Version June 2024
| Hypotension |
| 1. Minimal fluid resuscitation to avoid fluid overload. |
| 2. Normally systolic blood pressure (SBP) is 20 to 30 mmHg lower than baseline but patient is asymptomatic. In younger patients, may tolerate SBP 80 mmHg; in older patients, may tolerate SBP 85 to 90 mmHg, depending on baseline. If baseline is higher, may maintain SBP at 100 mmHg. |
| 3. Although saline may be utilized initially, it should be used judiciously to avoid fluid overload and extensive capillary leak. |
| 4. Colloid administration may be necessary if SBP is lower, for symptomatic hypotension, or if urine output declines. |
| 5. Pressors, either dopamine, 1 to 6 mcg/kg/min (if not tachycardic), or phenylephrine, 0.1 to 2.0 mcg/kg/min, may be used to stabilize blood pressure. |
| 6. Patients routinely gain 4.5 kg (10 lbs) in water weight. |
| Cardiac arrhythmia |
| 1. Sinus tachycardia is common and may reflect maximal toxicity between doses, or a reaction to hypotension or dopamine administration. Extension of time between doses may control this. |
| 2. Supraventricular tachycardia may occur with therapy and may require treatment depending on rate. Therapy can be continued once this is controlled, by extending time between doses. If this occurs near the end of the course of treatment, treatment should probably be discontinued. |
| 3. IL-2 doses should be withheld for atrial fibrillation, but may be resumed when conversion to sinus rhythm is accomplished and the patient is hemodynamically stable. |
| 4. If significant (ventricular) arrhythmias occur during treatment, IL-2 should be held and an evaluation for cardiac damage must be undertaken, for ischemia or infarction. |
| 5. Although isolated premature ventricular contractions may not signal discontinuation of IL-2, if they increase in frequency or become sustained, IL-2 therapy should be stopped. |
| Metabolic acidosis |
| 1. Metabolic acidosis may occur with reductions in serum bicarbonate. |
| 2. Sodium bicarbonate should be utilized to maintain serum HCO3 above 18 mEq/L. |
| 3. If bicarbonate is persistently low, IL-2 should be held. |
| Fevers/chills |
| 1. These can be prevented to some extent by premedication with acetaminophen, 650 mg orally every 4 hours, and indomethacin, 25 mg orally every 6 hours throughout IL-2 administration. H-2 blockers should be administered to protect the gastric mucosa. |
| 2. Patients who develop dose-related significant shaking chills, usually 30 to 90 minutes following the dose, should receive intravenous meperidine (pethidine) 25 to 50 mg to stop them. They may then need prochlorperazine for nausea. |
| Nausea/vomiting |
| 1. Although not occurring in all patients, we routinely provide premedication daily with 5HT3 antagonists (eg, ondansetron), as well as prochlorperazine for dose-related nausea. Dexamethasone is not routinely given. |
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