cytomegalovirus immune globulin(site-oh-meg-a-loe-vye-rus) ,
Pregnancy Category: C
Pharmacologic: immune globulins
ClassificationTherapeutic: vaccines immunizing agents
Pharmacologic: immune globulins
Prevention of cytomegalovirus (CMV) disease associated with transplantation of kidney, lung, liver, pancreas, or heart (if transplant is other than kidney from CMV-positive donors to CMV-negative recipient, then concurrent ganciclovir should be considered).
Consists of IgG antibodies capable of providing passive immunity against CMV disease.
Prevention of serious sequelae of CMV disease in transplant patients.
Absorption: Administered IV only, resulting in complete bioavailability.
Metabolism and Excretion: Unknown.
Half-life: 7 days.
Time/action profile (CMV antibody titers)
Contraindicated in: Hypersensitivity to immune globulins or albumin; Selective IgA deficiency.
Use Cautiously in: Obstetric / Lactation: Pregnancy or lactation (safety not established); Renal insufficiency or predisposition to acute renal failure.
Adverse Reactions/Side Effects
Central nervous system
- pulmonary edema
- hepatic dysfunction
- acute renal failure
- back pain
- muscle cramps
- allergic reactions including chills
- anaphylaxis (life-threatening)
Drug-Drug interactionMay interfere with immune response to some live-virus vaccines including measles, mumps, and rubella (MMR ; do not administer within 3 mo of immune globulin).
Intravenous (Adults) 150 mg/kg within 72 hr of transplantation, followed by 100 mg/kg at 2, 4, 6, and 8 wk, then 50 mg/kg at 12 and 16 wk post-transplantation.Liver, Pancreas, Lung, or Heart Transplant
Intravenous (Adults) 150 mg/kg within 72 hr of transplantation, and at 2, 4, 6, and 8 wk, then 100 mg/kg after at 12 and 16 wk post-transplantation.
Intravenous (Children) Safety and efficacy has not been established in pediatrics, however adult doses have been used in children.
Powder for injection: 1000-mg vial, 2500-mg vial
- Monitor vital signs prior to, during, and following infusion and before any increases in infusion rate.
- Monitor patient for adverse reactions throughout therapy. If patient develops minor side effects (nausea, vomiting, muscle cramps, back pain, fever, flushing, chills), slow infusion rate or stop infusion temporarily. If hypotension or anaphylaxis occurs, stop infusion and administer treatment (epinephrine and diphenhydramine).
Potential Nursing DiagnosesRisk for infection (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- Intermittent Infusion: Reconstitute with 50 mL of sterile water for injection with a double-ended needle or large syringe. To avoid foaming, do not shake vial. If using a double-ended needle, insert into water first, as powder is supplied in an evacuated vial and water will transfer by suction. After sterile water is transferred, release residual vacuum to speed dissolution. Rotate gently to wet undissolved powder. Allow 30 min for powder to dissolve. Solution should be clear, colorless, and free of particulate matter. Infusion should be started within 6 hr and completed within 12 hr of reconstitution.
- Administer via infusion pump through a separate IV line. If not possible, solution may be piggybacked in an IV line containing 0.9% NaCl, D5W, D10W, D20W, or combinations of dextrose and saline, but do not dilute to more than 1:2. Do not use filters.
- Rate: Administer initial dose at 15 mg/kg/hr for first 30 min. If no adverse reactions occur, rate may be increased to 30 mg/kg/hr; if no adverse reactions occur in subsequent 30 min, rate may be increased to 60 mg/kg/hr. Do not exceed 75 mL/hr volume or 60 mg/kg/hr rate. Monitor patient closely during rate changes. May cause pain at injection site.
- During subsequent doses, rate may be increased in same increments every 15 min if no adverse reactions occur, until 60 mg/kg/hr maximum is reached.
- Instruct patient to notify health care professional if any adverse reactions occur.
- If live virus vaccines were administered within 14 days of immune globulin, vaccination should be repeated 3 mo after the last dose of immune globulin.
- Prevention of serious sequelae of CMV disease, including blindness, associated with transplantation of kidney, lung, liver, pancreas, or heart.