Generic Name:

Anti-Thymocyte Globulin (Rabbit), Rabbit ATG

Trade Name:

Thymoglobulin

Action:

Immunosuppression by destruction of thymus derived lymphocytes byphagocytosis

Indications:

Prevention or treatment of organ transplant rejection

Usual Dose:

MD ORDER SHOULD SPECIFY SOURCE (e.g. Rabbit)

Prophylaxis: 1 – 2 mg/kg/day for 5 to 14 days

Treatment: 1.5 mg/kg/day for 7 to 14 days

ADMINISTER FIRST DOSE OVER 6 HOURS. Subsequent doses may be infused over 4 hours through a high-flow vein.

Standard Concentration:

Dilute in either 0.45% Sodium Chloride or 0.9% Sodium Chloride ONLY

Maximum concentration is 0.5 mg/mL

Administration Guidelines:

Administer via 0.22-micr on in-line filter. A dedicated line required for administration; do not give with other parenteral medications or carrier.

Central line preferred for venous administration. In cases of emergency or extenuating circumstances, Rabbit ATG may be given peripherally into a high-flow vein while preparation for central line is underway using at least a 2-inch peripheral IV cannula.

Prepared solutions must be used immediately. Under refrigeration, solution is stable for 24 hours.

Special Considerations:

To prevent foaming, aspirate medication carefully

Do not shake IV once mixed to prevent denaturation of the proteins

Premedication to reduce adverse reactions:

· Diphenhydramine 25-50mg, 30 minutes before first treatment

· Methylprednisolone 40-60 mg, 30 minutes before the first (and possibly second) treatment.

· Acetaminophen 650 mg PO/PR is given 30 minutes prior to first and second treatment. This may be continued throughout the treatment.

CBC should be drawn prior to administration (baseline CBC to monitor for leukopenia & thrombocytopenia)

Concomitant immunosuppression may be reduced during treatment

Precautions and Side Effects:

Chills, fever may occur with first dose

Leukopenia (57%) and Thrombocytopenia (36%)

Local inflammatory reaction if venous extravasation occurs

Hypertension, tachycardia, peripheral edema, myalgia

Headache, nausea, vomiting, diarrhea