Antithymocyte immunoglobulin, rabbit

Intravenous
Prophylaxis of rejection in kidney graft transplant

Intravenous
Prophylaxis of rejection in cardiac graft transplant

Intravenous
Treatment of kidney transplant rejection

Reconstitute powder with 5 mL of sterile water for injection and further dilute with NaCl 0.9% or glucose 5% to a total volume of 50-500 mL.

Incompatible with heparin and hydrocortisone in dextrose infusion solution.

Hypersensitivity to rabbit proteins. Active, acute or chronic infections which contraindicate additional immunosuppression. Lactation. Concurrent vaccination with live viral vaccines.

Patient with severe neutropenic aplastic anaemia. Hepatic impairment. Children. Pregnancy.

Significant: Haematologic effects (e.g. thrombocytopenia, leucopenia, neutropenia, lymphopaenia), severe infections, risk of transmission of infectious agents.
Blood and lymphatic system disorders: Anaemia, leukocytosis.
Cardiac disorders: Tachycardia.
Gastrointestinal disorders: Abdominal pain, nausea, diarrhoea, vomiting, constipation, dyspepsia.
General disorders and administration site conditions: Pain, malaise, fever.
Infections and infestations: Cytomegalovirus disease, sepsis, intestinal candidiasis, herpes simplex.
Metabolism and nutrition disorders: Peripheral oedema, hyper/hypokalaemia, acidosis, hypophosphataemia, anorexia.
Musculoskeletal and connective tissue disorders: Chills.
Nervous system disorders: Headache.
Psychiatric disorders: Insomnia, anxiety.
Respiratory, thoracic and mediastinal disorders: Dyspnoea, pulmonary disease, chest pain, cough.
Skin and subcutaneous tissue disorders: Rash, diaphoresis, acne vulgaris, pruritus.
Vascular disorders: Hypo/hypertension.
Potentially Fatal: Anaphylactic reactions, infusion related reactions (e.g. severe cytokine release syndrome (CRS) associated with cardiopulmonary events), malignancies (e.g. lymphoma, lymphoproliferative disorders).

This drug may cause adverse events which may impair ability to drive or operate machinery.

Monitor lymphocyte count, complete blood count with differential, platelet count, coagulation parameters; vital signs and symptoms of anaphylaxis during and after infusion; signs and symptoms of infection.

Potentially Fatal: May diminish the therapeutic effect and enhance the toxic effect of live vaccines.

May interfere with rabbit antibody-based immunoassays and with cross-match or panel-reactive antibody cytotoxicity assays.

Description:
Mechanism of Action: Antithymocyte immunoglobulin is a polyclonal preparation derived from rabbit antibodies. It causes immunosuppression, mostly acting on T-lymphocytes, leading to T-cell depletion and down modulation of adhesion molecules resulting in interference of rejection pathways.
Synonym: antilymphocyte immunoglobulin, rabbit.
Onset: T-cell depletion: Within 24 hours.
Duration: Lymphopaenia: Up to 1 year.
Pharmacokinetics:
Excretion: Elimination half-life: 2-3 days.

Store between 2-8°C. Do not freeze. Protect from light.

Immunosuppressants

L04AA04 - antithymocyte immunoglobulin (rabbit) ; Belongs to the class of selective immunosuppressive agents. Used to induce immunosuppression.

Anon. Antithymocyte Globulin (Rabbit). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 05/06/2018.

Anon. Antithymocyte Globulin (Rabbit). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/06/2018.

Buckingham R (ed). Antilymphocyte Immunoglobulins. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/06/2018.

Joint Formulary Committee. Antithymocyte Immunoglobulin (Rabbit). British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/06/2018.

Thymoglobulin Injection, Powder, Lyophilized, for Solution (Genzyme Corporation). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/06/2018.