lymphocyte immune globulin, antithymocyte globulin (equine)

Acts as an immunosuppressant by eliminating antigen-reactive T lymphocytes in the peripheral blood or altering the function of T-lymphocytes, which are involved in humoral immunity and partly in cell-mediated immunity.

Therapeutic effects:

Resolution of acute rejection episode in renal transplant patients.
Sustained improvement in peripheral blood cell counts in aplastic anemia.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Not widely distributed to tissues; binds to circulating lymphocytes, granulocytes, platelets, and bone marrow cells.

Metabolism/Excretion: Unknown.

Half-Life: 1.5–13 days.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to Atgam or any other equine gamma globulin products;
Lactation: Lactation.

Use Cautiously in:

Rep: Women of reproductive potential and men with female partners of reproductive potential;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk.

Adv. Reactions/Side Effects ⬆ ⬇

CV: bradycardia, edema, hypertension, hypotension, tachycardia

Derm: rash, pruritus, urticaria

GI: abdominal pain, diarrhea, ↑liver enzymes, nausea, vomiting

GU: ↑serum creatinine

Hemat: leukopenia, thrombocytopenia, lymphadenopathy, neutropenia

Local: infusion site pain, thrombophlebitis

MS: arthralgia, back pain

Neuro: dizziness, headache

Resp: chest pain, dyspnea

Misc: chills, fever, CYTOKINE RELEASE SYNDROME (CRS), HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), INFECTION, infusion-related reactions, serum sickness

Interactions ⬆ ⬇

Drug-drug:

May ↓ the antibody response to and ↑ risk of adverse reactions from live-virus vaccines; avoid concurrent use.

Route/Dosage ⬆ ⬇

Renal Allograft Rejection

IV (Adults and Children ): 10–15 mg/kg once daily for 14 days; then, if needed, up to seven additional doses can be administered every other day for a maximum total of 21 doses in a total of 28 days.

Aplastic Anemia

IV (Adults and Children ): 10–20 mg/kg once daily for 8–14 days; then, if needed, up to seven additional doses can be administered every other day for a maximum total of 21 doses.

Availability ⬆ ⬇

Solution for injection: 50 mg/mL

Assessment ⬆ ⬇

Monitor for anaphylaxis and infusion reactions (generalized rash, tachycardia, dyspnea, hypotension) during and for ≥24 hr after infusion. Keep epinephrine and emergency equipment close. If anaphylaxis occurs, discontinue Atgam and manage according to guidelines.
Monitor for CRS (fever, chills, headache, chest pain, hypotension, dyspnea, tachypnea, edema). If symptoms occur, manage according to clinical guidelines.
Monitor for serum sickness, a delayed hypersensitivity reaction. If rash, arthralgia, fever, chills, or pain occur, manage according to clinical guidelines.
Monitor for transmissible and opportunistic infections, sepsis, and viral reactivation (e.g., herpes simplex virus).

Lab Test Considerations:

Monitor CBC regularly during therapy. May ↓ platelets and WBC. If thrombocytopenia occurs, consider platelet transfusion to maintain acceptable levels. If thrombocytopenia or neutropenia are severe and unremitting, consider discontinuing Atgam.
Monitor liver and renal function as clinically indicated.

Implementation ⬆ ⬇

Use concomitantly with other immunosuppressants.
Skin testing is strongly recommended prior to initiation of therapy to identify those at greatest risk of anaphylaxis. Consult an allergist. If skin test is positive, seriously consider alternative therapy. Skin testing does not inform risk of delayed hypersensitivity reactions.

IV Administration:

Intermittent Infusion: Diluent: Dilute the total daily dose of Atgam in an inverted bottle/bag of 0.9% NaCl, D5/0.225% NaCl, or D5/0.45% NaCl, so the undiluted solution does not contact the air inside. Gently swirl to mix. Solution is transparent to opalescent, colorless to pale pink or brown and may have a granular or flaky deposit. Do not shake. Once diluted, may store at room temperature for 24 hr including infusion time. Concentration: 4 mg/mL.
Y-Site Compatibility:
- letermovir

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care professional immediately if signs of infusion reaction, anaphylaxis, or serum sickness occur.
Inform patient that despite testing, Atgam may transmit infectious agents. Advise patient to report signs and symptoms of infection to health care professional.
Advise patient to report unusual bleeding or bruising, fever chills, muscle aches, cough, shortness of breath, diarrhea, or stomach pain to health care professional.
Inform patient that laboratories will be necessary to monitor blood cells and liver and kidney function.
Advise patient not to have live vaccines just prior to, while receiving, or after therapy with Atgam. Live-virus vaccines may interfere with therapy.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Rep: Advise women of reproductive potential and men with a female partner of reproductive potential to use effective contraception during and for ≥10 wk after therapy and avoid breastfeeding. May cause ↓ fertility in women.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇