From the Guidelines
For the management of rigors, acetaminophen 650 mg PO q4h scheduled, indomethacin 50–75 mg q6h or equivalent, meperidine 25 mg with option to repeat another dose within 30 mins as needed, and hydromorphone 0.5 mg IV every 15 min as needed are recommended. These medications are suggested based on the expert consensus guidelines on management and best practices for tumor-infiltrating lymphocyte cell therapy 1. The choice between meperidine and hydromorphone may depend on institutional protocol, with the option to administer the other if the first is not effective.
Key Medications for Rigors
- Acetaminophen: 650 mg PO q4h scheduled
- Indomethacin: 50–75 mg q6h or equivalent
- Meperidine: 25 mg with option to repeat another dose within 30 mins as needed
- Hydromorphone: 0.5 mg IV every 15 min as needed
It's crucial to note that these recommendations are based on guidelines for managing toxicity in the context of tumor-infiltrating lymphocyte cell therapy, which may involve specific considerations not applicable to all cases of rigors. However, in the absence of more specific guidance for other contexts, these recommendations can be considered based on the principle of managing symptoms while addressing the underlying cause, especially in scenarios where the cause of rigors is related to a treatable condition such as infection or inflammation 1.
Considerations for Use
- Monitoring and Adjustment: The use of these medications should be monitored closely, with adjustments made as necessary to balance efficacy with the risk of side effects.
- Underlying Cause: Identifying and treating the underlying cause of rigors is crucial, whether it be infection, inflammation, or another condition.
- Supportive Care: Adequate hydration and other supportive measures can complement pharmacological treatment in managing rigors effectively.
From the FDA Drug Label
ALLERGIC Syndrome of abdominal pain, fever, chills, nausea and vomiting; anaphylaxis; bronchospasm
- Reactions occurring in 3% to 9% of patients treated with ibuprofen tablets. The medication for rigors (chills) is ibuprofen (PO), as it is used to treat fever and chills, which are symptoms of the allergic syndrome listed in the drug label 2.
From the Research
Medications for Rigors (Chills)
- Acetaminophen and ibuprofen are commonly used to treat fever, which is often accompanied by rigors (chills) 3, 4.
- A study comparing the efficacy of acetaminophen and ibuprofen found that ibuprofen was consistently superior to acetaminophen in a range of painful conditions, including acute pain and osteoarthritis 4.
- Another study found that combined therapy with acetaminophen and ibuprofen may be superior to acetaminophen alone in treating fever in children 3.
- Ciprofloxacin and ceftriaxone are antibiotics that have been used to treat various infections, including gonorrhea and spontaneous bacterial peritonitis, which can cause fever and rigors 5, 6.
- A study comparing the efficacy of cefotaxime, ceftriaxone, and ciprofloxacin in treating spontaneous bacterial peritonitis found that all three antibiotics were effective, but there was no significant difference in their efficacy 6.