Antithymocyte globulins can cause anaphylaxis when injected intravenously. Although antithymocyte globulin (equine) is processed to reduce the level of antibodies that will react to non-T cells, health care providers should be prepared for the potential risk of anaphylaxis and monitor patients for signs and symptoms during infusion.
Note: Test dose: While a skin test is recommended prior to administration of the initial dose, anaphylaxis may still occur in patients who display negative skin tests. Consider testing initially with an epicutaneous prick of undiluted antithymocyte globulin (ATG); if no wheal in 10 minutes, then use 0.02 mL intradermally of a 1:1000 dilution of ATG in normal saline along with a separate saline control of 0.02 mL; observe in 10 minutes. A positive skin reaction consists of a wheal with the initial prick test (undiluted) or ≥3 mm in diameter larger than the saline control with the diluted intradermal test. Alternatively, a 0.1 mL test dose (5 mg/mL concentration) may be administered intradermally along with a separate saline control; erythema larger than 5 mm in diameter (compared to the control) is considered a positive test (Molldrem 2002). A positive skin test is suggestive of an increased risk for systemic allergic reactions with an infusion. If ATG treatment is deemed appropriate following a positive skin test, the first infusion should be administered in a controlled environment with intensive life support immediately available. A systemic reaction precludes further administration.
Consider premedication with an antihistamine, corticosteroids, and/or an antipyretic. Concomitant immunosuppressants should also be administered.
Aplastic anemia, moderate to severe: IV: 10 to 20 mg/kg once daily for 8 to 14 days, then if needed, may administer every other day for 7 more doses for a total of 21 doses in 28 days or
Aplastic anemia, severe (off-label dosing): IV: 40 mg/kg once daily for 4 days (in combination with cyclosporine) (Rosenfeld 1995; Scheinberg 2011) or 40 mg/kg once daily for 4 consecutive days (in combination with cyclosporine and eltrombopag) (Patel 2022; Peffault de Latour 2022).
Acute graft-versus-host disease, treatment (off-label use): IV: 30 mg/kg every other day for 6 doses (MacMillan 2007) or 15 mg/kg twice daily for 10 doses (MacMillan 2002)
Lung transplant, induction therapy (off- label use): IV: 5 to 15 mg/kg daily for the first 3 days after transplant (Hachem 2005). Additional data may be necessary to further define the role of antithymocyte globulin (equine) in this condition.
Myelodysplastic syndromes, refractory, lower-risk disease (off-label use): IV: 40 mg/kg once daily for 4 days; an intradermal test dose was administered prior to treatment (Molldrem 2002).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Antithymocyte globulin (horse derived, Atgam): Pediatric drug information")
Test dose: While a skin test is recommended prior to administration of the initial dose, anaphylaxis may still occur in patients who display a negative skin test. Consider testing initially with an epicutaneous prick of undiluted antithymocyte globulin (ATG); if no wheal in 10 minutes, then use 0.02 mL intradermally of a 1 mg/mL dilution of ATG in normal saline along with a separate saline control of 0.02 mL; observe in 10 minutes. A positive skin reaction consists of a wheal with the initial prick test (undiluted) or ≥3 mm in diameter larger than the saline control with the diluted intradermal test. A positive skin test is suggestive of an increased risk for systemic allergic reactions with an infusion, although anaphylaxis may occur in patients who display negative skin tests. If ATG treatment is deemed appropriate following a positive skin test, the first infusion should be administered in a controlled environment with intensive life support immediately available. A systemic reaction precludes further administration of the drug. Note: Consider premedication with an antihistamine, corticosteroids, and/or an antipyretic.
Aplastic anemia, moderate to severe when no HLA-matched sibling donor:
Manufacturer's labeling: Children and Adolescents: IV: 10 to 20 mg/kg/dose once daily for 8 to 14 days; then if needed, may administer every other day up to a total of 21 doses in 28 days
Alternate dosing (in combination with cyclosporine): Limited data available: Children ≥2 years and Adolescents: IV: 40 mg/kg/dose once daily for 4 days (Afable 2011; Rosenfeld 1995; Scheinberg 2009; Scheinberg 2011)
Renal transplantation rejection, treatment: Children and Adolescents: IV: 10 to 15 mg/kg/dose once daily for 14 days, then if needed, may administer every other day up to a total of 21 doses in 28 days
Acute graft-versus-host disease, steroid-resistant, treatment: Limited data available: Children and Adolescents: IV: 30 mg/kg/dose every other day for 6 doses (MacMillan 2007) or 15 mg/kg/dose twice daily for 10 doses (MacMillan 2002)
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing. Begin at the lower end of dosing ranges.
American Society for Blood and Marrow Transplantation practice guideline committee position statement on chemotherapy dosing in adults with a BMI ≥30 kg/m2: Utilize actual body weight to calculate weight-based dosing for hematopoietic cell transplant conditioning regimens (ASBMT [Bubalo 2014]).
Anaphylaxis: Discontinue infusion immediately; administer epinephrine. May require corticosteroids, respiration assistance, and/or other resuscitative measures. Do not resume infusion.
Hemolysis (severe and unremitting): May require discontinuation of treatment.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injectable, Intravenous [preservative free]:
Atgam: 50 mg/mL (5 mL) [thimerosal free]
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injectable, Intravenous:
Atgam: 50 mg/mL (5 mL)
IV: For IV use only. Infuse over at least 4 hours through a 0.2 to 1 micron inline filter. Allow solution to reach room temperature prior to infusion. Infusion must be completed with 24 hours of preparation. Administration through a central line is recommended; high flow veins are preferred to reduce phlebitis (infuse into vascular shunt, arterial venous fistula, or high-flow central vein). May cause vein irritation (chemical phlebitis) if administered peripherally (peripheral administration is not recommended).
Monitor closely throughout the infusion for allergic reactions. Appropriate resuscitative equipment should be nearby during administration. May require premedication with an antipyretic, antihistamine, and/or a corticosteroid to prevent reactions. Discontinue infusion for anaphylaxis or respiratory distress. Administer epinephrine, corticosteroids, antihistamines, and/or antipyretics as indicated to manage reactions.
Due to possible infusion-related reactions, it may be preferable to avoid initiating treatment late in the day or on weekends; consider withholding beta-blockers prior to administration to avoid suppressing compensatory responses to anaphylaxis (Scheinberg, 2012).
IV: Infuse dose over at least 4 hours through a 0.2 to 1 micron in-line filter. May need to slow rate of infusion if patient experiences fever or chills during infusion (Rosenfeld 1995). Allow solution to reach room temperature prior to infusion. Infusion must be completed with 24 hours of preparation. May cause vein irritation (chemical phlebitis) if administered peripherally; infuse into a vascular shunt, arterial venous fistula, or high-flow central vein. Any severe systemic reaction to the skin test, such as generalized rash, tachycardia, dyspnea, hypotension, or anaphylaxis, should preclude further therapy. Epinephrine and resuscitative equipment should be nearby. Patient may need to be pretreated with an antipyretic, antihistamine, and/or corticosteroid. Mild itching and erythema can be treated with antihistamines.
Aplastic anemia, moderate to severe: Treatment of moderate-to-severe aplastic anemia in patients not considered suitable candidates for bone marrow transplantation.
Limitations of use: The usefulness of antithymocyte globulin (equine) has not been demonstrated in patients with aplastic anemia who are suitable candidates for transplantation, or in aplastic anemia secondary to neoplastic disease, storage disease, myelofibrosis, Fanconi syndrome, or in patients with known prior treatment with myelotoxic agents or radiation therapy.
Acute graft-versus-host disease (treatment); Lung transplant (induction therapy); Myelodysplastic syndromes, refractory, lower-risk disease
Antithymocyte globulin equine (Atgam) may be confused with antithymocyte globulin rabbit (Thymoglobulin)
Atgam may be confused with Ativan
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs that have a heightened risk of causing significant patient harm when used in error.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Central nervous system: Chills, headache
Dermatologic: Dermatological reaction (wheal/flare), pruritus, skin rash, urticaria
Hematologic & oncologic: Leukopenia, thrombocytopenia
Neuromuscular & skeletal: Arthralgia
Miscellaneous: Fever
1% to 10%:
Cardiovascular: Bradycardia, cardiac disease, cardiac failure, chest pain, edema, hypertension, hypotension, myocarditis, phlebitis, thrombophlebitis
Central nervous system: Agitation, brain disease (viral), burning sensation (burning of soles and burning of palms), dizziness, encephalitis, generalized ache, lethargy, seizure
Dermatologic: Diaphoresis, night sweats
Gastrointestinal: Diarrhea, nausea, stomatitis, vomiting
Genitourinary: Proteinuria
Hematologic & oncologic: Lymphadenopathy
Hepatic: Abnormal hepatic function tests, hepatosplenomegaly
Hypersensitivity: Anaphylaxis, serum sickness
Infection: Viral infection
Local: Injection site reaction (pain, redness, swelling)
Neuromuscular & skeletal: Back pain, joint stiffness, myalgia
Ophthalmic: Periorbital edema
Renal: Renal function test abnormality
Respiratory: Dyspnea, pleural effusion, respiratory distress
<1%, postmarketing, and/or case reports: Abdominal pain, acute renal failure, anaphylactoid reaction, anemia, apnea, confusion, cough, deep vein thrombosis, disorientation, dizziness, eosinophilia, epigastric pain, epistaxis, erythema, flank pain, gastrointestinal hemorrhage, gastrointestinal perforation, granulocytopenia, hemolysis, hemolytic anemia, herpes simplex infection (reactivation), hiccups, hyperglycemia, infection, involuntary body movements, laryngospasm, malaise, muscle rigidity, neutropenia, pancytopenia, paresthesia, pulmonary edema, pure red cell aplasia, renal artery thrombosis, sore mouth, sore throat, tachycardia, thrombosis of vein (iliac), toxic epidermal necrolysis, tremor, vasculitis, viral hepatitis, weakness, wound dehiscence
History of systemic reaction (eg, anaphylactic reaction) to prior administration of antithymocyte globulin or any other equine gamma globulin preparation.
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to antithymocyte globulin (equine) or any components of the formulation.
Concerns related to adverse effects:
• Anaphylaxis: [US Boxed Warning]: Antithymocyte globulins may cause anaphylaxis when injected intravenously. Although antithymocyte globulin (equine) is processed to reduce the level of antibodies that will react to non-T cells, health care providers should be prepared for the potential risk of anaphylaxis and monitor for signs/symptoms during infusion. Hypersensitivity and anaphylactic reactions may occur; discontinue for symptoms of anaphylaxis; immediate treatment (including epinephrine 1 mg/mL) should be available. Systemic reaction (rash, dyspnea, hypotension, tachycardia, or anaphylaxis) precludes further administration of antithymocyte globulin (equine; ATG). Respiratory distress, hypotension, or pain (chest, flank, or back) may indicate an anaphylactoid/anaphylactic reaction. Serious immune-mediated reactions have been reported (rare), including anaphylaxis, infusion reactions, and serum sickness. Skin testing is recommended prior to administration of the initial ATG dose. A positive skin test is suggestive of an increased risk for systemic allergic reactions with an infusion, although anaphylaxis may occur in patients who display negative skin tests. If ATG treatment is deemed appropriate following a positive skin test, the first infusion should be administered in a controlled environment with intensive life support immediately available. Also observe for signs/symptoms of allergic reactions during repeat courses of administration. Skin testing is not predictive for later development of serum sickness.
• Hematologic toxicity: Thrombocytopenia may occur; may require platelets transfusion support. Discontinue if severe and unremitting leukopenia or thrombocytopenia occur in solid organ transplant recipients.
• Hemolysis: Clinically significant hemolysis has been reported (rarely). Severe and unremitting hemolysis may require treatment discontinuation. Chest, flank or back pain may indicate hemolysis.
• Hepatic function: Abnormal hepatic function tests have been observed in patients with aplastic anemia and other hematologic disorders receiving ATG.
• Infection: ATG is an immunosuppressant; monitor closely for signs of infection. An increased incidence of cytomegalovirus (CMV) infection has been reported in studies.
• Renal function: Abnormal renal function tests have been observed in patients with aplastic anemia and other hematologic disorders receiving ATG.
Concurrent drug therapy issues:
• Immunizations: Live viral vaccines may not replicate and antibody response may be reduced if administered during ATG treatment. Patients should not be immunized with attenuated live viral vaccines prior to planned ATG treatment, during, and after treatment.
Other warnings/precautions:
• Administration: Administer via central line due to chemical phlebitis that may occur with a peripheral vein. Dose must be administered over at least 4 hours; patient may need to be pretreated with an antipyretic, antihistamine, and/or corticosteroid. Should be administered with concomitant immunosuppressants.
• Disease transmission: Product of equine and human plasma; may have a risk of transmitting disease, including a theoretical risk of Creutzfeldt-Jakob disease (CJD).
• Potency: Product potency and activity may vary from lot to lot.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Abrocitinib: May enhance the immunosuppressive effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Baricitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Baricitinib. Risk X: Avoid combination
BCG Products: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination
Belatacept: Antithymocyte Globulin (Equine) may enhance the adverse/toxic effect of Belatacept. Specifically, the risk for venous thrombosis of the renal allograft may be increased. Management: A 12-hour interval between administration of these 2 agents is suggested if these agents are to be used concomitantly. Monitor for venous thrombosis of the renal allograft. Risk D: Consider therapy modification
Brincidofovir: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy
Cladribine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination
Coccidioides immitis Skin Test: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing therapeutic immunosuppressants several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider therapy modification
COVID-19 Vaccine (Adenovirus Vector): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters). Risk D: Consider therapy modification
COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy
COVID-19 Vaccine (mRNA): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification
COVID-19 Vaccine (Subunit): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy
COVID-19 Vaccine (Virus-like Particles): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy
Dengue Tetravalent Vaccine (Live): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination
Denosumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Denosumab. Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and immunosuppressants. If combined, monitor for signs/symptoms of serious infections. Risk D: Consider therapy modification
Deucravacitinib: May enhance the immunosuppressive effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Efgartigimod Alfa: May diminish the therapeutic effect of Fc Receptor-Binding Agents. Risk C: Monitor therapy
Filgotinib: May enhance the immunosuppressive effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Inebilizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy
Influenza Virus Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating immunosuppressants if possible. If vaccination occurs less than 2 weeks prior to or during therapy, revaccinate 2 to 3 months after therapy discontinued if immune competence restored. Risk D: Consider therapy modification
Leflunomide: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents. Risk D: Consider therapy modification
Natalizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination
Ocrelizumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy
Ofatumumab: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy
Pidotimod: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy
Pimecrolimus: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Pimecrolimus. Risk X: Avoid combination
Pneumococcal Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy
Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination
Polymethylmethacrylate: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the potential for allergic or hypersensitivity reactions to Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification
Rabies Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification
Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Ruxolitinib (Topical): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination
Sipuleucel-T: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification
Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk C: Monitor therapy
Tacrolimus (Topical): Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination
Talimogene Laherparepvec: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination
Tertomotide: Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination
Tofacitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Tofacitinib. Management: Coadministration of tofacitinib with potent immunosuppressants is not recommended. Use with non-biologic disease-modifying antirheumatic drugs (DMARDs) was permitted in psoriatic arthritis clinical trials. Risk X: Avoid combination
Typhoid Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination
Upadacitinib: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination
Vaccines (Inactivated/Non-Replicating): Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before initiating or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider therapy modification
Vaccines (Live): May enhance the adverse/toxic effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may diminish the therapeutic effect of Immunosuppressants (Therapeutic Immunosuppressant Agents). Risk X: Avoid combination
Yellow Fever Vaccine: Immunosuppressants (Therapeutic Immunosuppressant Agents) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination
Antithymocyte globulin (equine) is a purified immunoglobulin G. Placental transfer of human IgG is dependent upon the IgG subclass, maternal serum concentrations, newborn birth weight, and gestational age, generally increasing as pregnancy progresses. The lowest exposure would be expected during the period of organogenesis (Palmeira 2012; Pentsuk 2009).
Information related to the use of antithymocyte globulin (equine) in pregnancy is limited (Aitchison 1989; Miller 1995; Pajor 1992). Antithymocyte globulin (equine) is not recommended for the treatment of aplastic anemia in pregnancy (Killick 2016).
The Transplant Pregnancy Registry International (TPR) is a registry that follows pregnancies that occur in maternal transplant recipients or those fathered by male transplant recipients. The TPR encourages reporting of pregnancies following solid organ transplant by contacting them at 1-877-955-6877 or https://www.transplantpregnancyregistry.org.
It is not known if antithymocyte globulin (equine) is present in breast milk.
Due to the potential for serious adverse reactions in the nursing infant, the manufacturer recommends a decision be made to discontinue nursing or to discontinue the drug, considering the importance of treatment to the mother.
Complete blood count with differential and platelet count. Monitor vital signs during administration; monitor for infusion reactions; monitor for signs/symptoms of infection.
Solid organ transplant: Absolute CD3 count (cells/µL) monitoring and CD3 based-dosing has been considered in renal and heart transplant recipients. It may be beneficial in certain patient populations but is not routinely recommended or utilized. Dose adjustments have been recommended based on the CD3 count (Krasinska 2002).
Immunosuppressant involved in the elimination of antigen-reactive T lymphocytes (killer cells) in peripheral blood or alteration in the function of T-lymphocytes, which are involved in humoral immunity and partly in cell-mediated immunity; induces complete or partial hematologic response in aplastic anemia
Distribution: Poor into lymphoid tissues; binds to circulating lymphocytes, granulocytes, platelets, bone marrow cells
Half-life elimination: 5.7 ± 3 days
Excretion: Urine (~1%)
Injection (Atgam Intravenous)
50 mg/mL (per mL): $687.09
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