Antithymocyte immunoglobulin, equine: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the Indonesia prescribing information.

Generic Medicine Info

Indications and Dosage

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.
Elderly: Initiate at the lower end of dosing range.
Child: 5-25 mg/kg daily.

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.
Elderly: Initiate at the lower end of dosing range.
Child: Same as adult dose.

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.

Monitoring Parameters

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:
Mechanism of Action: 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

Immunosuppressants

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.

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