Thymoglubin
Thymoglobulin(antithymocyte globulin rabbit) is used to prevent and treat rejection of a kidney transplant. This medication belongs to a class of drugs known as immunosuppressants. It works by decreasing your body's natural defense (immune system). This helps prevent your body from rejecting the kidney transplant so it can work normally.
Mechanism of effect
Binds to multiple, T-cell specific antigens leading to T-lymphocyte cell death via complement mediated cytotoxicity or apoptosis.
Pharmacodynamic
Antithymocyte Globulin (ATG) is a concentrated anti-human T-lymphocyte immunoglobulin preparation derived from rabbits after immunization with a T-lympoblast cell line. ATG is an immunosuppressive product for the prevention and treatment of acute rejection following organ transplantation. ATG reduces the host immune response against tissue transplants or organ allografts.
Pharmacokinetics
Half-Life: 2-3 days
Peak Plasma: 23-170 mcg/mL
Drug indications
prophylaxis of organ rejection- kidney transplantDosage
Treatment: 1.5 mg/kg IV infusion qDay x 7-14 days
Prophylaxis: 1.5 mg/kg IV qDay with the first dose initiated prior to reperfusion of the donor kidney; usual duration is 4-7 days
Side effects
Infection , Pain , Diarrhea , Headache , nausea , dizziness , asthenia , Hypertension , Peripheral edema , fever , Abdominal pain , Leukopenia , Herpes SimplexInteractions
Anti-thymocyte , Everolimus , Pneumovax , Tacrolimus , Tetanus immuneglobulin , Sirolimus , Rilonacept , Hepatitis B Vaccine , Anthrax vaccine , Typhoid vaccine (live), oral , Yellow fever vaccine , Japanese Encephalitis Virus Vaccine , Alefacept , Anakinra , Zoster Vaccines , Muromonab-CD3 , DIPHTHERIA & TETANUS TOXOID (Td ) , Ustekinumab , Measles vaccine , Rubella Vaccines , Mumps vaccine , Golimumab , Tocilizumab , Canakinumab , Cyclosporine , Glatiramer acetate , Hydroxychloroquine , Human papillomma virus vaccine , Influenza vaccine , Adalimumab , Varicella-Zoster VaccinesAlerts
To prevent overimmunosuppression, physicians may decrease the dose of the maintenance immunosuppression regimen during the period of antithymocyte globulin rabbit use
Serious immune-mediated reactions, including anaphylaxis (including fatal anaphylaxis) or severe cytokine release syndrome (CRS), reported; if an anaphylactic reaction occurs, terminate the infusion immediately and implement emergency treatment (eg, 0.3-0.5 mL epinephrine (1 mg/mL) SC and other resuscitative measures including oxygen, IV fluids, antihistamines, corticosteroids, pressor amines, and airway management, as clinically indicated
CRS reported with rapid infusion rates; CRS is attributed to the release of cytokines by activated monocytes and lymphocytes; severe acute CRS can cause serious cardiorespiratory events and/or death; close compliance with the recommended dosage and infusion time may reduce the incidence and severity of infusion-associated reactions; slowing the infusion rate may minimize many of this risk (see Administration)
Low counts of platelets and WBCs (including low counts of lymphocytes and neutrophils) have been identified and are reversible following dose adjustments (see Dosage Modifications)
Routinely used in combination with other immunosuppressive agents; infections (bacterial, fungal, viral and protozoal), reactivation of infection (particularly CMV), and sepsis reported; these infections can be fatal; monitor carefully and administer appropriate anti-infective treatment when indicated
Immunosuppressives may increase the incidence of malignancies, including lymphoma or lymphoproliferative disorders
Points of recommendation
IV Preparation
Aseptically reconstitute required number of vials with 5 mL supplied diluent (SWI) immediately before use
Gently rotate vials to dissolve particulate matters if any; discard if particulate matters persist
Transfer all reconstituted drug into infusion bag containing saline or dextrose, invert bag to mix
Recommended volume: 50 mL of infusion solution per vial (total volume between 50-500 mL)
IV Administration
Premedicate recommended with corticosteroids, acetaminophen, and/or an antihistamine 1 hr before each infusion; may reduce the incidence and intensity of infusion-associated reactions
Infuse IV through 0.22 micron filter into high-flow vein
Infuse first dose over at least 6 hr and subsequent doses over at least 4 hr
Storage
Store refrigerated between 2-8°C (36-46°F)
Protect from light
Protect from freezing
Pregnancy level
HAVE NOT BEEN ESTABLISHEDBreast feeding warning
Has not been studied in breastfeeding women; unknown if excreted in human milk
Because other immunoglobulins are excreted in human milk, breastfeeding should be discontinued during antithymocyte globulin rabbit therapy
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