basiliximab

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basiliximab

 [bas″ĭ-lik´sĭ-mab]
a monoclonal antibody that is an interleukin-2 receptor antagonist; used in prophylaxis of acute organ rejection after renal transplantation.

basiliximab

SimulectAeroBec (UK), Apo-Beclomethasone (CA), Asmabec (UK), Beclodisk (CA) (UK), Becloforte (CA) (UK), Beconase AQ Nasal Spray, Filair (UK), Hayfever Relief (UK), Nasobec (UK), Pollenase Nasal (UK), QVAR, Rivanase (CA)

Pharmacologic class: Monoclonal antibody

Therapeutic class: Immunosuppressant

Pregnancy risk category B

Pharmacologic class: Corticosteroid

Therapeutic class: Anti-inflammatory agent

Pregnancy risk category C

FDA Box Warning

• Give under supervision of physician experienced in immunosuppressive therapy and management of organ transplant recipients, in facility with adequate diagnostic and treatment resources.

Action

Blocks specific interleukin-2 (IL-2) receptor sites on activated T lymphocytes. Specific binding competitively inhibits IL-2-mediated activation and differentiation of lymphocytes responsible for cell-mediated immunity. Also impairs immunologic response to antigenic challenges.

Availability

Powder for injection: 10 mg, 20 mg in single-use vials

Indications and dosages

Prevention of acute organ rejection in kidney transplantation

Adults and children weighing 35 kg (77 lb) or more: 20 mg I.V. 2 hours before transplantation surgery, then 20 mg I.V. 4 days after surgery. Withhold second dose if complications, hyper-sensitivity reaction, or graft loss occurs.

Children weighing less than 35 kg (77 lb): 10 mg I.V. 2 hours before transplantation surgery, then 10 mg I.V. 4 days after surgery. Withhold second dose if complications, hypersensitivity reaction, or graft loss occurs.

Contraindications

• Hypersensitivity to drug
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• elderly patients
• females of childbearing age.

Administration

Give by central or peripheral I.V. route only.
• Reconstitute by adding 5 ml of sterile water for injection to vial for bolus injection, or dilute with normal saline solution or dextrose 5% in water to a volume of 50 ml and infuse over 20 to 30 minutes. Discard any remaining product after preparing each dose.
• Don't infuse other drugs simultaneously through same I.V. line.
• Know that drug should be used only as part of regimen that includes cyclosporine and corticosteroids.

Adverse reactions

CNS: headache, insomnia, paresthesia, dizziness, drowsiness, tremor, anxiety, confusion, coma, seizures

CV: palpitations, edema, chest pain, ECG abnormalities, hypotension, hypertension, prolonged QT interval

EENT: blurred vision, eye irritation, tinnitus, earache, epistaxis, nasopharyngitis, sinusitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, anorexia, oral blisters, oral candidiasis, GI hemorrhage

GU: urinary incontinence, intermenstrual bleeding, oliguria, renal failure

Hematologic: anemia, disseminated intravascular coagulation, hemorrhage, neutropenia, thrombocytopenia Metabolic: hypokalemia, hypomagnesemia, hyperglycemia, acidosis, hypoglycemia, hyperkalemia

Musculoskeletal: bone, back, neck, or limb pain

Respiratory: dyspnea, cough, hypoxia, tachypnea, hemoptysis, upper respiratory tract infection, pleural effusions

Skin: bruising, pruritus, dermatitis, skin lesions, diaphoresis, night sweats, erythema, hyperpigmentation, urticaria

Other: fever, lymphadenopathy, facial edema, bacterial infection, herpes simplex infection, injection site erythema, hypersensitivity reaction, sepsis

Interactions

Drug-drug.Immunosuppressants: additive immunosuppression

Drug-diagnostic tests.Calcium, glucose, potassium: increased or decreased levels

Hemoglobin, neutrophils, platelets: decreased values

Triglycerides: increased levels

White blood cells: decreased levels

Drug-herbs.Astragalus, echinacea, melatonin: interference with immunosuppressant action

Patient monitoring

Watch for signs and symptoms of hypersensitivity reaction. Keep emergency drugs at hand in case these occur.
• Monitor vital signs and observe patient frequently during I.V. infusion.
• Monitor laboratory values and drug blood level.

Patient teaching

• Teach patient about purpose of therapy. Explain that drug decreases the risk of acute organ rejection.
• Tell patient he may be more susceptible to infection because of drug's immunosuppressant effect.
• Inform patient that he'll need lifelong immunosuppressant drug therapy.
• Advise women of childbearing age to use reliable contraception before, during, and for 2 months after therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.


beclomethasone dipropionate

AeroBec (UK), Apo-Beclomethasone (CA), Asmabec (UK), Beclodisk (CA) (UK), Becloforte (CA) (UK), Beconase AQ Nasal Spray, Filair (UK), Hayfever Relief (UK), Nasobec (UK), Pollenase Nasal (UK), QVAR, Rivanase (CA)


Pharmacologic class: Corticosteroid

Therapeutic class: Anti-inflammatory agent

Pregnancy risk category C

 

Action

Unclear. May decrease inflammation by stabilizing leukocytic lysosomal membrane, decreasing number and activity of inflammatory cells, inhibiting bronchoconstriction (leading to direct smooth muscle relaxation), and reducing airway hyperresponsiveness.

Availability

Inhalation aerosol: 40-mcg metered inhalation in 7.3-g canister; 80-mcg metered inhalation in 7.3-g canister

Inhalation capsules: 100 mcg, 200 mcg

Nasal spray: 0.042% (25-g bottle containing 180 metered inhalations)

Indications and dosages

Maintenance treatment of asthma as prophylaxis; asthma patients who require systemic steroids for whom adding an inhaled steroid may reduce or eliminate the need for systemic steroids

Adults and children ages 12 and older: When previous therapy was bronchodilator alone, 40 to 80 mcg by oral inhalation (QVAR) b.i.d.; maximum of 320 mcg b.i.d. When previous therapy was inhaled steroid, 40 to 160 mcg by oral inhalation (QVAR) b.i.d.; maximum of 320 mcg b.i.d.

Children ages 5 to 11: When previous therapy was bronchodilator alone, 40 mcg by oral inhalation (QVAR) b.i.d.; maximum of 80 mcg b.i.d. When previous therapy was inhaled steroid, 40 mcg by oral inhalation (QVAR) b.i.d.; maximum of 80 mcg b.i.d.

Seasonal or perennial rhinitis

Adults and children ages 12 and older: One or two inhalations (42 to 84 mcg Beconase AQ Nasal Spray) in each nostril b.i.d.

Children ages 6 to 12: One inhalation (42 mcg Beconase AQ Nasal Spray) in each nostril b.i.d.

Contraindications

• Hypersensitivity to drug
• Status asthmaticus

Precautions

Use cautiously in:
• active untreated infections, diabetes mellitus, glaucoma, underlying immunosuppression
• patients receiving concurrent systemic corticosteroids
• pregnant or breastfeeding patients
• children younger than age 6.

Administration

• Use spacer device to ensure proper delivery of dose and to help prevent candidiasis and hoarseness.
• After inhalation, tell patient to hold his breath for a few seconds before exhaling.
• For greater efficacy, wait 1 minute between inhalations.
• If patient is also receiving a bronchodilator, administer it at least 15 minutes before beclomethasone.
• Discontinue drug after 3 weeks if symptoms don't improve markedly.

Adverse reactions

CNS: headache

EENT: cataracts, nasal irritation or congestion, epistaxis, perforated nasal septum, nasopharyngeal or oropharyngeal fungal infections, hoarseness, throat irritation

GI: esophageal candidiasis

Metabolic: adrenal suppression Respiratory: cough, wheezing, bronchospasm

Skin: urticaria, angioedema

Other: anosmia, Churg-Strauss syndrome, hypersensitivity reactions

Interactions

None significant

Patient monitoring

• Assess patient's mouth daily for signs of fungal infection.
• Observe patient for proper inhaler use.

Patient teaching

• Instruct patient to hold inhaled drug in airway for several seconds before exhaling and to wait 1 minute between inhalations.
• Advise patient to rinse mouth after using inhaler and to wash and dry inhaler thoroughly to help prevent fungal infections and sore throat.
• Encourage patient to document use of drug and his response in a diary.
• If patient is also using a bronchodilator, teach him to use it at least 15 minutes before beclomethasone.
• As appropriate, review all other significant and life-threatening adverse reactions.

basiliximab

/bas·i·lix·i·mab/ (bas″ĭ-lik´sĭ-mab) a chimeric monoclonal antibody that is an interleukin-2 receptor antagonist; used in the prophylaxis of acute organ rejection after renal transplantation.

basiliximab

a monoclonal antibody used for immunosuppression.
indications This drug is used in combination with cyclosporine and corticosteroids to treat acute allograft rejection in renal transplant patients.
contraindications Known hypersensitivity to this drug contraindicates its use.
adverse effects Life-threatening effects of this drug include pulmonary edema and cardiac failure. Other adverse effects include hypotension, headache, constipation, abdominal pain, infection, and moniliasis. Common side effects include pyrexia, chills, tremors, dyspnea, wheezing, chest pain, vomiting, nausea, and diarrhea.

basiliximab

A high-affinity, mouse–human chimeric monoclonal antibody raised against the alpha chain (CD25) of the IL-2 receptor on T cells. It is used to prevent or minimise the rejection of transplanted solid organs, and meant to complement other drugs.

basiliximab

Simulect® Nephrology A high-affinity, monoclonal antibody used to minimize acute rejection post renal transplant, which complements antirejection drugs–eg, Neoral®. See Kidney transplant.

basiliximab

A chimeric monoclonal antibody to the alpha chain (CD 25), one of the three transmembrane protein chain receptors of INTERLEUKIN 2R. This interleukin plays an important role in T lymphocyte proliferation. On resting T cells the level of expression of CD 25 is low but allogenic stimulation after organ grafting causes it to rise. This provides specificity for a means of control of graft rejection. Trials have suggested that basiliximab can reduce graft rejection by one third. A brand name is Simulect.