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(C) Vancouver
General Hospital.
This monograph may not be reproduced without permission.
For further information, please contact a Pharmacist. |
NAME OF DRUG
antithymocyte globulin (Equine)
CLASSIFICATION
Lymphocyte Selective Immunosuppressant
ALTERNATE NAMES
ATGAM, ATG
INDICATIONS
- treatment of aplastic anemia
RECONSTITUTION AND STABILITY
- refrigerate; do not freeze
- solution is usually transparent to slightly opalescent or
colourless to light brown
- inspect vials for particulate matter prior to dilution; use
an in-line filter (pore size 0.2-1.0 microns) to prevent administration of
any insoluble material that may develop with storage
- use only saline solutions for dilution
- avoid foaming of diluted solution; do not shake
- diluted solutions are stable for 24 hours (including actual
infusion time)
- concentrations should not exceed 1 mg/mL for peripheral
vein administration (higher concentrations may be given by central line)
COMPATIBILITY
- compatible with 0.45% and 0.9% saline solution
- incompatible with dextrose solutions and highly acidic
solutions
- incompatible with other drugs
ROUTES OF ADMINISTRATION
IV infusion only - over a minimum of 4 hours
VH & HSC ADMINISTRATION POLICY
A - Not to be administered by the direct IV route
H
-
The IV infusion must be controlled by an automated infusion control
device.
DOSAGE
Adults: 10-40 mg/kg/day depending on protocol
Children: 5-25 mg/kg/day
Test dose is recommended before administration of first
infusion:
- 0.1 mL of 1:1000 (5 mcg) dilution in normal saline
intradermally, and contralateral saline control (use only freshly diluted
drug for skin testing)
- systemic reaction (generalized rash, tachycardia,
hypotension, dyspnea or other signs of anaphylaxis) precludes use
- local reaction within 1 hour indicates that administration
may proceed with caution
POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION
- anaphylaxis
- hemolysis, thrombocytopenia
- respiratory distress
- may indicate anaphylactoid reaction
- hypotension - may indicate anaphylactoid reaction
- chills, fever, arthralgias
- chemical phlebitis (see IMPORTANT IMPLICATIONS)
- itching, erythema
IMPORTANT IMPLICATIONS
- chemical phlebitis may be minimized by administering the
infusion solution into a high flow vein
- allergic reactions can occur in the presence of a negative
skin test; anaphylaxis precautions are necessary
- OBSERVE THE PATIENT FREQUENTLY FOR POSSIBLE ALLERGIC
REACTIONS THROUGHOUT THE INFUSION
- treatment should be discontinued in the event of
anaphylaxis or severe and unremitting thrombocytopenia or leukopenia
Rev March 2004