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July 28, 1997

Efficacy of Nefopam for the Prevention and Treatment of Amphotericin B—Induced Shivering

Author Affiliations

From the Institute of Anesthesia and Intensive Care, University La Sapienza, Rome (Drs Rosa, Dell'Utri, Conti, Cogliati, Orsi, and Gasparetto), and the Institute of Anesthesia and Intensive Care, University of Trieste, Trieste (Dr Pelaia), Italy.

Arch Intern Med. 1997;157(14):1589-1592. doi:10.1001/archinte.1997.00440350097010

Background:  Shivering is experienced by up to 70% of patients undergoing amphotericin B therapy. Treatment with meperidine hydrochloride, currently the most widely used medication for controlling amphotericin B—induced shivering, was compared with nefopam hydrochloride, which has been successfully used to treat post-operative shivering.

Methods:  Forty-five patients with cancer and systemic fungal infections randomly received nefopam hydrochloride, 0.3 mg/kg, meperidine hydrochloride, 0.7 mg/kg, or saline solution intravenously 15 minutes before the cessation of amphotericin B infusion (1 mg/kg for 45 minutes). If shivering persisted, patients in the control (saline solution) group received either nefopam hydrochloride, 0.3 mg/kg, or meperidine hydrochloride, 0.7 mg/kg.

Results:  Occurrence of shivering 15 minutes after the cessation of amphotericin B infusion was significantly less frequent in the nefopam (6.6%) and meperidine (40%) groups compared with the control group (66.6%). The incidence of shivering in the nefopam group with respect to the meperidine group was also significantly reduced. Moreover, nefopam administration to 5 persistently shivering patients in the control group definitively stopped the shivering in all of them (100%) in a mean (±SD) time of 29.1±4.8 seconds, while meperidine terminated shivering in 4 (80%) of 5 patients in a mean (±SD) time of 200.0±30.2 seconds. The adverse reactions that can be ascribed to nefopam or meperidine use were nausea and sedation, respectively, and may be considered negligible.

Conclusion:  Nefopam seems to be more effective than meperidine in preventing and quickly suppressing amphotericin B—induced shivering.Arch Intern Med. 1997;157:1589-1592