lymphocyte immune globulin, antithymocyte globulin (equine)

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.

Availability ⬆ ⬇

Solution for injection: 50 mg/mL

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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.

Classifications ⬆ ⬇

Therapeutic Classification: Immunosuppressant agents

Pharmacologic Classification: immune globulins

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

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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Indications ⬇

Contraind./Precautions ⬆ ⬇