lymphocyte immune globulin

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: 5.7 days.

Time/Action Profile ⬆ ⬇

(decreased circulating T lymphocytes)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

History of hypersensitivity during previous courses of therapy or systemic reaction to skin testing;
Hypersensitivity to thimerosal;
Hypersensitivity to equine gamma globulin preparations.

Use Cautiously in:

OB: Pregnancy or lactation (safety not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: chest pain, hypotension

Derm: dermatologic reactions, erythema, itching

GI: diarrhea, nausea, stomatitis, vomiting

Hemat: leukopenia, thrombocytopenia, anemia, hemolysis

Local: pain/phlebitis at IV site

MS: arthralgia

Neuro: headache

Resp: dyspnea

Misc: chills, fever, serum sickness–like reactions, ANAPHYLAXISALLERGIC REACTIONS INCLUDING , clotted AV fistula, night sweats

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of corticosteroids and immunosuppressants may mask some adverse reactions.

Route/Dosage ⬆ ⬇

Skin Test

Intradermal (Adults ): 0.1 mL of 1:1000 dilution (5 mcg of horse serum).

Renal Allograft Recipients

IV (Adults ): 10–30 mg/kg/day for 14 days, then every other day for 14 days.
IV (Children ): 5–25 mg/kg/day for 14 days, then every other day for 14 days.

Aplastic Anemia

IV (Adults ): 10–20 mg/kg/day for 8–14 days, then every other day for 21 doses total.

Availability ⬆ ⬇

Injection: 50 mg/mL

Assessment ⬆ ⬇

Assess patient for hypersensitivity reaction (respiratory distress; hypotension; pain in chest, flank, or back) continuously throughout administration. Keep epinephrine, antihistamines, corticosteroids, syringes, and an airway at bedside at all times. If a reaction occurs, stop infusion immediately; administer 0.3 mL aqueous epinephrine 1:1000 IM. Administer corticosteroids and resuscitative measures as needed. Do not resume therapy.
Monitor vital signs frequently throughout administration. Medication frequently causes chills, fever, itching, and erythema. Prophylactic administration of antihistamines and corticosteroids usually controls these symptoms.

Lab Test Considerations:

Monitor CBC and platelets throughout therapy. May cause leukopenia and thrombocytopenia. Thrombocytopenia is usually transient and does not normally require discontinuation of therapy or transfusion.
- May also cause hemolysis. Treatment includes transfusion of erythrocytes and administration of mannitol, furosemide, sodium bicarbonate, and fluids, if necessary.

Implementation ⬆ ⬇

Medication should be used only by physicians experienced in immunosuppressive therapy and management of renal transplant patients and should be administered only in facilities equipped and staffed with adequate laboratory and medical resources.
- Patients with aplastic anemia may need a transfusion of platelets before administration to maintain platelets at a clinically acceptable level.
Test Dose: Administer an intradermal injection of 0.1 mL of a 1:1000 dilution in 0.9% NaCl and a 0.9% NaCl control. If a wheal or erythema >10 mm forms with or without a pseudopod and itching or a marked local swelling occurs, administer infusion with caution. If a systemic reaction (generalized rash, tachycardia, dyspnea, hypotension, anaphylaxis) occurs, do not administer infusion. Allergic reactions may occur in patients with a negative reaction to test dose.

IV Administration:

Intermittent Infusion: Diluent: Dilute total daily dose in 0.45% NaCl or 0.9% NaCl.Concentration: Not to exceed 1 mg/mL. Invert IV saline bottle so that undiluted drug does not come in contact with the air inside. May be infused through an in-line filter with a pore size of 0.2–1 micron. Refrigerate diluted solution if prepared before administration. Do not freeze; discard if frozen. Stable for 24 hr, including infusion time, if refrigerated.
- Administer through large veins to minimize phlebitis and thrombosis.
Rate: Administer over at least 4 hr.

Patient/Family Teaching ⬆ ⬇

Explain the purpose of the medication to the patient.
Instruct patient to notify health care professional promptly if fever; chills; cough; sore throat; signs of infection; bleeding gums; bruising; petechiae; blood in stools, urine, or emesis; numbness, tingling, or burning pain in hands, arms, legs, feet, or lips; increased fatigue; confusion; dizziness; weakness; dyspnea; tachycardia; or orthostatic hypotension occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Caution patient not to drink alcoholic beverages or take medication containing aspirin or NSAIDs, because these may precipitate gastric bleeding.
Instruct patient to notify health care professional immediately if signs of hypersensitivity reaction (itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing) occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Advise patient to the importance of follow up lab tests.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇