Risk Factors for Serious Hypotension Induced by Intravenous Acetaminophen in Patients With Hematologic Malignancy

Owing to their rapid antipyretic effects and predictable pharmacokinetic properties, acetaminophen (AAP) are commonly administered intravenously to severely ill patients. However, the potential development of hypotension as a consequence of intravenous AAP administration has not been thoroughly addressed. In this study, we aimed to identify the risk factors associated with the occurrence of serious hypotension following intravenous AAP administration during fever in patients with hematologic malignancies.

This retrospective study included hospitalized patients in the hemato-oncology department. Patients were evaluated for serious adverse drug reactions (ADRs) resulting from intravenous administration of AAP between January and December 2023 at a tertiary hospital. The control group comprised patients who received intravenous AAP but did not experience hypotension. After univariable analysis, multivariable analysis was performed to identify the risk factors for serious hypotension.

The serious hypotension group included 37 patients, while the control group had 111 patients randomized in a 1:3 ratio based on age and sex. Three risk factors were identified as increasing the likelihood of serious hypotension: body temperature prior to administration, acute kidney injury, and bacteremia. The mean arterial pressure prior to administration decreased the risk of developing serious hypotension by 0.96 times with an increase of 1 mmHg. There were no significant differences in the length of hospitalization or 90-day mortality between the two groups.

Given that patients with hematologic malignancies and associated risk factors may develop serious hypotension that can lead to death, it is essential to closely monitor blood pressure during intravenous administration of AAP.