Thymoglobulin is a purified gamma immunoglobulin obtained by immunization of rabbits with human thymocytes. This is often indicated for the treatment of kidney transplant acute rejection in conjunction with concomitant immunosuppression.
While receiving an organ transplant, the patient’s body's white blood cells will try to reject the transplanted organ. That’s why Thymoglobulin is used in adult renal transplant recipients to prevent the white blood cells from doing so.
Further, the effect of Thymoglobulin on the white blood cells may also reduce the body's ability to fight infections. Thus, doctor and patient should talk about both the positive effects and the risks of this medicine before beginning treatment.
Thymoglobulin is available in powder form which is later used to make a solution prior administration only by or under the direct supervision of a doctor.
2 What to Know Before Using
Before using Thymoglobulin, you must know all about the risks and complications associated with it. The most suitable drug therapy is chosen by a doctor with the active participation of the patient.
There are some important factors such as drug interactions, the presence of any metabolic impairment, history of hypersensitivity reaction, pregnancy, lactation etc. that may alter the desired therapeutic effects of a medicine.
Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects. Make sure you mention your doctor if you have any other medical problems because the use of this medicine is contraindicated in patients with hypersensitivity to rabbit proteins or to any product excipients.
Additionally, active acute or chronic infections contraindicate the use of this product as anti-thymocyte globulin (rabbit) decreases your body's ability to fight infection.
Moreover, it is always recommended to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem in order to avoid unwanted toxic effects which may take place because of drug interactions.
Based on a single compatibility study, the combination of Anti-thymocyte globulin (rabbit), heparin, and hydrocortisone in a dextrose infusion solution has been noted to precipitate and is not recommended. So, you should not mix this drug with other medicinal products in the same infusion.
Studies over animal have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of this medicine in pregnant women despite potential risks. In addition, breastfeeding should be discontinued during this drug therapy because immunoglobulins are excreted in human milk.
3 Proper Usage
To use Thymoglobulin properly, you must follow all instructions given by your doctor. The dosage schedule and the duration of drug therapy depend on the particular medical problem for which you are going to use this medicine.
The therapeutic dose may also vary with the patient’s condition or requirement and the strength of the medicine as well. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For treatment of acute renal graft rejection: the recommended dose is 1.5 mg/kg of body weight administered daily for 7 to 14 days.
For prophylaxis in adult renal transplant recipients: the recommended dose is 1.5 mg/kg/day intravenously for at least 7 days.
Anti-thymocyte globulin (rabbit) should be infused over a minimum of 6 hours for the first infusion and over at least 4 hours on subsequent days of therapy.
If the WBC count is between 2,000 and 3,000 cells/cmm of blood or if the platelet count is between 50,000 and 75,000 cells/cmm of blood, the dose should be reduced by one-half.
But if the WBC counts fall below 2,000 cells/cmm of blood or platelets below 50,000 cells/cmm of blood, the treatment should be stopped.
Further, it is advised to store this medicine in a refrigerator between +2°C and +8°C (36°F to 46°F). You should not use any unused drug remaining after infusion or after the expiration date indicated on the label.
4 Precautions to Take
Before using Thymoglobulin, there are some precautions you must take. Thymoglobulin should only be used by physicians experienced in immunosuppressive therapy for the treatment of renal transplant patients. In addition, regular visits to your doctor are recommended to check the prognosis while undergoing a drug therapy.
Moreover, the following guidelines should be followed:
This medicinal product should be used under strict medical supervision in a hospital setting, and patients should be carefully monitored during the infusions because infusion-associated reactions (IARs) including oxygen desaturation may occur during or following the administration.
In rare instances, serious immune-mediated reactions have been reported with the use of anti-thymocyte globulin (rabbit) and consist of anaphylaxis or severe cytokine release syndrome (CRS). If an anaphylactic reaction occurs, the infusion should be terminated immediately. Medical personnel should be available to treat patients who experience anaphylaxis.
Use of immunosuppressive agents, including anti-thymocyte globulin (rabbit), may increase the incidence of malignancies, including lymphoma or post-transplant lymphoproliferative disease (PTLD).
Thymoglobulin is routinely used in combination with other immunosuppressive agents. Infections (bacterial, fungal, viral, and protozoal), reactivation of infection (particularly cytomegalovirus), and sepsis have been reported after this drug therapy in combination with multiple immunosuppressive agents. Thus, careful patient monitoring and appropriate anti-infective prophylaxis are recommended.
5 Potential Side Effects
Make sure you meet with your doctor in using Thymoglobulin to avoid unwanted potential side effects. Along with the needed effects, a medicine may cause some unwanted effects such as pain, swelling, and erythema at the infusion site.
These reactions may not need any medical attention and usually go away during the treatment episode as your body adjusts to the medicine. Further, your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side effects.
Sometimes you may need to consult with the doctor if you notice any of the following toxic effects, especially:
Fever, chills, leukopenia, pain, headache, abdominal pain, diarrhea, hypertension, nausea, thrombocytopenia, peripheral edema, dyspnea, asthenia, hyperkalemia, tachycardia, and infection are the most frequent reported adverse events which are generally manageable or reversible.
Serious immune-mediated reactions have been reported in some individuals and consist of anaphylaxis or severe cytokine release syndrome (CRS). Severe, acute infusion-associated reactions (IARs) are consistent with CRS and can cause serious cardiorespiratory events and/or death.
Infections, reactivation of infection, sepsis, malignancies including post-transplant lymphoproliferative disorder (PTLD) and other lymphomas as well as solid tumors have been reported in combination with multiple immunosuppressive agents.
Prolonged use or overdose of anti-thymocyte globulin (rabbit) in association with other immunosuppressive agents may cause over-immunosuppression.
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