Indication |
Immunosuppression in solid organ transplantation ATG is usually used in combination with other immunosuppressive drugs Two licensed products are available in the United States: Thymoglobulin® and Atgam® Thymoglobulin® is licensed in the United Kingdom |
Preparations |
Thymoglobulin® - Rabbit anti-thymocyte globulin Intravenous infusion; 25mg per vial. Atgam® - Equine anti-thymocyte globulin Intravenous (IV) infusion; 50mg of equine gamma globulin per ml. |
Contraindications |
Thymoglobulin®: Do not administer if patient has a history of hypersensitivity reactions towards rabbit proteins or to excipients. Atgam®: Do not administer if patient has a history of hypersensitivity reactions towards equine proteins or to excipients.
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Cautions |
Monitor liver function tests. Atgam® There is a risk of developing Creutzfeldt-Jakob disease (CJD). Pre-administration procedures to identify possible patient hypersensitivity reactions: Firstly, commence with a skin prick test using undiluted Atgam®. |
Side-effects |
Cytopenias: Thrombocytopenia, leukopenia. |
Dose |
To reduce the risk of side effects it is recommended to administer an antihistamine and 100mg of hydrocortisone 15-60minutes prior to a full dose of ATG. Thymoglobulin®: Administer alongside other immunosuppressive drugs. To treat acute rejection: Dosing regimen: 1.5mg/kg once daily for 7 to 14 days. As an induction agent: Licensed dosing regimen: 1-1.5mg/kg once a day for 5 to 9 days. Continue with maintenance therapy. Atgam®: Administer alongside other immunosuppressive drugs. To treat acute rejection: The first dose can be administered as soon as acute rejection has been diagnosed. As an induction agent: The first dose can be administered 24 hours before or after the transplantation. |
Dose in renal impairment |
Dose as in normal renal function |
Interactions |
Avoid live vaccines for at least 6 months after treatment There is a risk of over-immunosuppression with concomitant prescribing of standard maintenance immunosuppressive regimens |
How to Prescribe | View Details |
Patient comment |
Advise patients to avoid live vaccines for at least 6 months after treatment Advise patients on the possible side effects during and after administration and to report any unusual symptoms. References: Thymoglobulin® https://www.drugs.com/monograph/antithymocyte-globulin-rabbit.html#unlbl-use https://www.genzymeclinicalresearch.com/pdf/thymoglobulin_pi.pdf Atgam® https://www.drugs.com/monograph/antithymocyte-globulin-equine.html https://labeling.pfizer.com/ShowLabeling.aspx?id=525 |