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Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

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Table 6. Common or Serious Adverse Reactions Associated With Drugs Used for Preventing or Treating Opportunistic Infections

(Last updated:May 07, 2013; last reviewed:May 07, 2013)

 

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Table 6. Common or Serious Adverse Reactions Associated With Drugs Used for Preventing or Treating Opportunistic Infections
Drugs Common or Serious Adverse Reactions
Acyclovir
Generally well-tolerated. Crystalluria (with high dose or pre-existing renal impairment), neurotoxicity (high doses, especially in patients with renal impairment; agitation, confusion, hallucination, seizure, coma), nephrotoxicity secondary to obstructive urolithiasis (particularly after rapid IV infusion), thrombophlebitis at peripheral IV infusion site, nausea, vomiting, headache 
Adefovir
Generally well-tolerated. Nephrotoxicity with underlying renal insufficiency, nausea, asthenia
Albendazole
Nausea, vomiting, hepatotoxicity, hypersensitivity reaction, dizziness, headache, reversible alopecia 

Rarely: granulocytopenia, agranulocytosis, or pancytopenia
Amikacin
Nephrotoxicity, ototoxicity (both hearing loss and vestibular toxicity are possible), neuromuscular blockade (associated with rapid infusion of large aminoglycoside doses), pain upon IM injection 
Amoxicillin/Clavulate and Ampicillin/Sulbactam
Diarrhea, nausea, vomiting, abdominal pain, Clostridium difficile-associated diarrhea and colitis, hypersensitivity reactions (immediate or delayed reactions including anaphylaxis), bone marrow suppression, drug fever, neurotoxicity at high doses (especially in patients with renal dysfunction)
Amphotericin B Deoxycholate and Lipid Formulations
Nephrotoxicity, infusion-related reactions (fever, chills, rigors, back pain, hypotension), hypokalemia, hypomagnesemia, anemia, thrombophlebitis, nausea, vomiting 

Liposomal formulations have lower incidence of nephrotoxicity and infusion-related reactions.
Anidulafungin
Generally well-tolerated. Hepatotoxicity, histamine-related infusion reactions (flushing, rash, pruritus, hypotension, dyspnea; rare if infusion rate <1.1 mg/min), hypokalemia, diarrhea 
Artemether/Lumefantrine
Generally well-tolerated. Rash, pruritus, nausea, vomiting, abdominal pain, anorexia, diarrhea, arthralgia, myalgia, dizziness, headache, hemolytic anemia (rare), QTc prolongation 
Artesunate
Generally well-tolerated. Bradycardia, dizziness, nausea and vomiting, skin rash, pruritus
Atovaquone
Rash, nausea, vomiting, diarrhea, hepatotoxicity, headache, hyperglycemia, fever 
Atovaquone/Proguanil
Pruritus, rash, nausea, vomiting, abdominal pain, diarrhea, anorexia, EM, asthenia, dizziness, headache, oral ulcers, hepatotoxicity
Azithromycin
Nausea, vomiting, diarrhea, hepatotoxicity, ototoxicity (with prolonged use), rash, urticaria, pruritus, abdominal pain; risk of torsades de pointes, use with caution in patients with underlying QTc prolongation
Aztreonam
Diarrhea, hypersensitivity reaction (rare), thrombophlebitis
Benznidazole 
Photosensitivity, allergic dermatitis, paresthesia, peripheral neuropathy, nausea, vomiting, abdominal pain, anorexia, weight loss
Boceprevir
Anemia, neutropenia, dysgeusia, dry mouth, nausea, headache, acute hypersensitivity reaction (urticarial, angioedema; rare)
Capreomycin
Nephrotoxicity, ototoxicity (both hearing loss and vestibular toxicity are possible), neuromuscular blockade (associated with rapid infusion of large aminoglycoside doses), pain upon IM injection
Caspofungin
Generally well-tolerated. Fever, thrombophlebitis, histamine-related infusion reactions (flushing, rash, pruritus, facial swelling, hypotension, dyspnea), hypokalemia, anemia, headache, hepatotoxicity
Ceftriaxone
Generally well-tolerated. Cholelithiasis, rash, diarrhea, drug fever, C. difficile-associated diarrhea and colitis; IM injections: injection-site reactions, pain
Cephalosporins
Hypersensitivity reaction, rash, nausea, vomiting, diarrhea, C. difficile-associated diarrhea and colitis, bone marrow suppression, CNS toxicities such as seizure and confusion (rare, mostly seen with high dose used in patients with renal insufficiency or elderly patients without dosage adjustment)
Chloroquine and Hydroxychloroquine
Headache, pruritus, skin pigmentation, nausea, vomiting, abdominal pain, diarrhea, anorexia, photosensitivity, visual disturbances, QTc prolongation, neuromyopathy (rarely with long-term use); hemolysis (with G6PD deficiency); hypersensitivity reaction (including TEN, SJS, and EM)
Cidofovir
Nephrotoxicity, proteinuria, ocular hypotony, anterior uveitis/iritis, neutropenia, metabolic acidosis, asthenia. 

Side effects most likely related to co-administration of probenecid: rash, nausea, vomiting, anorexia
Ciprofloxacin
Nausea, vomiting, abdominal pain, diarrhea, C. difficile-associated diarrhea and colitis, headache, dizziness, sleep disturbances, tendonitis and tendon rupture (associated age >60 and concomitant steroid use), photosensitivity, hypoglycemia, hepatotoxicity, QTc prolongation, neurotoxicity (especially with high doses, use in elderly patients, or in patients with renal dysfunction), seizures (rare) 
Clarithromycin
Hepatotoxicity, ototoxicity (with high doses or prolonged use), headache, nausea, vomiting, abdominal cramps, diarrhea, C. difficile-associated diarrhea and colitis, rash, QTc prolongation
Clindamycin
Nausea, vomiting, abdominal pain, diarrhea, C. difficile-associated diarrhea and colitis, rash, arrhythmia associated with rapid IV infusion
Clotrimazole (Troche)
Generally well-tolerated. Nausea, vomiting, anorexia, metallic taste, increase in serum transaminases (rare)
Cycloserine
Neuropsychiatric toxicities (headache, somnolence, lethargy, vertigo, tremor, dysarthria, irritability, confusion, paranoia, psychosis), seizures
Dapsone
Methemoglobinemia, hemolytic anemia (especially in patients with G6PD deficiency), neutropenia, rash, sulfone syndrome (fever, exfoliative dermatitis, lymphadenopathy, hepatic necrosis, hemolysis), peripheral neuropathy, hepatotoxicity
Doxycycline
Photosensitivity reaction, nausea, vomiting, diarrhea, esophageal ulceration, thrombophlebitis (with IV infusion)
Emtricitabine
Generally well-tolerated. Headache, nausea, hyperpigmentation, diarrhea, rash
Entecavir
Generally well-tolerated. Headache, fatigue, dizziness, nausea
Erythromycin
Nausea, vomiting, abdominal pain, hepatotoxicity, cholestatic jaundice, ototoxicity (hearing loss, tinnitus), rash, QTc prolongation and cardiac arrhythmia
Ethambutol
Optic neuritis (dose dependent), peripheral neuropathy, headache, nausea, vomiting, anorexia, hepatotoxicity, hyperuricemia, hypersensitivity reaction
Ethionamide
Gastrointestinal side effects (dose related): nausea, vomiting, diarrhea, abdominal pain, metallic taste, anorexia; dizziness, drowsiness, depression, hepatotoxicity, hypothyroidism (with or without goiter), gynecomastia
Famciclovir
Generally well-tolerated. Headache, nausea, vomiting, diarrhea 
Flucytosine
Concentration-dependent bone marrow suppression (anemia, neutropenia, thrombocytopenia), diarrhea, nausea, vomiting, rash
Fluconazole
Hepatotoxicity, rash, nausea, vomiting, diarrhea, abdominal discomfort, reversible alopecia (with doses ≥400 mg/d for >2 months)
Foscarnet
Nephrotoxicity, electrolyte imbalances (hypocalcemia, hypomagnesemia, hypophosphatemia, hyperphosphatemia, hypokalemia), penile ulceration, nausea, vomiting, anorexia, headache, seizure (associated with electrolyte imbalances), anemia, injection-site associated thrombophlebitis 
Fumagillin (Investigational)
Oral therapy: Neutropenia, thrombocytopenia, vertigo, nausea, vomiting, diarrhea, anorexia, abdominal cramps

Ocular therapy: Minimal systemic effect or local effect
Ganciclovir
Neutropenia, thrombocytopenia, anemia, injection-site-associated thrombophlebitis, confusion
Imipenem/Cilastatin 
Hypersensitivity reaction (immediate or delayed); CNS effects—seizure, myoclonus, confusion (more frequent with impenem than meropenem and dorepenem [especially with higher doses, in patients with underlying CNS disorders, or with renal insufficiency]), nausea, vomiting, diarrhea, C. difficile-associated diarrhea and colitis, thrombophlebitis, headache, bone marrow suppression, drug fever
Interferon-Alfa and Peginterferon-Alfa
Influenza-like syndrome (fever, headache, fatigue, and myalgia), neuropsychiatric disorders (depression and suicidal ideation), neutropenia, anemia, thrombocytopenia, thyroid dysfunction, injection-site reactions, alopecia, nausea, anorexia, diarrhea, weight loss, development or exacerbation of autoimmune disorders, ocular effects (retinal hemorrhage, retinal artery or vein obstructions, and cotton wool spots)
Isoniazid
Hepatotoxicity, peripheral neuropathy, optic neuritis, psychosis (rare)
Itraconazole
Hepatotoxicity, congestive heart failure, edema, hypokalemia, nausea, vomiting, diarrhea, abdominal pain, rash
Lamivudine
Generally well-tolerated. Nausea, vomiting
Levofloxacin
Nausea, vomiting, abdominal pain, diarrhea, C. difficile-associated diarrhea and colitis, headache, dizziness, sleep disturbances, tendonitis and tendon rupture (associated >60 years of age and concomitant steroid use), photosensitivity, hypoglycemia, hepatotoxicity, QTc prolongation, neurotoxicity (especially with high doses, use in elderly patients, or in patients with renal dysfunction), seizures (rare) 
Linezolid
Anemia, neutropenia, thrombocytopenia (especially with >2- to 4-week treatment), peripheral neuropathy, optic neuritis with long-term (months) therapy, serotonin syndrome (especially in patients receiving concomitant serotonergic agents), seizure (in patients with a history of seizure or with risk factors for seizure), lactic acidosis (rare)
Mefloquine
Depression, psychosis, rash (reports of TEN and SJS), nausea, vomiting, diarrhea, epigastric pain, agitation, dizziness, headache, insomnia, abnormal dreams, QTc prolongation, arrhythmias (extrasystole, sinus bradycardia)
Meropenem
Generally well-tolerated. Hypersensitivity reaction (immediate or delayed), nausea, vomiting, diarrhea, C. difficile-associated diarrhea and colitis, thrombophlebitis, headache, bone marrow suppression, drug fever
Micafungin
Generally well-tolerated. Histamine-related infusion reactions (such as flushing, rash, pruritus, hypotension, dyspnea) may occur, but it is rare if infused over 1 hour; anaphylaxis and anaphylactoid reaction; hepatotoxicity, thrombophlebitis, nausea, vomiting, diarrhea, hypokalemia, hemolysis (rare)
Miconazole Buccal Tablets
Dysgeusia, diarrhea, nausea, vomiting, upper abdominal pain, headache, local reactions (oral discomfort, burning, pain, tongue/mouth ulceration, gingival pruritus, pain and swelling, dry mouth), hypersensitivity reaction (rare—may occur in patients with known hypersensitivity reaction to milk product concentrate)
Miltefosine
Nausea, vomiting, diarrhea, leukocytosis, thrombocytosis, nephrotoxicity, retinal degeneration 
Moxifloxacin
Nausea, vomiting, abdominal pain, diarrhea, C. difficile-associated diarrhea and colitis, headache, dizziness, sleep disturbances, tendonitis and tendon rupture (associated >60 years of age and concomitant steroid use), photosensitivity, hypoglycemia, hepatotoxicity, QTc prolongation, neurotoxicity (especially with high doses, use in elderly patients, or in patients with renal dysfunction), seizures (rare) 
Nifurtimox
Anorexia, weight loss, nausea, vomiting, abdominal pain, headache, dizziness, mood changes, insomnia, myalgia, peripheral neuropathy, rash, pruritus, memory loss
Nitazoxanide
Generally well-tolerated. Nausea, vomiting, diarrhea, abdominal pain, headache
Nystatin (Oral Preparations)
Unpleasant taste, nausea, vomiting, anorexia, diarrhea, hypersensitivity reaction (rare)
Penicillin G
All Penicillin G Preparations: Hypersensitivity reactions (immediate or delayed reactions, including anaphylaxis), bone marrow suppression, nausea, vomiting, diarrhea, C. difficile-associated diarrhea and colitis, drug fever

Benzathine Penicillin G & Procaine Penicillin G: IM injection-site reactions (pain and erythema)

Aqueous Crystalline Penicillin G (IV): Thrombophlebitis, neurotoxicity at high doses (especially in patients with renal dysfunction)
Pentamidine
IV Infusion: Nephrotoxicity, infusion-related hypotension, thrombophlebitis, arrhythmias (including torsades de pointes), pancreatitis, hypoglycemia, hyperglycemia, diabetes mellitus, hepatotoxicity, electrolyte abnormalities, leukopenia, thrombocytopenia

Aerosolized Therapy: Bronchospasm, cough, dyspnea, tachypnea, metallic taste, pancreatitis (rare)
Pentavalent Antimony (Sodium Stibogluconate)
Nausea, vomiting, abdominal pain, anorexia, pancreatitis (rare), headache, hepatotoxicity, arthralgia, myalgia, cardiac toxicity with higher than 20 mg/kg dose, rash, thrombophlebitis, leukopenia, anemia, thrombocytopenia
Posaconazole
Nausea, vomiting, diarrhea, abdominal pain, headache, hepatotoxicity, hypokalemia, QTc prolongation, rash
Piperacillin-Tazobactam
Generally well-tolerated. Hypersensitivity reaction, rash, diarrhea, nausea, vomiting, C. difficile-associated diarrhea and colitis, thrombophlebitis, thrombocytopenia (rare), impaired platelet aggregation, seizure (high dose in patients with renal insufficiency)
Primaquine
Methemoglobinemia, hemolytic anemia (especially in patients with G6PD deficiency), leukopenia, neutropenia, abdominal cramps, nausea, vomiting
Pyrazinamide
Hepatotoxicity, hyperuricemia, arthralgia, nausea, vomiting 
Pyrimethamine
Neutropenia, thrombocytopenia, megaloblastic anemia, rash
Quinidine Glucuronate
QTc prolongation, lightheadedness, nausea, vomiting, diarrhea, abdominal pain, drug-induced SLE, headache, rash, hemolysis (with G6PD deficiency), hepatotoxicity 
Quinine
Headache, nausea, vomiting, diarrhea, cinchonism (tinnitus, vertigo, blurred vision), hypersensitivity reaction
Ribavirin
Hemolytic anemia, dyspnea, hyperbilirubinemia, nausea, vomiting, anorexia, dyspepsia, rash, dry cough
Rifabutin
Hepatotoxicity, uveitis (dose dependent), red-orange discoloration of body fluids, rash, arthralgia, neutropenia, nausea, vomiting, abdominal pain, diarrhea, anorexia
Rifampin
Hepatotoxicity (cholestatic hepatitis), red-orange discoloration of body fluids, thrombocytopenia, hemolytic anemia, rash, hypersensitivity reactions with flu-like syndrome, nausea, vomiting, anorexia, abdominal pain, flatulence, diarrhea, renal failure
Streptomycin
Nephrotoxicity, ototoxicity (both hearing loss and vestibular toxicity are possible), pain upon IM injection
Sulfadiazine
Rash (including SJS, EM, TEN), anemia, neutropenia, thrombocytopenia, crystalluria with or without urolithiasis, renal insufficiency, nausea, vomiting, drug fever, hepatotoxicity
Telaprevir
Anemia, rash, pruritus, nausea, vomiting, dysgeusia, diarrhea, ano-rectal discomfort (hemorrhoid, pruritus), proctitis, severe cutaneous eruption (including SJS, EM, TEN)
Telbivudine
Generally well-tolerated. Nausea, vomiting, abdominal pain, increase in creatine kinase, headache, dizziness
Tenofovir
Renal insufficiency, proximal renal tubulopathy (with hypophosphatemia, hypouricemia, normoglycemic glycosuria), decrease in bone mineral density, nausea
Tetracycline
Photosensitivity, tooth discoloration if taken by infants and children, pruritus, esophageal ulceration, nausea, vomiting, diarrhea, hepatotoxicity, rash
Trimethoprim-Sulfamethoxazole 
Rash (including SJS, EM, and TEN), photosensitivity, anemia, neutropenia, thrombocytopenia, hepatotoxicity, increase in serum creatinine (without change in GFR), interstitial nephritis, nausea, vomiting, crystalluria (in patients with inadequate hydration), hyperkalemia (more common with high dose TMP), drug fever
Valacyclovir
Generally well-tolerated. Nausea, vomiting, headache, crystalluria (with high dose or renal impairment), neurotoxicity (high doses, especially in patients with renal impairment; agitation, confusion, hallucination, seizure, coma)
Valganciclovir
Neutropenia, thrombocytopenia, anemia, nausea, vomiting, diarrhea, confusion
Vancomycin
Infusion-related reaction (infusion-rate related, flushing, hypotension, rash), thrombophlebitis, rash, neutropenia, thrombocytopenia (rare), ototoxicity (associated with excessive concentration), nephrotoxicity (associated with high daily dose and high trough concentrations)
Voriconazole
Visual disturbances (with initial dosing), optic neuritis (with >28 days treatment), skin photosensitivity, rash, hepatotoxicity, peripheral edema, headache, delirium, hallucination, encephalopathy (associated with trough >5.5 mcg/mL), QTc prolongation, peripheral neuropathy (rare)
Key to Acronyms: CNS = central nervous system; EM = erythema multiforme; G6PD = glucose-6-phosphate dehydrogenase; GFR = glomerular filtration rate; IM = intramuscular; IV = intravenous; SJS = Stevens-Johnson syndrome; SLE = systemic lupus erythematosus; TEN = toxic epidermal necrolysis; TMP = trimethoprim

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