varicella zoster immune globulin, human (Rx)

Brand and Other Names:VariZIG
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intramuscular injection

  • 125 IU/vial (lyophilized powder)
  • 100 IU/mL (after reconstitution)

Varicella, Postexposure Prophylaxis

Indicated for reducing the severity of chicken pox (varicella zoster virus) infections in high risk individuals after exposure

625 units IM within 10 days after exposure (ideally within 4 days [96 hr])

Consider a second full dose for high risk patients who have additional exposures to varicella >3 weeks after initial administration

Dosing Considerations

High risk groups include

  • Immunocompromised patients without evidence of immunity
  • Pregnant women without evidence of immunity

Reduces severity only

  • There is no convincing evidence that varicella zoster immune globulin (VZIG) reduces the incidence of chickenpox infection after exposure to VZV
  • There is no convincing evidence that established infections with VZV can be modified by VZIG administration
  • There is no indication for the prophylactic use of VZIG in immunodeficient children or adults when there is a past history of varicella, unless the patient is undergoing bone marrow transplantation

Administration

Inject IM into the deltoid muscle or the anterolateral aspects of the upper thigh

Due to the risk of sciatic nerve injury, do not use the gluteal region as a routine injection site; if gluteal region is used, only use the upper, outer quadrant

Depending on patient size, divide the IM dose and administer in 2 or more injection sites; not to exceed 3 mL/injection site

Dosage Forms & Strengths

intramuscular injection

  • 125 IU/vial (lyophilized powder)
  • 100 IU/mL (after reconstitution)

Varicella, Postexposure Prophylaxis

Indicated for reducing the severity of chicken pox (varicella zoster virus) infections in high risk individuals after exposure

125 IU/10kg IM; not to exceed 625 IU/dose

Administer within 10 days after exposure (ideally within 4 days [96 hr])

<2 kg: 62.5 IU IM

2.1-10 kg: 125 IU IM

10.1-20 kg: 250 IU IM

20.1-30 kg: 375 IU IM

30.1-40 kg: 500 IU IM

>40 kg: 625 IU IM

Consider a second full dose for high risk patients who have additional exposures to varicella >3 weeks after initial administration

Dosing Considerations

High risk groups include

  • Immunocompromised patients without evidence of immunity
  • Newborn infants whose mothers have signs and symptoms of varicella around the time of delivery (ie, 5 days before to 2 days after)
  • Hospitalized premature infants born at 28 weeks of gestation or greater whose mothers do not have evidence of immunity to varicella
  • Hospitalized premature infants born at <28 weeks of gestation or who weigh 1 kg or less at birth, regardless of their mothers' evidence of immunity to varicella

Reduces severity

  • There is no convincing evidence that varicella zoster immune globulin (VZIG) reduces the incidence of chickenpox infection after exposure to VZV
  • There is no convincing evidence that established infections with VZV can be modified by VZIG administration
  • There is no indication for the prophylactic use of VZIG in immunodeficient children or adults when there is a past history of varicella, unless the patient is undergoing bone marrow transplantation

Administration

For IM use only

Depending on patient size, divide the IM dose and administer in 2 or more injection sites; not to exceed 3 mL/injection site

Inject IM into the deltoid muscle or the anterolateral aspects of the upper thigh

Due to the risk of sciatic nerve injury, do not use the gluteal region as a routine injection site; if gluteal region is used, only use the upper, outer quadrant

Infants/small children: Administer IM in anterolateral aspect of thigh

Next:

Interactions

Interaction Checker

and varicella zoster immune globulin, human

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (0)

                  Minor (1)

                  • protein a column

                    protein a column decreases levels of varicella zoster immune globulin, human 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.

                  Previous
                  Next:

                  Adverse Effects

                  1-10%

                  Injection site pain (2%)

                  Headache (2%)

                  Frequency Not Defined

                  Chills

                  Fatigue

                  Rash

                  Nausea

                  Thrombosis

                  Previous
                  Next:

                  Warnings

                  Contraindications

                  Anaphylactic or hypersensitivity reactions to human immune globulin preparations

                  IgA-deficient patients with antibodies against IgA and a history of hypersensitivity may have an anaphylactoid reaction; contains <40 mcg/mL of IgA

                  Cautions

                  Thrombotic events reported during or following treatment with immune globulin products; individuals at risk include those with history of atherosclerosis, multiple cardiovascular risk factors, advanced age, impaired cardiac output, coagulation disorders, prolonged periods of immobilization, and/or known/suspected hyperviscosity

                  For IM administration only; patients with severe thrombocytopenia or any coagulation disorder that would contraindicate IM injections, only administer if the expected benefits outweigh the potential risks

                  Made from human plasma, may carry risk of transmitting infectious agents (eg, viruses, variant Creutzfeldt-Jakob disease [vCJD] agent)

                  Previous
                  Next:

                  Pregnancy & Lactation

                  Pregnancy Category: C

                  Lactation: Unknown whether distributed in breast milk

                  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.

                  Previous
                  Next:

                  Pharmacology

                  Mechanism of Action

                  Solvent/detergent-treated sterile lyophilized preparation of purified human immune globulin G (IgG) containing antibodies to varicella zoster virus

                  Provides passive immunization for nonimmune individuals exposed to varicella zoster virus, thereby reducing the severity of varicella infections

                  Absorption

                  Peak plasma time: 4.5 days

                  Peak plasma concentration: 136 mIU/mL

                  AUC: 2472-4087 mIU•day/mL (24-84 days)

                  Elimination

                  Half-life: 26.2 days

                  Total body clearance: 0.204 mL/day

                  Previous
                  Next:

                  Administration

                  IM Preparation

                  Only use the accompanying sterile diluent when reconstituting lyophilized powder

                  To reconstitute

                  • Remove caps from the sterile diluent provided and VZIG vials
                  • Wipe exposed central portion of each rubber stopper with suitable disinfectant
                  • Withdraw 1.25 mL of the sterile diluent using a suitable syringe and needle
                  • Inject diluent slowly into the VZIG vial at an angle so that the liquid is directed onto the inside glass wall of the vial containing the freeze-dried pellet
                  • Wet pellet by gently tilting and inverting the vial to avoid frothing; gently swirl upright vial until dissolved (<10 minutes); DO NOT SHAKE

                  Inspect visually for particulate matter and discoloration prior to administration

                  Do not use if turbid and/or discoloration is observed

                  IM Administration

                  For IM use only

                  Depending on patient size, divide the IM dose and administer in 2 or more injection sites; not to exceed 3 mL/injection site

                  Inject IM into the deltoid muscle or the anterolateral aspects of the upper thigh

                  Due to the risk of sciatic nerve injury, do not use the gluteal region as a routine injection site; if gluteal region is used, only use the upper, outer quadrant

                  Infants/small children: Administer IM in anterolateral aspect of thigh

                  Storage

                  Unopened vials: Store refrigerated between 2-8°C (36-46°F); do not freeze

                  Reconstituted vials: Use within 12 hr of reconstitution if stored at 2-8°C; contains no preservative

                  Previous
                  Next:

                  Images

                  No images available for this drug.
                  Previous
                  Next:

                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
                  Previous
                  Next:

                  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.
                  Additional Offers
                  Email to Patient

                  From:

                  To:

                  The recipient will receive more details and instructions to access this offer.

                  By clicking send, you acknowledge that you have permission to email the recipient with this information.

                  Email Forms to Patient

                  From:

                  To:

                  The recipient will receive more details and instructions to access this offer.

                  By clicking send, you acknowledge that you have permission to email the recipient with this information.

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