antithymocyte globulin equine (Rx)

Brand and Other Names:Atgam, ATG equine
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 50mg/mL

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

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

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            Contraindicated (1)

            • upadacitinib

              antithymocyte globulin equine, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated.

            Serious - Use Alternative (69)

            • adalimumab

              adalimumab and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • alefacept

              alefacept and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • anakinra

              anakinra and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • anthrax vaccine

              antithymocyte globulin equine decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • antithymocyte globulin rabbit

              antithymocyte globulin equine and antithymocyte globulin rabbit both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • axicabtagene ciloleucel

              antithymocyte globulin equine, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • azathioprine

              antithymocyte globulin equine and azathioprine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • basiliximab

              antithymocyte globulin equine and basiliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • BCG vaccine live

              antithymocyte globulin equine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • brexucabtagene autoleucel

              antithymocyte globulin equine, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • canakinumab

              antithymocyte globulin equine and canakinumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • ciltacabtagene autoleucel

              antithymocyte globulin equine, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • cyclosporine

              antithymocyte globulin equine and cyclosporine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • diphtheria & tetanus toxoids

              antithymocyte globulin equine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • diphtheria & tetanus toxoids/ acellular pertussis vaccine

              antithymocyte globulin equine decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine

              antithymocyte globulin equine decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • etanercept

              antithymocyte globulin equine and etanercept both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • everolimus

              antithymocyte globulin equine and everolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • glatiramer

              antithymocyte globulin equine and glatiramer both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • golimumab

              antithymocyte globulin equine and golimumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • hepatitis A vaccine inactivated

              antithymocyte globulin equine decreases effects of hepatitis A vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • hepatitis a/b vaccine

              antithymocyte globulin equine decreases effects of hepatitis a/b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • hepatitis a/typhoid vaccine

              antithymocyte globulin equine decreases effects of hepatitis a/typhoid vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • hepatitis b vaccine

              antithymocyte globulin equine decreases effects of hepatitis b vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • human papillomavirus vaccine, nonavalent

              antithymocyte globulin equine decreases effects of human papillomavirus vaccine, nonavalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

            • human papillomavirus vaccine, quadrivalent

              antithymocyte globulin equine decreases effects of human papillomavirus vaccine, quadrivalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

            • hydroxychloroquine sulfate

              antithymocyte globulin equine and hydroxychloroquine sulfate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • idecabtagene vicleucel

              antithymocyte globulin equine, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • infliximab

              antithymocyte globulin equine and infliximab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • influenza virus vaccine quadrivalent

              antithymocyte globulin equine decreases effects of influenza virus vaccine quadrivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • influenza virus vaccine quadrivalent, adjuvanted

              antithymocyte globulin equine decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

            • influenza virus vaccine quadrivalent, cell-cultured

              antithymocyte globulin equine decreases effects of influenza virus vaccine quadrivalent, cell-cultured by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • influenza virus vaccine quadrivalent, intranasal

              antithymocyte globulin equine decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • influenza virus vaccine trivalent

              antithymocyte globulin equine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • influenza virus vaccine trivalent, adjuvanted

              antithymocyte globulin equine decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

            • Japanese encephalitis virus vaccine

              antithymocyte globulin equine decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • leflunomide

              antithymocyte globulin equine and leflunomide both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • lisocabtagene maraleucel

              antithymocyte globulin equine, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • measles (rubeola) vaccine

              antithymocyte globulin equine decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • measles mumps and rubella vaccine, live

              antithymocyte globulin equine decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • measles, mumps, rubella and varicella vaccine, live

              antithymocyte globulin equine decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • meningococcal A C Y and W-135 polysaccharide vaccine combined

              antithymocyte globulin equine decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • muromonab CD3

              antithymocyte globulin equine and muromonab CD3 both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • mycophenolate

              antithymocyte globulin equine and mycophenolate both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • pneumococcal vaccine 13-valent

              antithymocyte globulin equine decreases effects of pneumococcal vaccine 13-valent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • pneumococcal vaccine heptavalent

              antithymocyte globulin equine decreases effects of pneumococcal vaccine heptavalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • pneumococcal vaccine polyvalent

              antithymocyte globulin equine decreases effects of pneumococcal vaccine polyvalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • rabies vaccine

              antithymocyte globulin equine decreases effects of rabies vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants may interfere with development of active immunity.

            • rabies vaccine chick embryo cell derived

              antithymocyte globulin equine decreases effects of rabies vaccine chick embryo cell derived by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • rilonacept

              antithymocyte globulin equine and rilonacept both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • rotavirus oral vaccine, live

              antithymocyte globulin equine decreases effects of rotavirus oral vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • rubella vaccine

              antithymocyte globulin equine decreases effects of rubella vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • sirolimus

              antithymocyte globulin equine and sirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • smallpox (vaccinia) vaccine, live

              antithymocyte globulin equine decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • tacrolimus

              antithymocyte globulin equine and tacrolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • temsirolimus

              antithymocyte globulin equine and temsirolimus both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • tetanus toxoid adsorbed or fluid

              antithymocyte globulin equine decreases effects of tetanus toxoid adsorbed or fluid by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • tick-borne encephalitis vaccine

              antithymocyte globulin equine decreases effects of tick-borne encephalitis vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • tisagenlecleucel

              antithymocyte globulin equine, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • tocilizumab

              tocilizumab and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • tofacitinib

              antithymocyte globulin equine, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • tongkat ali

              antithymocyte globulin equine and tongkat ali both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • travelers diarrhea and cholera vaccine inactivated

              antithymocyte globulin equine decreases effects of travelers diarrhea and cholera vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • typhoid polysaccharide vaccine

              antithymocyte globulin equine decreases effects of typhoid polysaccharide vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • typhoid vaccine live

              antithymocyte globulin equine decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • ustekinumab

              antithymocyte globulin equine and ustekinumab both increase immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

            • varicella virus vaccine live

              antithymocyte globulin equine decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • yellow fever vaccine

              antithymocyte globulin equine decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • zoster vaccine live

              antithymocyte globulin equine decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            Monitor Closely (24)

            • astragalus

              antithymocyte globulin equine increases and astragalus decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • belatacept

              belatacept and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              belatacept, antithymocyte globulin equine. Either decreases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Venous thrombosis of the renal allograft when belatacept and antithymocyte coadministered at the same or nearly the same time.

            • cholera vaccine

              antithymocyte globulin equine decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

            • dengue vaccine

              antithymocyte globulin equine decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

            • echinacea

              antithymocyte globulin equine increases and echinacea decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fingolimod

              antithymocyte globulin equine increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

            • haemophilus influenzae type b vaccine

              antithymocyte globulin equine decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored.

            • influenza virus vaccine quadrivalent, recombinant

              antithymocyte globulin equine decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

            • influenza virus vaccine trivalent, recombinant

              antithymocyte globulin equine decreases effects of influenza virus vaccine trivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

            • isavuconazonium sulfate

              antithymocyte globulin equine and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.

            • maitake

              antithymocyte globulin equine increases and maitake decreases immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meningococcal group B vaccine

              antithymocyte globulin equine decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

            • mercaptopurine

              antithymocyte globulin equine and mercaptopurine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

            • ocrelizumab

              antithymocyte globulin equine and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with high doses of corticosteroids is expected to increase the risk of immunosuppression.

            • ofatumumab SC

              ofatumumab SC, antithymocyte globulin equine. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

            • olaparib

              antithymocyte globulin equine and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

            • ozanimod

              ozanimod, antithymocyte globulin equine. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.

            • poliovirus vaccine inactivated

              antithymocyte globulin equine decreases effects of poliovirus vaccine inactivated by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

            • ponesimod

              ponesimod and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

            • siponimod

              siponimod and antithymocyte globulin equine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

            • sipuleucel-T

              antithymocyte globulin equine decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

            • trastuzumab

              trastuzumab, antithymocyte globulin equine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

            • trastuzumab deruxtecan

              trastuzumab deruxtecan, antithymocyte globulin equine. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .

            • zoster vaccine recombinant

              antithymocyte globulin equine decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.

            Minor (1)

            • protein a column

              protein a column decreases levels of antithymocyte globulin equine by Other (see comment). Minor/Significance Unknown. Comment: Since Prosorba binds IgG, it could theoretically interfere with the levels and/or effects of pharmacologic immune globulins.

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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.

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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

            BRAND FORM. UNIT PRICE PILL IMAGE
            Atgam intravenous
            -
            50 mg/mL solution
            Atgam intravenous
            -
            50 mg/mL solution

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            lymphocyte,anti-thymo immune globulin intravenous

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2022 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.