• Treatment of inhalational anthrax (in combination with appropriate anti-infectives).

Contraindicated in:

• History of anaphylactic/severe systemic hypersensitivity reaction to human immune globulin
• IgA deficiency with antibodies against IgA and history of IgA hypersensitivity.

Use Cautiously in:

• Advanced age, impaired cardiac output, hypercoagulable state, prolonged immobilization, history of venous/arterial thromboses, estrogen use, indwelling central vascular catheters or hyperviscosity (↑risk of thrombosis; maintain hydration, use lower infusion rate)
• Renal insufficiency, diabetes mellitus, age >65 yr, volume depletion, paraproteinemia, sepsis, exposure to nephrotoxic drugs (↑ risk of renal failure; maintain hydration, use lower infusion rate and monitor renal function)
• Large doses, underlying inflammatory states (↑ risk of hemolysis).

CV: THROMBOSIS.

GI: nausea.

GU: RENAL FAILURE.

Local: infusion site reactions.

MS: back pain.

Neuro: aseptic meningitis syndrome, headache.

Resp: transfusion-related acute lung injury.
Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS, transfusion of blood-borne infectious agents.

Drug-Drug:

• Estrogens may ↑ risk of thrombosis.
• May alter the efficacy of live attenuated vaccines including measles, mumps, rubella and varicella (defer vaccination for three mo).

• Solution for IV injection (requires further dilution): minimum potency of 60 units by Toxin Neutralization Assay/vial (contains trace amounts of IgA and maltose);

• IV (Adults and Children 17 yr or 60 kg): 7 vials (420 units); if symptoms are severe (substantial hemorrhage) consider initial dose of 14 vials (840 units) which may be repeated depending on clinical situation.
• IV (Children <1 yr- 16 yr): 60–420 units based on patient weight.
• IV (Children 50–<60 kg): 6 vials (360 units).
• IV (Children 35–<50 kg): 5 vials (300 units).
• IV (Children 25–<35 kg): 4 vials (240 units).
• IV (Children 18–<25 kg): 3 vials (180 units).
• IV (Children 10–<18 kg): 2 vials (120 units).
• IV (Children <10 kg): 1 vials (60 units).

Anthrasil

• Provides passive immunization, neutralizes anthrax toxin.

• Decreased severity and sequelae of inhalational anthrax.

Therapeutic Classification: vaccines/immunizing agents

Pharmacologic Classification: immune globulins

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-life: 174–187 days.

† Persistence of neutralizing activity.

• Explain purpose of anthrax immune globulin to patient.
• Advise patient to notify health care professional if signs and symptoms of hypersensitivity reactions (hives, rash, chest tightness, wheezing, shortness of breath, feeling light headed or dizzy when they stand) or if injection site pain, chills, fever, headache, nausea, vomiting, or joint pain occur.
• Advise patient to defer live vaccinations for 3 mo following administration of anthrax immune globulin and to be re-vaccinated if anthrax immune globulin was received shortly after being vaccinated.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

AN-thrax im-MYOON GLOB-yoo-lin