Intravenous injection transient reactions

Transient reactions to intravenous injections are fairly common, resulting in hypotension, renal pain, fever or rigors, especially if the injection is very rapid. 

Hypotension follows the intravenous injection of benzodiazepines, but is usually mild and transient (SED-11, 92) (56), except in neonates who are particularly sensitive to this effect (57). Local reactions to injected diazepam are quite common and can progress to compartment syndrome (SEDA-17, 44). In one study (58), two-thirds of the patients had some problem, and most eventually progressed to thrombophlebitis. Flunitrazepam is similar to diazepam in this regard... 

With the exception of the possible development of a hypervitaminosis associated with high-dose administration of vitamin D2 or D3, the compounds discussed in this chapter are relatively safe. Allergic reactions to the injection of calcitonin and PTH have occurred and chronic use of some bisphosphonates has been associated with the development of osteomalacia. The principal side effects of intravenous bisphosphonates are mild and include low-grade fever and transient increases in serum creatinine and phosphate levels. Oral bisphosphonates are poorly absorbed and can cause esophageal and gastric ulceration. They should be taken on an empty stomach the individual must remain upright for 30 minutes after ingestion. 

Both epoetin alfa and beta and darbepoetin alfa are quite well tolerated (47). Common adverse effects are infection, hypertension, hypotension, shunt thrombosis, myalgia, nausea, headache, and chest pain (34,48). After the first few doses of epoetin, flu-like sjmptoms occur transiently, with an incidence of 5.4-18% (34,49). These can be avoided by injecting epoetin subcutaneously rather than intravenously (31,33,50,51). It has also been suggested that such symptoms can be avoided by dose escalation, starting with an ultra-low dose (49). Subcutaneous injection can cause local reactions, probably due to allergy (52). 

Large doses of intravenous iron dextran and iron saccha-rate have been compared in a retrospective study of 379 patients who had attended peritoneal dialysis clinics in the past 5 years (12). Of these, 62 were selected to receive intravenous iron based on ferrokinetic markers of iron deficiency, non-adherence to oral iron, ineffectiveness of oral iron, or increased erythropoietin requirements. Intravenous iron was given as two injections of 500 mg each 1 week apart in 61 patients, 33 of whom received iron dextran, 23 iron saccharate, and five both iron dextran and iron saccha-rate. One patient developed anaphylaxis to a test dose of iron dextran and was excluded from further therapy. Blood samples were collected before and 3 and 6 months after iron infusions. Five of the 34 patients who received iron dextran developed minor adverse effects and one had an anaphylactic reaction to the test dose. Of the 23 patients who received iron saccharate, one had an anaphylactic reaction and two had transient chest pain, which subsided without therapy. There were more adverse effects with iron dextran (7.4% of injections) compared with iron saccharate (4.3% of injections), but this difference was not statistically significant. The number of episodes of peritonitis also increased during the 6 months after intravenous iron infusion, especially with iron dextran, compared with the number of episodes during the 6 months before iron infusions, although the difference was not statistically significant. 

The diagnostic efficacy and the safety of Sono Vue has been assessed in 218 patients with suspected coronary artery disease who underwent echocardiography (17). Each received intravenous Sono Vue 0.5, 1.0, 2.0, and 4.0 ml in random order at intervals of at least 5 minutes between injections. There were no clinically significant changes in physical examination, vital signs, or electrocardiography. There were no serious adverse effects, even in patients who had heart failure and a history of myocardial infarction. The non-serious adverse reactions were mild and transient and required no treatment. The most common adverse effects were headache (4%) and nausea (1.4%). 

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