VIR and opioid

Q: The intensity of Vancomycin Infusion Reaction (VIR) (Red Man Syndrome) can be minimized by concomitant administration of opioids?

A) True

B) False

Answer; B

VIR, popularly known as 'Red Man Syndrome'*, is a phenomenon that is described as an idiopathic reaction if Vancomycin is infused too fast. This believes to occur due to mast cell activation. Few drugs can enhance this reaction and should not be given concurrently with IV vancomycin. This includes opioids which are known to enhance dose- or rate-related mast cell degranulation. Also, radiocontrast dye and muscle relaxants are known to cause it. If needed, antihistamines should be given to decrease VIR or drug-drug-enhanced VIR.

The best prevention is to dilute and slow the infusion of the drug. A gram of vancomycin should be administered over about 2 hours.

*Red Man Syndrome is a derogatory term and should be avoided.

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References:

1. Renz CL, Thurn JD, Finn HA, et al. Oral antihistamines reduce the side effects from rapid vancomycin infusion. Anesth Analg 1998; 87:681.

2. Polk RE, Healy DP, Schwartz LB, et al. Vancomycin and the red-man syndrome: pharmacodynamics of histamine release. J Infect Dis 1988; 157:502.

3. Wong JT, Ripple RE, MacLean JA, et al. Vancomycin hypersensitivity: synergism with narcotics and "desensitization" by a rapid continuous intravenous protocol. J Allergy Clin Immunol 1994; 94:189.