Transient phlebitis: an unusual effect of intravenous diphenhydramine

"Getting Under Your Skin”: First Reported Case of Transient Reactive Phlebitis Involving Vancomycin Infusion Therapy

“…There have been several other reports of a TRP occurring after initiation of a medication drip, though none have reported vancomycin as a causative agent. Previously reported medications include morphine, pethidine, rocuronium, propofol, ciprofloxacin, diphenhydramine, and eptifibatide [5][6][7][8][9][10][11][12][13]. TRP is isolated to the recipient extremity and occurs downstream to the infusing intravenous cannula [5,[10][11][12][13].…”

“…Previously reported medications include morphine, pethidine, rocuronium, propofol, ciprofloxacin, diphenhydramine, and eptifibatide [5][6][7][8][9][10][11][12][13]. TRP is isolated to the recipient extremity and occurs downstream to the infusing intravenous cannula [5,[10][11][12][13]. Symptoms include a vermiform rash comprising the region of phlebitis and may be associated with mild pain [5][6][7][8]10,13].…”

“…TRP is isolated to the recipient extremity and occurs downstream to the infusing intravenous cannula [5,[10][11][12][13]. Symptoms include a vermiform rash comprising the region of phlebitis and may be associated with mild pain [5][6][7][8]10,13]. Pruritis, urticaria, and febrile episodes have not been reported.…”

“…These include directly mediated histamine release, activation of the kallikrein-kinin system with bradykinin generation, direct activation of c-nociceptors, and the release of local mediators. [8,[10][11][12][13]. A histamine-mediation reaction appears less likely to be the cause of TRP due to the absence of typical histamine-associated symptoms such as pruritis or urticaria, as well as the commonly utilized anti-histamine medication diphenhydramine having been reported in TRP [13].…”

“…[8,[10][11][12][13]. A histamine-mediation reaction appears less likely to be the cause of TRP due to the absence of typical histamine-associated symptoms such as pruritis or urticaria, as well as the commonly utilized anti-histamine medication diphenhydramine having been reported in TRP [13]. Dilution of the infusing medication, slowing the rate of infusion, or use of a large vein for IV infusion access may also help ameliorate symptoms and reduce the risk of developing TRP in susceptible patients [13].…”