Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 50mg/mL
Vaccinia Infection
6000 Units/kg IV; may require additional dose of 9000 Units/kg if patient unresponsive to lower dose
Renal Impairment
Use caution; administer at minimum rate of infusion; discontinue if renal deterioration worsens
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (6)
- axicabtagene ciloleucel
vaccinia immune globulin intravenous, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- brexucabtagene autoleucel
vaccinia immune globulin intravenous, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- ciltacabtagene autoleucel
vaccinia immune globulin intravenous, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- idecabtagene vicleucel
vaccinia immune globulin intravenous, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- lisocabtagene maraleucel
vaccinia immune globulin intravenous, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- tisagenlecleucel
vaccinia immune globulin intravenous, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
Monitor Closely (8)
- adenovirus types 4 and 7 live, oral
vaccinia immune globulin intravenous decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Use Caution/Monitor. Defer live vaccines for 3 months after immune globulin administration.
- BCG vaccine live
vaccinia immune globulin intravenous decreases effects of BCG vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Defer live vaccines for 3 months after immune globulin administration.
- efgartigimod alfa
efgartigimod alfa will decrease the level or effect of vaccinia immune globulin intravenous by receptor binding competition. Use Caution/Monitor. Coadministration of efgartigimod with medications that bind to the human neonatal Fc receptor may lower systemic exposures and effectiveness of such medications. Closely monitor for reduced effectiveness of medications that bind to the human neonatal Fc receptor. If long-term use of such medications is essential, consider discontinuing efgartigimod and using alternative therapies.
- measles mumps and rubella vaccine, live
vaccinia immune globulin intravenous decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Use Caution/Monitor. Defer live vaccines for 3 months after immune globulin administration.
- measles, mumps, rubella and varicella vaccine, live
vaccinia immune globulin intravenous decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Use Caution/Monitor. Defer live vaccines for 3 months after immune globulin administration.
- rubella vaccine
vaccinia immune globulin intravenous decreases effects of rubella vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Defer live vaccines for 3 months after immune globulin administration.
- smallpox (vaccinia) vaccine, live
vaccinia immune globulin intravenous decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Use Caution/Monitor. Defer live vaccines for 3 months after immune globulin administration.
- varicella virus vaccine live
vaccinia immune globulin intravenous decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Defer live vaccines for 3 months after immune globulin administration.
Minor (1)
- protein a column
protein a column decreases levels of vaccinia immune globulin intravenous 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.
Adverse Effects
1-10%
Abdominal pain
Arthalgia
Dizziness
Headache
Inj site reactions
Nausea
Dyspnea
URI
Contact dermatitis
Erythema
Flushing
Skin lacerations
Urticaria
Warnings
Black Box Warnings
Associated with renal dysfunction, acute renal failure, osmotic nephrosis, and death
Administer IV at minimum concentration available and minimum rate of infusion in patients predisposed to acute renal failure; IVIG products containing sucrose as a stabilizer or at daily doses >400 mg/kg account for a disproportionate share of case reports involving renal failure
Maltose in vaccinia immune globulin can interact with glucose monitoring and cause unncessary use of insulin
Patients predisposed to acute renal failure
- Any degree of preexisting renal insufficiency
- Diabetes mellitus
- Age >65 years
- Volume depletion
- Sepsis
- Paraproteinemia
- Currently taking nephrotoxic drugs
Contraindications
Hypersensitivity to immunoglobulins
Presence of isolated vaccinia keratitis
IGA deficiency
Cautions
Contains 5% sucrose as preservative. Immunoglobulins with sucrose preservative have been associated with ARF, renal dysfunction, osmotic nephrosis, proximal tubular nephropathy, & death
Not effective against postvaccinial encephalitis
Renal impairment & conditions that incr risk of renal impairment
Vaccination with live viruses should be deferred for at least 6 mth postadministration
Maltose in vaccinia immune globulin can cause false readings in glucose monitoring systems
Derived from human plasma, small risk of viral transmission through admin
Pregnancy & Lactation
Pregnancy Category: C
Lactation: 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.Pharmacology
Mechanism of Action
Human immune globulins from donors who received booster shots of vaccinia virus (Dryvax)
Pharmacokinetics
Half-Life: 13-67 days
Peak plasma time: ≤ 2 hr
Vd: 6630 L
Administration
IV Administration
Begin infusion within 6 hr of entering vial & complete within 12 hr of entering vial
Infuse at 1 mL/kg/hr for first 30 min, THEN 2 mL/kg/hr for next 30 min, THEN 3 mL/kg/hr for the remainder
Predilution not recommended
Through dedicated IV catheter with in-line 0.22 micron filter OR
IVPB into preexisting catheter if the catheter contains NS, D2.5W, D5W, D10W or D20W
If using preexisting catheter flush catheter before use, and do not dilute VIGIV more than 1:2
Adverse Event Management
Reduce infusion rate or interrupt if minor
In case of anaphylactoid reactions, may use epinephrine with or without diphenhydramine
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Formulary
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