EFFICACY OF NEFOPAM FOR THE PREVENTION AND TREATMENT OF AMPHOTERICIN B-INDUCED SHIVERING

Background: Shivering is experienced by up to 70% of patients undergoi ng amphotericin B therapy. Treatment with meperidine hydrochloride, cu rrently the most widely used medication for controlling amphotericin B -induced shivering, was compared with nefopam hydrochloride, which has been successfully used to treat postoperative shivering. Methods: For ty-five patients with cancer and systemic fungal infections randomly r eceived nefopam hydrochloride, 0.3 mg/kg, meperidine hydrochloride, 0. 7 mg/kg, or saline solution intravenously 15 minutes before the cessat ion of amphotericin B infusion (1 mg/kg for 45 minutes). If shivering persisted, patients in the control (saline solution) group received ei ther nefopam hydrochloride, 0.3 mg/kg, or meperidine hydrochloride, 0. 7 mg/kg. Results: Occurrence of shivering 15 minutes after the cessati on of amphotericin B infusion was significantly less frequent in the n efopam (6.6%) and meperidine (40%) groups compared with the control gr oup (66.6%). The incidence of shivering in the nefopam group with resp ect to the meperidine group was also significantly reduced. Moreover, nefopam administration to 5 persistently shivering patients in the con trol group definitively stopped the shivering in all of them (100%) in a mean (+/-SD) time of 29.1 +/- 4.8 seconds, while meperidine termina ted shivering in 4 (80%) of 5 patients in a mean (+/-SD) time of 200.0 +/- 30.2 seconds. The adverse reactions that ran be ascribed to nefop am or meperidine use were nausea and sedation, respectively, and may b e considered negligible. Conclusion: Nefopam seems to be more effectiv e than meperidine in preventing and quickly suppressing amphotericin B -induced shivering.