Antithymocyte Globulin (Rabbit)U.S. Brand Names: Thymoglobulin�(r)
Synonyms: Antithymocyte Immunoglobulin; ATG
Generic Available: No
Use: Treatment of renal transplant acute rejection in conjunction with concomitant immunosuppression
Contraindications: Patients with history of allergy or anaphylaxis to rabbit proteins, or who have an acute viral illness
Warnings/Precautions: Should only be used by physicians experienced in immunosuppressive therapy for the treatment of transplant patients. Adequate laboratory and supportive medical resources must be readily available for appropriate patient management. The first dose should be infused over at least 6 hours through a high-flow vein. Premedication with corticosteroids, acetaminophen, and/or an antihistamine may reduce infusion-related reactions. Chronic immunosuppression increases the risk of opportunistic infections and secondary malignancies. Antirabbit antibodies develop in 68% of patients. The impact of antirabbit antibodies on the efficacy of repeated therapy with antithymocyte globulin is unknown. The lymphocyte count should be monitored to verify T-cell depletion subsequent to retreatment with antithymocyte globulin.
Adverse Reactions: >10%: Central nervous system: Fever, chills, headache Dermatologic: Rash Endocrine & metabolic: Hyperkalemia Gastrointestinal: Abdominal pain, diarrhea Hematologic: Leukopenia, thrombocytopenia Neuromuscular & skeletal: Weakness Respiratory: Dyspnea Miscellaneous: Systemic infection, pain 1% to 10%: Gastrointestinal: Gastritis Respiratory: Pneumonia Miscellaneous: Sensitivity reactions: Anaphylaxis may be indicated by hypotension, respiratory distress, serum sickness, viral infection
Stability: Store intact vials under refrigeration (2°C to 8°C/36°F to 46°F); protect from light and do not freeze Reconstitute 25 mg vial with diluent provided by manufacturer (SWFI >5 mL). Roll vial gently to dissolve powder. Use contents of vial within 4 hours of reconstitution. Dilute dosage to a final concentration of 0.5 mg/mL in 0.9% sodium chloride injection or 5% dextrose injection. Gently invert admixture 1-2 times to mix solution. Use admixture immediately.
Mechanism of Action: May involve elimination of antigen-reactive T-lymphocytes (killer cells) in peripheral blood or alteration of T-cell function
Pharmacodynamics/Kinetics: Half-life elimination, plasma: 2-3 days
Dosage: I.V.: 1.5 mg/kg/day for 7-14 days
Administration: For I.V. use only; administer via central line; use of high flow veins will minimize the occurrence of phlebitis and thrombosis; administer by slow I.V. infusion through an in-line filter with pore size of 0.2 micrometer over a minimum of 6 hours for the first infusion and over at least 4 hours on subsequent days of therapy.
Monitoring Parameters: Lymphocyte profile, CBC with differential and platelet count, vital signs during administration; any severe systemic reaction to the skin test (eg, generalized rash, tachycardia, dyspnea, hypotension, or anaphylaxis) should preclude further therapy
Dental Health: Effects on Dental Treatment: No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions: No information available to require special precautions
Mental Health: Effects on Mental Status: None reported
Mental Health: Effects on Psychiatric Treatment: Leukopenia and thrombocytopenia are common; use caution with clozapine, carbamazepine, and valproic acid
Oncology: Emetic Potential: Very low (<10%)
Oncology: Vesicant: No
Dosage Forms: Injection, powder for reconstitution: 25 mg vial [packaged with diluent]
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(an te THY moe site GLOB yu lin (RAB bit)
