Adult Dosing
Prophylaxis of cytomegalovirus disease associated with kidney transplantation
- 150 mg/kg IV within 72 hrs of transplant followed by 100 mg/kg IV at 2, 4, 6, 8 wks post-transplant, then 50 mg/kg IV at 12 and 16 wks post-transplant
- Max: 150 mg Ig/kg per infusion
- Administer initial dose at rate of 15 mg Ig/kg/hr; if no adverse reactions after 30 mins, increase to 30 mg Ig/kg/hr and if no adverse reactions after subsequent 30 mins, then increase to 60 mg Ig/kg/hr [Max: 75 mL/hr]
- Administer subsequent doses at 15 mg Ig/kg/hr for 15 mins; if no adverse reactions, increase to 30 mg Ig/kg/hr for 15 mins and then increase to maximum rate of 60 mg Ig/kg/hr [Max: 75 mL/hr]
Prophylaxis of cytomegalovirus disease associated liver, pancreas, lung, heart transplant
- 150 mg/kg IV within 72 hrs of transplant, then at 2, 4, 6, 8 weeks post-transplant, then 100 mg/kg IV at 12 and 16 wks post-transplant
- Max: 150 mg Ig/kg per infusion
- Administer initial dose at rate of 15 mg Ig/kg/hr; if no adverse reactions after 30 mins, increase to 30 mg Ig/kg/hr and if no adverse reactions after subsequent 30 mins, then increase to 60 mg Ig/kg/hr [Max: 75 mL/hr]
- Administer subsequent doses at 15 mg Ig/kg/hr for 15 minutes; if no adverse reactions, increase to 30 mg Ig/kg/hr for 15 mins and then increase to maximum rate of 60 mg Ig/kg/hr [Max: 75 mL/hr]
Note:
- Do not exceed the given rate of administration and closely monitor the patient after each rate change
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
See Supplemental Patient Information
- Cytomegalovirus immune globulin intravenous (CMV-IGIV) is made from human plasma and can carry the possibility for transmission of blood-borne viral agents and the Creutzfeldt-Jakob disease. Most of the virus are inactivated by the manufacturing process or by solvent detergent treatment; however, still there are chances of new blood-borne viruses and so should be given only if benefit is expected
- Renal dysfunction, acute renal failure, osmotic nephrosis and death can occur with Immune Globulin IV (Human) products, administer at the minimum concentrations available and the minimum rate of infusion in patients at risk of acute renal failure
- Continuously monitor patient's vital signs and observe for any symptoms throughout. Keep epinephrine and diphenhydramine readily available for treatment of an acute anaphylactic reaction. Discontinue the drug immediately and give antidote if hypotension or anaphylaxis occurs
- Prior to the initiation of IGIV, assure that patients are not volume depleted. Evaluate renal function tests and urine output prior to initial infusion and periodically thereafter; discontinue the product if renal function deteriorates
- Aseptic meningitis syndrome (AMS), characterized by severe headache, nuchal rigidity, drowsiness, fever, photophobia, painful eye movements, nausea/vomiting, CSF positive with pleocytosis and elevated protein levels, has been reported with IGIV treatment usually within several hours to two days. Perform thorough neurological examination to rule out other causes of meningitis and discontinue the IGIV treatment
- IGIV products can contain blood group antibodies which may act as hemolysins and can cause hemolysis leading to hemolytic anemia; monitor the patient for clinical signs and symptoms of hemolysis
- Noncardiogenic pulmonary edema [Transfusion-Related Acute Lung Injury (TRALI)] characterized by severe respiratory distress, pulmonary edema, hypoxemia, normal left ventricular function, and fever have been reported in patients administered IGIV within 1-6 hours after transfusion. Monitor the patient and perform appropriate tests for the presence of anti-neutrophil antibodies in both the product and the patient's serum and manage TRALI using oxygen therapy with adequate ventilator support
- IGIV is associated with thrombotic events particularly in patients with a history of atherosclerosis, multiple cardiovascular risk factors, advanced age, impaired cardiac output, and/or known or suspected hyperviscosity; perform baseline assessment of blood viscosity and outweigh the potential risks and benefits of IGIV against those of alternative therapies
Cautions: Use cautiously in
- Renal impairment
- Volume depleted
- History of atherosclerosis
- Multiple cardiovascular risk factors
- Impaired cardiac output
- Hyperviscosity
- Diabetes mellitus
- Age >65 yrs
- Paraproteinemia
- Sepsis
- Concomitant nephrotoxic drugs
- History of migraine
- Coagulation disorder
- Prolonged immobilization
Supplemental Patient Information
- Advise patients to report immediately any symptoms of sudden weight gain, reduced urine output, and/or shortness of breath to their physician as these may suggest kidney damage
Pregnancy Category:C
Breastfeeding: Safety unknown.
US Trade Name(s)
US Availability
CytoGam
- INJ: 2500 mg+/-500 mg/vial
Canadian Trade Name(s)
Canadian Availability
Cytogam
- INJ: 2500 mg+/-500 mg/vial
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
cytomegalovirus immune globulin (generic)