Side Effect: Chills and Rigors

What are chills and rigors?

Chills and rigors are both symptoms that are caused by involuntary muscle contractions associated with a feeling of coldness. They are typically a response to a sudden drop in body temperature.

What do chills and rigors look like?

• Chills can be accompanied by shivering, teeth chattering, goosebumps, and increased heart rate.
• Rigors are more intense involuntary muscle contractions with violent shivering and uncontrollable shaking.
  • Both chills and rigors can also be accompanied by a fever.

Who gets chills and rigors?

Chills and rigors can be experienced by patients with cancer and individuals with other medical conditions, such as those with autoimmune disorders, and commonly result from bacterial infections in the bloodstream. In patients with cancer, chills and rigors are often associated with treatment such as chemotherapy or immunotherapy such as rituximab, which cause an immune response and release of cytokines in the body as they work to kill cancer cells. Chills and rigors can also be caused by the cancer itself.

Your doctor may recommend that your blood is checked for infection (this is called a blood culture) if you experience chills or rigors, especially during cancer treatment and after certain chemotherapy regimens as your immune system may not be working normally.

How do you prevent chills and rigors in patients with cancer?

Preventing chills and rigors in patients with cancer involves optimizing the treatment of cancer by minimizing the use of treatments or other supportive care that can trigger these symptoms when other equally or more effective options exist.

Below are some simple ways to help prevent or minimize chills and rigors that result from certain cancer treatments:

• Stay warm during treatments that are known to trigger chills and rigors
• Drink plenty of water
• Medications such as acetaminophen (Tylenol®), antihistamines (Benadryl®), and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil or Motrin®) or naproxen (Aleve®), can help reduce the risk of chills and rigors
  • Depending upon your specific condition, these medications may or may not be recommended

How do you treat chills and rigors in patients with cancer?

Treatment of chills and rigors depends on the underlying cause and managing those symptoms:

Medications:

• Meperidine (Demerol®) has been shown to be effective in controlling these symptoms.
• Other medications that may be used include acetaminophen, antihistamines, and benzodiazepines.
  • Acetaminophen and Ibuprofen may be used to reduce a fever iwhen it occurs during or after chills or rigors
• Fluids: If dehydration is contributing to the chills and rigors, intravenous fluids may be administered.
• Staying Warm: Using warm blankets, a heating pad or blanket, and warm fluids can help with the sensation of coldness.

Chemotherapy adjustment: your doctor may change cancer treatments or adjust the dosing of your cancer treatment to prevent chills and rigors from happening in the future if reasonable alternatives exist.

It is important to tell your healthcare team if you experience chills and rigors. Treatment may vary based on the individual and underlying causes.