antithymocyte globulin rabbit (Rx)

Brand and Other Names:Thymoglobulin, ATG rabbit
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 25mg/vial

Acute Renal Graft Rejection

Indicated for the prophylaxis and treatment of acute rejection in patients receiving a kidney transplant in conjunction with concomitant immunosuppression

Treatment: 1.5 mg/kg IV infusion qDay x 7-14 days  

Prophylaxis: 1.5 mg/kg IV qDay with the first dose initiated prior to reperfusion of the donor kidney; usual duration is 4-7 days

Also see Administration

Recommended concomitant medications

  • Use with concomitant immunosuppressants
  • Administer prophylactic antifungal and antibacterial therapy if clinically indicated
  • Antiviral prophylactic therapy is recommended for patients who are seropositive for CMV at the time of transplant and for CMV-seronegative patients scheduled to receive a kidney from a CMV-seropositive donor

Dosage Modifications

Monitor patients for adverse reactions during and after infusion

Monitor total WBC and platelet counts during and after therapy

WBCs 2000-3000 cells/mm³ or platelets 50,000-75,000 cell/mm³: Reduce dose by 50%

WBCs <2000 cell/mm³ or platelets <50,000 cell/mm³: Consider discontinuing

Aplastic Anemia (Off-label)

1.5 mg/kg IV infusion qDay for 7-14 days OR  

3.5 mg/kg IV infusion qDay x 5 days, together with cyclosporine + G-CSF

Myelodysplastic Syndrome (Orphan)

Treatment of myelodysplastic syndrome Data limited; 3.75 mg/kg IV infusion qDay x 5 days  

Orphan indication sponsor

  • Genzyme Corporation; 500 Kendall Street; Cambridge, MA 02142

Solid Organ Transplant Rejection (Orphan)

Indicated for prophylaxis of acute allograft rejection in adult recipients in solid organ transplantation

Orphan indication sponsor

  • Fresenius Biotech North America; 920 Winter Street; Waltham, MA 02451

Graft Versus Host Disease (Orphan)

Indicated for prevention of graft vs host disease; 2 mg/kg IV infusion qDay x 3-4 days

Orphan indication sponsor

  • Fresenius Biotech North America; 920 Winter Street; Waltham, MA 02451

Prophylaxis of Renal Transplant Rejection (Orphan)

Indicated for prophylaxis of acute organ rejection in renal transplant recipients

Orphan indication sponsor

  • Genzyme Corporation; 500 Kendall Street; Cambridge, MA 02142

Safety and efficacy not established

Liver Transplant Rejection (Orphan)

Induction treatment to prevent rejection and to minimize maintenance immunosupression in pediatric liver transplant recipients

Orphan indication sponsor

  • Children's Hospital of Pittsburgh, University of Pittsburgh; Pittsburgh, PA 15213
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Interactions

Interaction Checker

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              Serious - Use Alternative (63)

              • adalimumab

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

              • alefacept

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

              • anakinra

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

              • anthrax vaccine

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

              • antithymocyte globulin equine

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

              • azathioprine

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

              • basiliximab

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

              • BCG vaccine live

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

              • canakinumab

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

              • cyclosporine

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

              • diphtheria & tetanus toxoids

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

              • everolimus

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

              • glatiramer

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

              • golimumab

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

              • hepatitis A vaccine inactivated

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

              • infliximab

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

              • influenza virus vaccine quadrivalent

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

              • leflunomide

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

              • measles (rubeola) vaccine

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

              • mycophenolate

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

              • pneumococcal vaccine 13-valent

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

              • rabies vaccine

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

              • rotavirus oral vaccine, live

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

              • sirolimus

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

              • smallpox (vaccinia) vaccine, live

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

              • tacrolimus

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

              • temsirolimus

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

              • tetanus toxoid adsorbed or fluid

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

              • tocilizumab

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

              • tofacitinib

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

              • tongkat ali

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

              • travelers diarrhea and cholera vaccine inactivated

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

              • ustekinumab

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

              • varicella virus vaccine live

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

              Monitor Closely (23)

              • astragalus

                antithymocyte globulin rabbit 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 rabbit both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • cholera vaccine

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

              • fingolimod

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

              • maitake

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

              • ocrelizumab

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

              • trastuzumab

                trastuzumab, antithymocyte globulin rabbit. 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 rabbit. 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 rabbit 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 rabbit 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

              >10%

              Abdominal pain (38%)

              Asthenia (27%)

              Chills (57%)

              Diarrhea (37%)

              Dyspnea (28%)

              Fever (63%),

              Headache (40%)

              HTN (37%)

              Hyperkalemia (27%)

              Infection (37%)

              Leukopenia (57%)

              Malaise (13%)

              Nausea (37%)

              Pain (46%)

              Peripheral edema (34%)

              Tachycardia (27%)

              Thrombocytopenia (37%)

              1-10%

              Dizziness

              Digestive

              Gastritis

              Oral moniliasis

              Herpes simplex infection

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              Warnings

              Black Box Warnings

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

              Contraindications

              History of allergy or anaphylaxis to rabbit proteins

              Active acute or chronic infections that contraindicate any additional immunosuppression

              Cautions

              To prevent overimmunosuppression, physicians may decrease the dose of the maintenance immunosuppression regimen during the period of antithymocyte globulin rabbit use

              Serious immune-mediated reactions, including anaphylaxis (including fatal anaphylaxis) or severe cytokine release syndrome (CRS), reported; if an anaphylactic reaction occurs, terminate the infusion immediately and implement emergency treatment (eg, 0.3-0.5 mL epinephrine (1 mg/mL) SC and other resuscitative measures including oxygen, IV fluids, antihistamines, corticosteroids, pressor amines, and airway management, as clinically indicated

              CRS reported with rapid infusion rates; CRS is attributed to the release of cytokines by activated monocytes and lymphocytes; severe acute CRS can cause serious cardiorespiratory events and/or death; close compliance with the recommended dosage and infusion time may reduce the incidence and severity of infusion-associated reactions; slowing the infusion rate may minimize many of this risk (see Administration)

              Low counts of platelets and WBCs (including low counts of lymphocytes and neutrophils) have been identified and are reversible following dose adjustments (see Dosage Modifications)

              Routinely used in combination with other immunosuppressive agents; infections (bacterial, fungal, viral and protozoal), reactivation of infection (particularly CMV), and sepsis reported; these infections can be fatal; monitor carefully and administer appropriate anti-infective treatment when indicated

              Immunosuppressives may increase the incidence of malignancies, including lymphoma or lymphoproliferative disorders

              Safety of immunization with attenuated live vaccines following antithymocyte globulin rabbit therapy has not been studied, and therefore, is not recommended following recent therapy

              May interfere with rabbit antibody–based immunoassays and with crossmatch or panel-reactive antibody cytotoxicity assays

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              Pregnancy & Lactation

              Pregnancy

              Unknown whether antithymocyte globulin rabbit therapy can cause fetal harm; use only if benefit outweighs risk

              Animal reproduction studies have not been conducted

              Lactation

              Has not been studied in breastfeeding women; unknown if excreted in human milk

              Because other immunoglobulins are excreted in human milk, breastfeeding should be discontinued during antithymocyte globulin rabbit therapy

              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

              Rabbit gamma-globulins that may cause immunosuppression by acting against human T cell surface antigens and depleting CD4 lymphocytes

              Pharmacokinetics

              Half-Life: 2-3 days

              Peak Plasma: 23-170 mcg/mL

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              Administration

              IV Preparation

              Aseptically reconstitute required number of vials with 5 mL supplied diluent (SWI) immediately before use

              Gently rotate vials to dissolve particulate matters if any; discard if particulate matters persist

              Transfer all reconstituted drug into infusion bag containing saline or dextrose, invert bag to mix

              Recommended volume: 50 mL of infusion solution per vial (total volume between 50-500 mL)

              IV Administration

              Premedicate recommended with corticosteroids, acetaminophen, and/or an antihistamine 1 hr before each infusion; may reduce the incidence and intensity of infusion-associated reactions

              Infuse IV through 0.22 micron filter into high-flow vein

              Infuse first dose over at least 6 hr and subsequent doses over at least 4 hr

              Storage

              Store refrigerated between 2-8°C (36-46°F)

              Protect from light

              Protect from freezing

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              Images

              No images available for this drug.
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              Patient Handout

              Patient Education
              anti-thymocyte globulin (rabbit) intravenous

              ANTI-THYMOCYTE GLOBULIN (RABBIT) - INJECTION

              (AN-ti THIGH-mow-site GLOB-ue-lin)

              COMMON BRAND NAME(S): Thymoglobulin

              USES: This medication is used to prevent and treat rejection of a kidney transplant. This medication belongs to a class of drugs known as immunosuppressants. It works by decreasing your body's natural defense (immune system). This helps prevent your body from rejecting the kidney transplant so it can work normally.

              HOW TO USE: Before receiving this medication, you may be directed to take other medicines (such as acetaminophen, antibiotic, antihistamine, corticosteroid) to decrease side effects during your treatment.This medication is given by a health care professional as directed by your doctor. The dosage is based on your weight, medical condition, lab tests, and response to treatment. It is slowly injected into a vein, usually over at least 4 to 6 hours. Tell your doctor or nurse right away if you notice redness, pain, or swelling during your injection.Follow your doctor's directions for taking your other medications to help prevent your body from rejecting the kidney transplant or to prevent infection. Ask your doctor or pharmacist if you are not sure how to take any of your medicines.

              SIDE EFFECTS: Nausea, fever, chills, diarrhea, dizziness, headache, or tiredness may occur. Redness, pain, or swelling at the injection site may also occur. If any of these effects persist or worsen, tell your doctor promptly.People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, fast/irregular heartbeat, joint/muscle pain, severe stomach/abdominal pain, weakness.Because this drug works by weakening the immune system, it may lower your ability to fight infections. This may make you more likely to get a serious (rarely fatal) infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as cough, sore throat, fever, chills, pain when urinating).This medication may increase the risk of developing certain types of cancer. Consult your doctor for details.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or 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: Before receiving this medication, tell your doctor or pharmacist if you are allergic to it; or to rabbit proteins; or if you have had a severe reaction to other immune globulins; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Tell your doctor your medical history, especially of: bleeding/blood clotting problems, recent/current infections.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medication can make you more likely to get infections or may worsen any current infections. Wash your hands well to prevent the spread of infection. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.This medication may increase your risk of developing skin cancer. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Your doctor may direct you to avoid phototherapy while you use this product. Ask your doctor for details.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other drugs that weaken the immune system (such as azathioprine, cyclosporine, cancer chemotherapy).This medication may interfere with certain lab tests, possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

              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: Laboratory and/or medical tests (such as complete blood counts) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

              STORAGE: Not applicable. This medication is given in a hospital or clinic and will not be stored at home.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 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.