Infusion Treatment Reactions: 10 Things Your Oncology Nurse Wants You to Know

Infusion treatment reactions refer to symptoms that can occur around your IV treatments. Certain medications are more likely to cause a reaction than others. In all cases, evidence-based steps are taken to keep you safe. We know that particular medications can cause a more immediate reaction while others can be delayed. 

Thanks to clinical trials, we have a good sense of what to expect with infusion treatments. Rest assured that your oncology team has established guidelines on how to best care for you around your treatments.    

Infusion reactions can range from very mild to more severe. Sometimes they can be scary for the patient as well as family, caregivers, or other observers nearby. 

We would like to share some information on what to expect, including a few tips, as well as truths to dispel myths.  

  • Before starting your infusion, your team will do everything possible to help prevent a reaction from occurring. Depending on the treatment you are receiving, you may be given “pre-medications” before the infusion is started to help prevent a reaction. These medications could be in the form of a pill or IV. “Pre-medications” typically include a class of medications called steroids (i.e. “dexamethasone”), anti-nausea medications, histamine blockers (such as Pepcid and/or Benadryl), and/or Tylenol. You may receive all of these pre-medications or any combination of a few of them. 

  • Certain medications you receive to stop a reaction may make you feel drowsy, tired, and/or “loopy.” It is likely that after an infusion reaction, the side effects of the medications you receive to stop the reaction may last for a few hours or even overnight. It is best to have a caregiver on standby to drive you home in case a reaction does occur. 

Pro Tip: For your first infusion, having a trusted individual with you during the infusion can be helpful. This can help ensure your safety getting home if you do have any side effects from the medications.  

  • If you have an infusion reaction, the infusion nurses will work quickly to get the symptoms you are experiencing under control. Infusion nurses are highly trained at managing infusion reactions. Every infusion room/suite is stocked with emergency medications within easy reach for immediate administration if a reaction occurs. There are established algorithms for how to treat patients who have reactions to their medications. 

  • When a patient has an infusion reaction, it is all hands-on deck in the infusion room. An infusion nurse is likely to be the first person at your side. The first step is always to stop the drug that is infusing. Other members of the team that you may see include a pharmacist, your oncologist (or one that is on call), your NP or PA, respiratory therapists, and medical assistants. All team members work together closely and quickly to maintain patient safety in the event of a reaction. While it may be overwhelming and scary to have so many people surrounding you, the team is working diligently to help you feel better. 

  • The infusion team may ask your family or caregivers who are with you to step outside, or away from you, during an infusion reaction. Your team needs room to work safely and quickly. They may need to give you medications, provide you with oxygen, start another IV line, and/or connect you to a vital sign machine that monitors your blood pressure, heart rate, and oxygen levels with the goal of getting your reaction under control as quickly as possible. Space can also be limited. Most often, someone on the team is assigned to keep loved ones updated on what is happening.

Pro Tip: Ask your infusion nurse what the process and protocol is in your infusion room during reaction events. 

  • An infusion reaction does NOT mean your treatment is over or that you cannot receive this treatment anymore. Infusion reactions are quite common especially with certain medications. Depending on the severity of the reaction, you may receive emergency medications to get the reaction symptoms under control. Once all symptoms are gone, your infusion may be restarted at a slower rate while you are monitored closely for any signs of reaction. The likelihood of having a second reaction may vary. 

  • Not all infusion reactions occur with the first treatment. There are certain cancer treatments that come with an increased risk of reaction with cumulative doses. Talk with your nurse and oncologist to find out the reaction potential for the specific treatment you are getting. These details are good to have to help eliminate fear of the unknown and be aware of when an infusion reaction could most likely occur.

  • Infusion reaction symptoms vary greatly among patients. It is a good rule of thumb to report anything out of the ordinary right away to your infusion nurse. If you are feeling any new sensations or symptoms that you did not have before your infusion started, let the infusion nurses know immediately.

  • The more common symptoms reported include itching; back pain; tongue feeling different; or feeling hot, dizzy, or nauseous. Some people experience hives, tremors, or shaking. Certain medications can make you sensitive to different temperatures. This list is not all inclusive and there are many more symptoms that could be associated with individual reactions. It is always best to report anything out of the ordinary to your infusion nurses. 

  • You will not “bother” us for reporting something that turns out to be nothing. Oncology infusion nurses have one primary goal: to keep patients safe during their treatments. It is much better to report something that may or may not be an issue so that your infusion nurse can investigate and be sure you are okay. We are experts; let us determine if a symptom you are feeling needs further examination.  


​Rituximab Hypersensitivity: From Clinical Presentation to Management

Infusion-Related Reaction, Hypersensitivity, Reaction, Management. CJON 2021, 25(5), 591-594. DOI: 10.1188/21.CJON.591-594