Anti T lymphocyte globulin
Lymphocyte immune globulin, anti-thymocyte globulin (equine) sterile solution
(Atgam)
Classification: Immunosuppressant
Action/Kinetics: Obtained from hyperimmune serum of horses immunized with human
thymus lymphocytes. Reduces the number of circulating, thymus-dependent
lymphocytes that form rosettes from sheep erythrocytes. Antilymphocytic effect
may be due to alteration of the function of T-lymphocytes, which are
responsible, in part, for cell-mediated immunity. t1/2, serum: 5.7 days when the
drug is given with other immunosuppressants and measured as horse IgG.
Uses: Management of allograft rejection in renal transplant clients, given
either at the time of rejection or as an adjunct with other immunosuppressants
to delay onset of the first rejection episode. Treatment of moderate to severe
aplastic anemia in those who are unsuitable for bone marrow transplantation.
Contraindications: In those who have demonstrated a severe systemic reaction
during prior administration of the drug or any other equine gamma globulin
preparation.
Special Concerns: A systemic reaction, such as a generalized rash, tachycardia,
dyspnea, hypotension, or anaphylaxis, precludes any further administration of
the drug. Potency may vary from lot to lot. The possibility of transmission of
infectious agents exists. Use with caution during lactation.
Side Effects: General side effects. Whole body: Fever, chills, systemic or
localized infection, malaise, serum sickness, edema, sweating. GI: N&V,
diarrhea, GI bleeding or perforation sore mouth or throat, epigastric or stomach
pain, abdominal pain. CNS: Headache, seizures confusion, disorientation,
dizziness, faintness, paresthesias. CV: Hypertension or hypotension,
tachycardia, deep vein thrombosis, thrombophlebitis, CHF, vasculitis, renal
artery thrombosis. Hematologic: Thrombocytopenia, leukopenia, eosinophilia,
neutropenia, granulocytopenia, anemia, lymphadenopathy, aplasia, pancytopenia,
hemolysis, hemolytic anemia. Dermatologic: Rashes. Respiratory: Dyspnea, apnea,
cough, pulmonary edema nosebleed. Musculoskeletal: Chest, back, or flank pain;
arthralgia, myalgias, leg pains, abnormal involuntary movement or tremor,
rigidity. Miscellaneous: Herpes simplex infection, swelling or redness at
infusion site, swelling, anaphylaxis, laryngospasm/edema hyperglycemia, acute
renal failure viral hepatitis, enlarged or ruptured kidney.
When used for renal transplantation with other immunosuppressants. Whole body:
Fever, chills, weakness or faintness. CNS: Headache, dizziness, paresthesia,
seizures. GI: Diarrhea, nausea and/or vomiting, stomatitis, hiccoughs,
epigastric pain, malaise. Hematologic: Leukopenia, thrombocytopenia.
Dermatologic: Rash, pruritus, urticaria, wheal, flare. CV: Hypotension,
peripheral thrombophlebitis, edema, hypertension, renal artery stenosis,
tachycardia. Musculoskeletal: Arthralgia, chest or back pain (or both), myalgia.
Respiratory: Dyspnea, laryngospasm, pulmonary edema. Miscellaneous: Clotted
arteriovenous fistula, pain at infusion site, night sweats, anaphylaxis herpes
simplex reactivation, hyperglycemia, iliac vein obstruction, localized
infection, lymphadenopathy, serum sickness, systemic infection, toxic epidermal
necrosis wound dehiscence.
When used for aplastic anemia with support therapy. Whole body: Fever, chills,
diaphoresis, aches. GI: N&V, diarrhea. CNS: Headache, agitation, lethargy,
listlessness, lightheadedness, seizures encephalitis or postviral
encephalopathy. CV: Chest pain, phlebitis, bradycardia, myocarditis, cardiac
irregularity, hypotension, CHF, hypertension. Hematologic: Lymphadenopathy,
postcervical lymphadenopathy, tender lymph nodes. Respiratory: Bilateral pleural
effusion, respiratory distress. Musculoskeletal: Arthralgia, myalgia, joint
stiffness, muscle aches. Miscellaneous: Periorbital edema, edema,
hepatosplenomegaly, burning soles/palms, foot sole pain, proteinuria,
anaphylaxis.
Laboratory Test Alterations: SGOT, SGPT, alkaline phosphatase, serum
creatinine.
Drug Interactions: Previously masked reactions to Atgam may appear when the drug
is given concomitantly with corticosteroids or other immunosuppressants.
How Supplied: Injection: 50 mg/mL
Dosage
β’IV Only Renal allograft recipients.
Adults: 10-20 mg/kg daily. Children: 5-25 mg/kg daily. Usually used
concomitantly with azathioprine and corticosteroids. When used to delay the
onset of allograft rejection, a fixed dose of 15 mg/kg for 14 days is used;
then, the dose is given every other day for 14 days for a total of 21 doses in
28 days. Give the first dose within 24 hr before or after the transplant. When
used to treat rejection, the recommended dose is 10-15 mg/kg daily for 14 days;
additional alternate day therapy can be given for a total of 21 doses. The first
dose can be delayed until after the diagnosis of the first rejection episode.
Aplastic anemia.
10-20 mg/kg daily for 8-14 days; additional alternate day therapy may be given
for a total of 21 doses.