NAME OF DRUG
antithymocyte globulin (Rabbit)

Lymphocyte-Selective Immunosuppressant

ALTERNATE NAME 

THYMOGLOBULIN 

INDICATIONS

• treatment and prevention of acute allograft rejection episodes in solid organ transplantation 
• treatment of steroid-resistant graft-versus-host disease (GVHD) in patients who have undergone bone marrow transplantation (BMT). 
• has also been studied in patients with low-risk myelodysplastic syndrome (MDS)

RECONSTITUTION AND STABILITY

• store unreconstituted vials in refrigerator; protect from light 
• each 25mg vial is reconstituted with the accompanying 5mL diluent (sterile water for injection) to provide a concentration of 5mg/mL 
• dilute reconstituted vial in 50mL NS or D5W. The diluted solution is stable x 24 hrs at room temperature 
• administer through an in-line 0.22 micron filter

COMPATIBILITY

• compatible with NS, D5W - incompatible with other drugs

ROUTES OF ADMINISTRATION

• IV infusion only 
  • VIA CENTRAL LINE ONLY 
  • initial dose over a minimum of 6-12 hours 
  • if no reaction, then subsequent doses can be infused 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

Solid organ transplantation: 

• Prophylaxis: 1-1.5mg/kg daily (maximum daily dose 150mg) x 5-10 days 
• Treatment: 1.5-2.0 mg/kg daily (maximum daily dose 150mg) x 7-10 days
• Pre-medication required for first 2-3 doses with methylprednisolone, acetaminophen and diphenhydramine one hour prior to infusion

Steroid-resistant acute GVHD following BMT: 

• 1mg/kg actual body weight x 4 doses on days 1,3, 5 and 7. 
• hold cylcosporine (or tacrolimus) for 7 days

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• fever, chills, arthralgia, skin rash and , rarely, anaphylactoid reactions 
• injection site reaction including pain, swelling, erythema and chemical phlebitis

IMPORTANT IMPLICATIONS

• contraindicated in patients with known hypersensitivity to rabbit proteins, acute viral illness or history of anaphylaxis with previous anti-human thymocyte immunoglobulin 
• adverse effects include fever, skin rash, dyspnea, thrombocytopenia, neutropenia, opportunistic infection (including EBV-LPD), and serum sickness. Signs of serum sickness including thrombocytopenia may be observed towards the end of the first week of treatment and can be controlled with steroids. If severe, the drug must be discontinued. 
• monitoring should include full blood cell counts 
• premedication with corticosteroids, acetaminophen, and/or an antihistamine 1 hour prior to the infusion is recommended to reduce the incidence and intensity of side effects during the infusion

Rev. Jan 2004