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antithymocyte globulin equine (Rx)Brand and Other Names:Atgam, ATG equine

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 50mg/mL
more...

Renal Allograft

Range: 10-30 mg/kg IV qDay 

Delaying onset of rejection (start within 24 hours of transplant)

  • 15 mg/kg IV qDay x 14 days, THEN qODay x 14 days (total of 21 doses in 28 days)

Treatment of rejection

  • 10-15 mg/kg IV qDay x 14 days, THEN qODay PRN (total of 21 doses in 28 days)

Aplastic Anemia

10-20 mg/kg IV qDay x 8-14 days, then qODay PRN up to total of 21 doses 

Skin Allograft (Off-label)

Initial: 10 mg/kg IV 24 hours prior to first allograft 

Maintenance: usual 10-15 mg/kg IV qODay, but extremely variable (5-40 mg/kg qODay have been used)

Continue till allografts cover >20% of total BSA

Other Indications & Uses

Management of renal allograft rejection, usually with other immunosuppressants

Moderate-severe aplastic anemia (if bone marrow transplant unsuitable)

Off-label: bone marrow allograft

Dosage Forms & Strengths

injectable solution

  • 50mg/mL
more...

Renal Allograft

Range: 5-25 mg/kg IV qDay 

Delaying onset of rejection (start within 24 hours of transplant)

  • 15 mg/kg IV qDay x 14 days, THEN qODay x 14 days (total of 21 doses in 28 days)

Treatment of rejection

  • 10-15 mg/kg IV qDay x 14 days, THEN qODay PRN (total of 21 doses in 28 days)

Aplastic Anemia

As adult

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Interactions

Interaction Checker

antithymocyte globulin equine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Renal Transplant Patients

            >10%

            • Fever (33-51%)
            • Thrombocytopenia (11-30%)
            • Rash (27%)
            • Chills (14-16%)
            • Leukopenia (14%)
            • Systemic infection (13%)
            • Dermatologic rxns (12%)

            1-10%

            • Arthralgia, clotted AV fistula, hypotension, peripheral thrombophlebitis
            • Headache
            • Diarrhea, nausea or vomiting, stomatitis
            • Chest or back pain
            • Night sweats
            • Pain at the infusion site
            • Dyspnea

            <1%

            • Edema, hypertension, pulmonary edema, tachycardia
            • Dizziness, malaise, paresthesia, seizures, weakness or faintness
            • Toxic epidermal necrosis, wound dehiscence
            • Epigastric pain, hiccoughs, iliac vein obstruction
            • Myalgia
            • Renal artery thrombosis
            • Herpes simplex reactivation, localized infection, systemic infection, serum sickness
            • Anaphylaxis, hyperglycemia, laryngospasm

            Aplastic Anemia Patients

            >10%

            • Arthralgia (50%)
            • Chills (50%)
            • HA (16%)

            5-10%

            • Myalgia (10%)
            • Chest pain (7%)
            • Nausea (7%)
            • Phlebitis (5%)

            (<5%)

            • Bilateral pleural effusion, cardiac irregularity, CHF, edema, hypotension
            • Agitation, lethargy, seizures
            • Diarrhea, vomiting
            • Joint stiffness, Lymph node tenderness, muscle ache
            • Proteinuria
            • Respiratory distress
            • Anaphylactic reaction
            • Diaphoresis

            Post Marketing Experience

            Serum sickness

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            Warnings

            Black Box Warnings

            Should only be prescribed by physicians experienced in immunosuppressive therapy for renal transplant recipients

            Patients should only receive the drug in facilities equipped and staffed with adequate laboratory and supportive medical resources

            Contraindications

            Hypersensitivity to antithymocyte globulin, other equine gamma globulins

            Cautions

            Test for allergic response by intradermal injection before start of treatment

            Discontinue if anaphylaxis, unremitting thrombocytopenia, or unremitting leukopenia occur

            Aplastic anemia patients may need prophylactic platelet transfusion

            Observe patients carefully for previously masked reactions when reducing dose of corticosteroids, other immunosuppressants

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known if excreted in breast milk, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            IgG against human antigen reactive T lymphocytes (equine-derived); causes either elimination of T lymphocytes in peripheral blood or alteration in T-lymphocyte function; in aplastic anemia may induce complete or partial hematologic response

            Pharmacokinetics

            Half-Life: 1.5-12 days

            Peak Plasma: 727±310 mcg/mL

            Excretion: 1% excreted unchanged in urine

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            Administration

            IV Incompatibilities

            IV Preparation

            Dilute required dose in 1/2NS or NS (usually 250-1000 mL); final concentration preferably <4 mg/mL

            Contact with air may result in denaturation of protein

            Do not dilute in dextrose injections, may precipitate if low salt concentration

            Do not dilute in highly acidic IV solutions because of potential physical instability

            Following addition to IV infusion solution, gently rotate or swirl container to thoroughly mix; do not shake

            IV Administration

            IV infusion over at least 4 hr (usually 4-8 hr)

            Administer via high-flow central vein, a vascular shunt, or arteriovenous fistula (eg, Brescia-Cimino fistula); high-flow veins recommended to minimize risk of phlebitis & thrombosis

            Use inline filters with all IV infusions to prevent inadvertent administration of any insoluble material that may develop during storage; 0.2-1 micron filters are generally used, but 5 micron filters have also been employed

            Storage

            Refrigerate

            Protect from freezing

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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