| Lymphocyte immune globulin,
anti-thymocyte globulin (equine) sterile solution
Lymphocyte immune globulin, anti-thymocyte globulin (equine) sterile solution
(Atgam)
Lymphocyte immune globulin, anti-thymocyte globulin
(LIM-foh-sight im-MYOUN GLOH-byou- lin an-tih-THIGH-moh-sight GLOH-byou-lin,
EE-kwine)
Pregnancy Category: C Atgam (Rx)
Classification:
Immunosuppressant
Action/Kinetics: Obtained from
hyperimmune serum of horses immunized with human thymus lymphocytes. Reduces the number of
circulating, thymus-dependent lymphocytes that form rosettes from sheep erythrocytes.
Antilymphocytic effect may be due to alteration of the function of T-lymphocytes, which
are responsible, in part, for cell-mediated immunity. t1/2, serum: 5.7
days when the drug is given with other immunosuppressants and measured as horse IgG.
Uses: Management of allograft
rejection in renal transplant clients, given either at the time of rejection or as an
adjunct with other immunosuppressants to delay onset of the first rejection episode.
Treatment of moderate to severe aplastic anemia in those who are unsuitable for bone
marrow transplantation.
Contraindications: In those who
have demonstrated a severe systemic reaction during prior administration of the drug or
any other equine gamma globulin preparation.
Special Concerns: A systemic
reaction, such as a generalized rash, tachycardia, dyspnea, hypotension, or anaphylaxis,
precludes any further administration of the drug. Potency may vary from lot to lot. The
possibility of transmission of infectious agents exists. Use with caution during
lactation.
Side Effects: General side
effects. Whole body: Fever, chills, systemic or localized infection, malaise,
serum sickness, edema, sweating. GI: N&V, diarrhea, GI bleeding or
perforation sore mouth or throat, epigastric or stomach pain, abdominal
pain. CNS: Headache, seizures confusion, disorientation,
dizziness, faintness, paresthesias. CV: Hypertension or hypotension, tachycardia,
deep vein thrombosis, thrombophlebitis, CHF, vasculitis, renal artery thrombosis. Hematologic:
Thrombocytopenia, leukopenia, eosinophilia, neutropenia, granulocytopenia, anemia,
lymphadenopathy, aplasia, pancytopenia, hemolysis, hemolytic anemia. Dermatologic:
Rashes. Respiratory: Dyspnea, apnea, cough, pulmonary edema
nosebleed. Musculoskeletal: Chest, back, or flank pain; arthralgia, myalgias, leg
pains, abnormal involuntary movement or tremor, rigidity. Miscellaneous: Herpes
simplex infection, swelling or redness at infusion site, swelling, anaphylaxis,
laryngospasm/edema hyperglycemia, acute renal failure
viral hepatitis, enlarged or ruptured kidney.
When used for renal transplantation with other immunosuppressants. Whole body:
Fever, chills, weakness or faintness. CNS: Headache, dizziness, paresthesia, seizures.
GI: Diarrhea, nausea and/or vomiting, stomatitis, hiccoughs, epigastric pain,
malaise. Hematologic: Leukopenia, thrombocytopenia. Dermatologic: Rash,
pruritus, urticaria, wheal, flare. CV: Hypotension, peripheral thrombophlebitis,
edema, hypertension, renal artery stenosis, tachycardia. Musculoskeletal:
Arthralgia, chest or back pain (or both), myalgia. Respiratory: Dyspnea,
laryngospasm, pulmonary edema. Miscellaneous: Clotted arteriovenous fistula, pain
at infusion site, night sweats, anaphylaxis herpes simplex
reactivation, hyperglycemia, iliac vein obstruction, localized infection, lymphadenopathy,
serum sickness, systemic infection, toxic epidermal necrosis
wound dehiscence.
When used for aplastic anemia with support therapy. Whole body: Fever,
chills, diaphoresis, aches. GI: N&V, diarrhea. CNS: Headache, agitation,
lethargy, listlessness, lightheadedness, seizures encephalitis
or postviral encephalopathy. CV: Chest pain, phlebitis, bradycardia, myocarditis,
cardiac irregularity, hypotension, CHF, hypertension. Hematologic: Lymphadenopathy,
postcervical lymphadenopathy, tender lymph nodes. Respiratory: Bilateral pleural
effusion, respiratory distress. Musculoskeletal: Arthralgia, myalgia, joint
stiffness, muscle aches. Miscellaneous: Periorbital edema, edema,
hepatosplenomegaly, burning soles/palms, foot sole pain, proteinuria, anaphylaxis.
Laboratory Test Alterations:  SGOT, SGPT, alkaline phosphatase, serum
creatinine.
Drug Interactions: Previously
masked reactions to Atgam may appear when the drug is given concomitantly with
corticosteroids or other immunosuppressants.
How Supplied: Injection:
50 mg/mL
Dosage
•IV Only Renal allograft recipients.
Adults: 10-20 mg/kg daily. Children: 5-25 mg/kg daily. Usually used
concomitantly with azathioprine and corticosteroids. When used to delay the onset of
allograft rejection, a fixed dose of 15 mg/kg for 14 days is used; then, the dose is given
every other day for 14 days for a total of 21 doses in 28 days. Give the first dose within
24 hr before or after the transplant. When used to treat rejection, the recommended dose
is 10-15 mg/kg daily for 14 days; additional alternate day therapy can be given for a
total of 21 doses. The first dose can be delayed until after the diagnosis of the first
rejection episode.
Aplastic anemia.
10-20 mg/kg daily for 8-14 days; additional alternate day therapy may be given for a total
of 21 doses. |
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