Triad of acute infusion-related reactions associated with liposomal amphotericin B: analysis of clinical and epidemiological characteristics.
We investigated the clinical characteristics and treatment of patients with a distinctive triad of acute infusion-related reactions (AIRRs) to liposomal amphotericin B (L-AMB) via single-center and multicenter analyses. AIRRs occurred alone or in combination within 1 of 3 symptom complexes: (1) chest pain, dyspnea, and hypoxia; (2) severe abdomen, flank, or leg pain; and (3) flushing and urticaria. The frequency of AIRRs in the single-center analysis increased over time. Most AIRRs (86%) occurred within the first 5 min of infusion. All patients experienced rapid resolution of symptoms after intravenous diphenhydramine was administered. The multicenter analysis demonstrated a mean overall frequency of 20% (range, 0%-100%) of AIRRs among 64 centers. A triad of severe AIRRs to L-AMB may occur in some centers; most of these reactions may be effectively managed by diphenhydramine administration and interruption of L-AMB infusion.
Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health Clinical Center, Bethesda, Maryland 20892, USA.
Maureen M
MM
Roden
Lucienne D
LD
Nelson
Tena A
TA
Knudsen
Paul F
PF
Jarosinski
Judith M
JM
Starling
Stacey E
SE
Shiflett
Karim
K
Calis
Robert
R
DeChristoforo
Gerald R
GR
Donowitz
Donald
D
Buell
Thomas J
TJ
Walsh
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002637:Chest Pain / Q000209:etiology; D004338:Drug Combinations; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005483:Flushing / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008081:Liposomes; D008297:Male; D010713:Phosphatidylcholines / Q000009:adverse effects; D010715:Phosphatidylglycerols / Q000009:adverse effects; D012307:Risk Factors
D000935:Antifungal Agents; D004338:Drug Combinations; D008081:Liposomes; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B