Actimmune, Immukin (UK)
Pharmacologic class: Biological response modifier
Therapeutic class: Antineoplastic
Pregnancy risk category C
Enhances cellular toxicity and killer cell activity and promotes generation of oxygen metabolites in phagocytes, resulting in destruction of microorganisms.
Injection: 100 mcg (2 million international units)/0.5-ml vial
⊘Indications and dosages
➣ Chronic granulomatous disease; severe malignant osteoperosis
Adults with body surface area (BSA) above 0.5 m2: 50 mcg/m2 (1 million international units/m2) subcutaneously three times weekly
Adults with BSA of 0.5 m2 or less: 1.5 mcg/kg subcutaneously three times weekly in deltoid or anterior thigh
• Hypersensitivity to drug, its components, or Escherichia coli-derived products
Use cautiously in:
• thyroid disorders, bone marrow depression, hepatic or cardiac disease, seizure disorders, compromised CNS function
• pregnant or breastfeeding patients
• children ages 18 and younger.
• Administer into deltoid muscle by subcutaneous route only.
• Give at bedtime if flulike symptoms occur.
• Provide antiemetics to ease nausea and vomiting, as prescribed.
CNS: dizziness, confusion, paresthesia, lethargy, depression, difficulty thinking or concentrating, insomnia, anxiety, fatigue, amnesia, nervousness, drowsiness, asthenia, malaise
CV: chest pain, hypertension, palpitations, arrhythmias
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, pancreatitis
Hematologic: anemia, leukopenia, thrombocytopenia, neutropenia
Musculoskeletal: joint pain, back pain, myalgia
Skin: flushing, rash, dry skin, erythema
Other: flulike symptoms, weight loss, edema, hypersensitivity reaction
Drug-drug.Bone marrow depressants: increased bone marrow depression
Zidovudine: increased zidovudine blood level
Drug-diagnostic tests.Hepatic enzymes: increased levels
Neutrophils, platelets: decreased counts
☞ Before and monthly during therapy, assess CBC with white cell differential, glucose and electrolyte levels, and liver and kidney function tests.
• Assess fluid intake and output. Keep patient well hydrated.
• Monitor for GI upset. Provide small, frequent meals or antiemetics to ease severe nausea and vomiting.
☞ Monitor patient for mental status changes and depression.
• Assess for flulike symptoms. If these occur, give drug at bedtime and provide supportive care, such as rest and acetaminophen for headache and fever.
• Teach patient or caregiver how to administer drug subcutaneously, rotate injection sites, and track dosing schedule and injection sites on calendar.
☞ Tell patient to contact prescriber immediately if depression occurs.
• Advise patient to eat small, frequent meals to combat nausea, vomiting, and appetite loss.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Inform female patient that drug is linked to fetal abnormalities. Advise her not to get pregnant during therapy, and to use barrier contraception.
• Tell female patient to consult prescriber before breastfeeding.
• Tell patient he'll need regular follow-up examinations and blood tests to monitor drug effects.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
interferon gamma-1b(in-ter-feer-on) ,
ClassificationTherapeutic: immune modifiers
- Staphylococcus aureus,
- Toxoplasma gondii,
- Leishmania donovani,
- Listeria monocytogenes,
- Mycobacterium avium intracellulare.
Time/action profile (blood levels)
Adverse Reactions/Side Effects
Central nervous system
- headache (most frequent)
- decreased mental status
- nausea (most frequent)
- vomiting (most frequent)
- abdominal pain
- rash (most frequent)
- edema or tenderness at injection site (most frequent)
- arthralgia (most frequent)
- myalgia (most frequent)
- back pain
- gait disturbances
- chills (most frequent)
- fever (most frequent)
Drug-Drug interactionMay have additive bone marrow–depressing effects with antineoplastics or radiation therapy.
Route/DosageBody Surface Area >0.5 m2
- Assess patient for signs and symptoms of infection before and throughout therapy. Flu-like syndrome (fever, headache, chills, myalgia, fatigue) is a frequent side effect that may decrease in severity as treatment continues. Side effects may be minimized by administering at bedtime. Headache and fever may be treated with acetaminophen. If adverse reactions are severe, dose may be reduced by 50% or discontinued.
- Lab Test Considerations: Monitor CBC with differential, platelet count, blood chemistries including liver and kidney function, and urinalysis before and every 3 mo throughout therapy.
Potential Nursing DiagnosesRisk for infection (Indications)
- Vial must be refrigerated; do not freeze. If vial is left at room temperature for more than 12 hr, discard vial. Vials do not contain a preservative and are for single use only. Do not shake.
- Subcutaneous: Administer in the right or left arm or anterior thigh.
- Home Care Issues: Instruct patient or family on proper technique for administering injection and care and disposal of equipment. Provide a puncture-proof container for disposal of needles.
- Advise patient of the need for contraception throughout therapy.
- Decrease in frequency and severity of infections in patients with chronic granulomatous disease.
- Slowed disease progression in severe, malignant osteopetrosis.