Atgam (lymphocyte immune globulin,antithymocyte (equine))

Dosage of ATG (equine) is expressed in terms of equine IgG.

Monitoring peripheral blood levels of rosette-forming cells (RFCs) during ATG (equine) therapy in allograft recipients has been used by some clinicians to determine the degree of immunosuppression attained and to guide dosage adjustment, with ATG (equine) dosage adjusted to maintain the level of RFCs at about 10% of the pretreatment level; however, other clinicians have questioned the reliability and value of this method. The availability of monoclonal antibodies has allowed monitoring of specific T-cell subsets, and some clinicians currently monitor peripheral blood levels of OKT3-reactive cells as a method for guiding dosage adjustment, with ATG (equine) dosage adjusted to maintain the level of OKT3-reactive cells at about 10% of the pretreatment value.

Antithymocyte globulin (equine) (ATG (equine)) is administered by slow IV infusion. Intradermal sensitivity testing is recommended in all individuals prior to administration of the initial dose of ATG (equine). (See Dosage and Administration: Intradermal Sensitivity Testing.)

ATG (equine) concentrate for injection must be diluted prior to IV infusion. For IV infusion, the required dose of ATG (equine) should be diluted in 0.45 or 0.9% sodium chloride injection (usually 250-1000 mL); the final concentration preferably should not exceed 4 mg of equine IgG per mL. The use of dextrose injections or highly acidic infusion solutions is not recommended. (See Chemistry and Stability: Stability.) The IV infusion solution container into which ATG (equine) concentrate is added should be inverted to prevent contact of undiluted ATG (equine) with air inside the container. Following addition of ATG (equine) to the IV infusion solution, the container should be gently rotated or swirled to thoroughly mix the resultant solution; ATG (equine) concentrate for injection and diluted solutions of the drug should not be shaken since excessive foaming and/or denaturation of the protein may occur. The manufacturer recommends that diluted solutions of ATG (equine) be refrigerated at 2-8degreesC if administration is delayed and that the solutions not be used after a period of 24 hours (including actual infusion time), even if stored at 2-8degreesC.

Patients should be observed continuously throughout IV infusion of ATG (equine) for possible allergic reactions, during both the initial and any subsequent course(s) of therapy. (See Cautions: Precautions and Contraindications.) To prevent or minimize febrile reactions, patients are usually pretreated with an antipyretic (e.g., 650 mg acetaminophen orally), antihistamine (e.g., 25-50 mg diphenhydramine hydrochloride orally), or corticosteroid (e.g., 25-50 mg hydrocortisone IV) or some combination of these agents. ATG (equine) infusions may be administered via a high-flow central vein, a vascular shunt, or an arteriovenous fistula (e.g., Brescia-Cimino fistula); administration via high-flow veins is recommended to minimize the risk of phlebitis and thrombosis. Inline filters should be used with all IV infusions of ATG (equine) to prevent inadvertent administration of any insoluble material that may develop during storage; filters with a pore size of 0.2-1 mcm have generally been used, but 5-mcm filters have also been employed. The required dose of ATG (equine) should be infused over at least 4 hours (usually 4-8 hours). ATG (equine) concentrate for injection and the diluted solution for infusion should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

No enhanced messaging available.

Animal reproduction studies have not been performed with ATG (equine), and it is not known whether ATG (equine) can cause fetal harm when administered to pregnant women. The manufacturer states that use of ATG (equine) during pregnancy is not recommended and should be considered only under exceptional circumstances.

Information on the distribution of ATG (equine) into milk is not available. ATG (equine) may be distributed into milk, since immunoglobulins (e.g., IgA, IgM, IgG) are present in the colostrum. ATG (equine) should be used with caution in nursing women.

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