Cytomegalovirus Immune Globulin Intravenous (Human)
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Classification: Attenuation of CMV in kidney transplant clients Action/Kinetics: Obtained from pooled adult human plasma that has been selected for high titers of antibody for CMV. Is purified. When reconstituted, each mL contains 50 mg of immunoglobulin that is primarily IgG with trace amounts of IgA and IgM; albumin is also present. In individuals exposed to CMV, the immune globulin can increase the relevant antibodies to levels that prevent or reduce the incidence of serious CMV disease. Uses: Attenuation of primary CMV disease for kidney transplant recipients who are seronegative for CMV and who receive a kidney from a CMV seropositive donor. With ganciclovir to prevent CMV in clients undergoing liver, lung, pancreas, and heart transplants from CMV-seropositive donors to CMS-seronegaitve recipients. ( NOTE: There is a 50% decrease in primary CMV disease in renal transplant clients given this product.) Contraindications: Use in clients with a history of a prior severe reaction to this product or other human immunoglobulin preparations. Special Concerns: Individuals with selective immunoglobulin (Ig) A deficiency may develop antibodies to IgA and could develop anaphylactic reactions to subsequent administration of blood products that contain IgA. Side Effects: Usually minor and often due to the rate of infusion; the infusion schedule should be adhered to closely. GI: N&V.; Body as a whole: Flushing, chills, fever. Musculoskeletal: Muscle cramps, back pain. Respiratory: Wheezing. Hypotension and allergic reactions such as angioneurotic edema and anaphylactic shock are possible but have not been observed. Overdose Management: Symptoms: Major effects would be those related to volume overload. Also possible are anaphylaxis and a drop in BP. Treatment: Discontinue the infusion immediately and have epinephrine and diphenhydramine available for treatment of acute allergic symptoms. Drug Interactions: The antibodies present in this product may interfere with the immune response to live virus vaccines, including measles, mumps, and rubella. Thus, such vaccinations should be deferred until at least 3 months after administration of CMV immune globulin or revaccination may be required. How Supplied: Injection: 50 ± 10 mg/mL
Dosage
The rate of infusion for the initial dose is 15 mg/kg/hr. If no side effects occur after 30 min, the rate may be increased to 30 mg/kg/hr. If no side effects occur after a subsequent 30-min period, the dose may be increased to 60 mg/kg/hr at a volume not to exceed 7.5 mL/hr. This rate of infusion must not be exceeded. For subsequent doses, the rate of infusion is 15 mg/kg/hr for 15 min. If no side effects occur, increase the rate to 30 mg/kg/hr for 15 min and then increase to a maximum rate of 60 mg/kg/hr at a volume not to exceed 7.5 mL/hr. This rate of infusion must not be exceeded. |