. 

Potentially severe adverse effects can result from systemic administration of cholinomimetic drugs, and none should be administered by intramuscular or intravenous injection. If significant amounts of these drugs enter the circulation, nausea, abdominal cramps, diarrhea, salivation, hypotension with reflex tachycardia, cutaneous vasodilation, sweating, and bronchoconstric-tion can result. Pilocarpine can cross the blood-brain barrier and affect cognitive function. Even the topical application of cholinomimetics to the eyes can present... 

Botulinum toxin is used clinically in the treatment of blepharospasm, writer s cramp, spasticities of various origins, and rigidity due to extrapyramidal disorders. It is also used to treat gustatory sweating and cosmetically to decrease facial wrinkles. Botulinum toxin A Botox, Oculinum) injected intramuscularly produces functional denervation that lasts about 3 months. Clinical benefit is seen within 1 to 3 days. Adverse effects range from diplopia and irritation with blepharospasm to muscle weakness with dystonias. 

The minor adverse effects include nausea, vomiting, pain and inflammation at the site of injection after intramuscular administration has been reported. After intrathecal administration (which is a contraindication) it may lead to convulsions, arachnoiditis and encephalopathy. 

Pentamidine is a highly toxic drug, with adverse effects noted in about 50% of patients receiving 4 mg/kg/d. Rapid intravenous administration can lead to severe hypotension, tachycardia, dizziness, and dyspnea, so the drug should be administered slowly (over 2 hours), and patients should be recumbent and monitored closely during treatment. With intramuscular administration, pain at the injection site is common, and sterile abscesses may develop. 

When used in therapeutic doses, dimercaprol is associated with a high incidence of adverse effects, including hypertension, tachycardia, nausea, vomiting, lacrimation, salivation, fever (particularly in children), and pain at the injection site. Its use has also been associated with thrombocytopenia and increased prothrombin time—factors that may limit intramuscular injection because of the risk of hematoma formation at the injection site. Despite its protective effects in acutely intoxicated animals, dimercaprol may redistribute arsenic and mercury to the central nervous system, and it is not advocated for treatment of chronic poisoning. Water-soluble analogs of dimercaprol—unithiol and succimer—have higher therapeutic indices and have replaced dimercaprol in many settings. 

Substituted benzamides include metodopramide (discussed previously) and trimethobenzamide. Their primary mechanism of antiemetic action is believed to be dopamine-receptor blockade. Trimethobenzamide also has weak antihistaminic activity. For prevention and treatment of nausea and vomiting, metodopramide may be given in the relatively high dosage of 10-20 mg orally or intravenously every 6 hours. The usual dose of trimethobenzamide is 250 mg orally, 200 mg rectally, or 200 mg by intramuscular injection. The principal adverse effects of these central dopamine antagonists are extrapyramidal restlessness, dystonias, and parkinsonian symptoms. 

Three cases of severe lipoatrophy, one also with leukoderma, occurring within the same family after intramuscular injection of triamcinolone, suggested genetic susceptibility to this adverse effect (SEDA-3, 303). 

In a randomized, placebo-controlled study in women who received leuprolide acetate depot 11.25 mg intramuscularly with tibolone 2.5 mg/day (n = 36), leuprolide acetate depot 11.25 mg with placebo (n = 37), or a placebo injection with placebo tablets (n = 39), irritable bowel syndrome related to the menstrual cycle improved in those who received leuprolide (5). There were hot flushes in those who took leuprolide compared with placebo no data were given about the frequency of hot flushes, but there were no withdrawals because of this symptom. Amenorrhea also occurred. Both flushing and amenorrhea are expected adverse effects of leuprolide. 

Phentolamine [RegitineJ. Phentolamine is a competitive alpha antagonist used primarily to control blood pressure during management of pheochromocytoma. The drug is usually administered via intravenous or intramuscular injection. Phentolamine is not usually used to treat essential hypertension because with prolonged use, effectiveness tends to decrease and patients begin to develop adverse side effects. 

Clinical Use. Emetine and dehydroemetine (Mebadin) are used primarily to treat protozoal infections in the intestinal tract and extraintestinal sites such as the lungs and liver. These drugs are powerful amebicides and are generally reserved for severe, acute cases of intestinal amebiasis (dysentery).51 Because of the potential for adverse effects, these drugs are no longer marketed in the United States, and safer agents like metronidazole are often used in their place. Emetine and dehydroemetine are typically administered by deep subcutaneous injection or intramuscular injection. 

Intramuscular injection of carboprost tromethamine can also be used to induce abortion. Unlike the one-time intrauterine instillation of dinoprost, carboprost is given repeatedly up to the total dose of 2.6 mg normally required to cause abortion. Intra-amniotic administration has close to a 100% success rate, with fewer and less severe adverse effects than intravenous administration. 

Palivizumab is a humanized monoclonal antibody directed against the F glycoprotein on the surface of RSV. It was recently approved for the prevention of RSV infection in high-risk infants and children such as premature infants and those with bronchopulmonary dysplasia. A placebo-controlled trial utilizing once-monthly intramuscular injections (15 mg/kg) for 5 months beginning at the start of the RSV season demonstrated a 55% reduction in the risk of hospitalization for RSV in treated patients. The major observed adverse effect has been elevation in serum aminotransferase levels. 

In a double-blind, placebo-controlled, dose-response trial, 270 acutely agitated patients were randomized to receive 1-3 intramuscular injections of olanzapine (2.5, 5, 7.5, or 10 mg), haloperidol (7.5 mg), or placebo within 24 hours (60). Olanzapine had a dose-related effect in reducing agitation olanzapine was better than placebo but not better than haloperidol the most frequently reported adverse event was hypotension, which occurred with olanzapine (n = 7) but not haloperidol or placebo. Acute dystonias did not occur in patients given olanzapine or placebo but occurred in two patients given haloperidol. 

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