Antithymocyte immunoglobulin, equine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Treatment of kidney transplant rejection 10-15 mg/kg once daily for 14 days, then every other day, if needed, up to 21 doses in 28 days. Prophylaxis of rejection in kidney graft transplant 15 mg/kg once daily for 14 days, then every other day, if needed, up to a total of 21 doses in 28 days. Administer 1st dose within 24 hours before or after the transplant. Aplastic anaemia 10-20 mg/kg once daily for 8-14 consecutive days, then every other day, if needed, up to a total of 21 doses in 28 days.
Dosage Details
Intravenous
Treatment of kidney transplant rejection
Adult: In combination with other immunosuppressants: 10-15 mg/kg once daily for 14 days, then every other day, if needed, up to a total of 21 doses in 28 days. Infuse over at least 4 hours via an in-line filter (0.2-1 micron). Administer 1st dose within 24 hours before or after the transplant. Pre-medicate with antihistamine, antipyretic, and/or corticosteroid.
Child: 5-25 mg/kg daily.
Elderly: Initiate at the lower end of dosing range.

Intravenous
Prophylaxis of rejection in kidney graft transplant
Adult: In combination with other immunosuppressants: 15 mg/kg once daily for 14 days, then every other day, if needed, up to a total of 21 doses in 28 days. Infuse over at least 4 hours via an in-line filter (0.2-1 micron). Administer 1st dose within 24 hours before or after the transplant. Pre-medicate with antihistamine, antipyretic, and/or corticosteroid.
Elderly: Initiate at the lower end of dosing range.

Intravenous
Aplastic anaemia
Adult: In combination with other immunosuppressants: 10-20 mg/kg once daily for 8-14 consecutive days, then every other day, if needed, up to a total of 21 doses in 28 days. Infuse over at least 4 hours via an in-line filter (0.2-1 micron). Pre-medicate with antihistamine, antipyretic, and/or corticosteroid.
Child: Same as adult dose.
Elderly: Initiate at the lower end of dosing range.
Reconstitution
Dilute with appropriate volume of NaCl 0.9% or dextrose 5% in NaCl 0.225% or 0.45% to a final concentration not exceeding 4 mg/mL. Gently swirl or rotate the bottle. Do not shake.
Incompatibility
Dextrose only solution, highly acidic solution.
Contraindications
Hypersensitivity to equine gamma globulin preparations. Concomitant administration of live viral vaccines.
Special Precautions
Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Infusion site reactions (e.g. pain, swelling, redness), infection (e.g. cytomegalovirus infection), leucopenia, thrombocytopenia, dyspnoea, hypotension, hypertension, tachycardia, oedema, serum sickness, abnormal hepatic or renal function tests. Rarely, haemolysis.
Gastrointestinal disorders: Diarrhoea, nausea, vomiting, abdominal pain.
General disorders and administration site conditions: Fever, chills, malaise.
Immune system disorders: Serum sickness.
Musculoskeletal and connective tissue disorders: Myalgia, arthralgia.
Nervous system disorders: Headache, dizziness.
Skin and subcutaneous tissue disorders: Rash, pruritus, urticaria.
Potentially Fatal: Hypersensitivity reactions (e.g. anaphylaxis).
Patient Counseling Information
This drug may cause, dizziness, syncope, convulsion, or confusional state, if affected, do not drive or operate machinery.
MonitoringParameters
Perform skin testing prior to initiation of therapy. Monitor closely for signs and symptoms of hypersensitivity, infection, vital signs, and infusion reactions during administration. Obtain CBC with differential and platelet count regularly.
Drug Interactions
Potentially Fatal: Concomitant administration of live vaccines may cause uncontrolled viral replication in immunosuppressed patients.
Action
Description: Antithymocyte immunoglobulin (equine) is a lymphocyte-selective immunosuppressant that reduces the peripheral circulation and alters the function of thymus-dependent T-lymphocytes. It also directly stimulates the growth of haematopoietic stem cells and release of haematopoietic growth factors such as interleukin-3 and granulocyte/macrophage colony stimulating factor.
Synonym: antilymphocyte immunoglobulin, horse.
Pharmacokinetics:
Distribution: Binds to circulating lymphocytes, granulocytes, platelets, bone marrow cells.
Excretion: Via urine, approx 1%. Elimination half-life: 5.7 ± 3 days.
Storage
Store between 2-8°C. Do not freeze.
MIMS Class
ATC Classification
L04AA03 - antilymphocyte immunoglobulin (horse) ; Belongs to the class of selective immunosuppressive agents. Used to induce immunosuppression.
References
Anon. Antithymocyte Globulin (Equine). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 04/06/2018.

Anon. Antithymocyte Globulin (Equine). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/06/2018.

Atgam Injection, Solution (Pharmacia and Upjohn Company LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 04/06/2018.

Buckingham R (ed). Antilymphocyte Immunoglobulins. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/06/2018.

Disclaimer: This information is independently developed by MIMS based on Antithymocyte immunoglobulin, equine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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