CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMVIG, CMV-IVIG)
| CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMVIG, CMV-IVIG) (cy-to-meg'a-lo-vi-rus) CytoGam Classifications: biologic response modifier; immunoglobulin; Therapeutic: immunoglobulin Prototype: Interferon alfa-2a Pregnancy Category: C |
Availability
50 mg/mL injection
Action
Cytomegalovirus immune globulin (CMVIG) is a preparation of immunoglobulin G (IgG) antibodies derived from a large number of healthy donors with high concentrations of antibodies directed against cytomegalovirus (CMV).
Therapeutic Effect
The CMV antibodies attenuate or reduce the incidence of serious CMV disease, such as CMV-associated pneumonia, CMV-associated hepatitis, and concomitant fungi and parasitic superinfections.
Uses
Attenuation of primary cytomegalovirus (CMV) disease associated with kidney transplantation.
Unlabeled Uses
Prevention of CMV disease in other organ transplants (especially heart) when the recipient is seronegative for CMV and the donor is seropositive.
Contraindications
History of previous severe reactions associated with CMVIG or other human immunoglobulin preparations, selective immunoglobulin A (IgA) deficiency; pregnancy (category C).
Cautious Use
Myelosuppression, maltose or sucrose hypersensitivity; cardiac disease, lactation.
Route & Dosage
| Prevention of CMV Disease Adult: IV 150 mg/kg within 72 h of transplantation, then 100 mg/kg 2, 4, 6, and 8 wk posttransplant, then 50 mg/kg 12 and 16 wk posttransplant |
Administration
Intravenous
PREPARE: IV Infusion: Use a double ended transfer needle or large syringe to reconstitute with 50 mL sterile water. Gently rotate vial to dissolve; do not shake. Allow 30 min to dissolve powder. Reconstituted solution contains 50 mg/mL. Must be completely infused within 12 h since solution contains no preservative. ADMINISTER: IV Infusion: Use a constant infusion pump and give at rate of 15, 30, 60 mg/kg/h over first 30 min, second 30 min, third 30 min, respectively. Monitor closely during and after each rate change. If flushing, nausea, back pain, fever, or chills develops, slow or temporarily discontinue infusion. If BP begins to decrease, stop infusion and institute emergency measures. Infusion of Subsequent IV Doses: The intervals for increasing the dose from 15 to 30 to 60 mg may be shortened from 30 to 15 min. Never infuse more than 75 mL/h CMVIG.
|
Adverse Effects (≥1%)
Body as a Whole: Muscle aches, back pain, anaphylaxis (rare), fever and chills during infusion. CV: Hypotension, palpitations. GI: Nausea, vomiting, metallic taste. CNS: Headache, anxiety. Respiratory: Shortness of breath, wheezing. Skin: Flushing.Interactions
Drug: May interfere with the immune response to live virus vaccines (BCG, measles/mumps/rubella, live polio), defer vaccination with live viral vaccines for approximately 3 mo after administration of CMVIG; revaccination may be necessary if these vaccines were given shortly after CMVIG.Nursing Implications
Assessment & Drug Effects
- Monitor vital signs preinfusion, before increases in infusion rate, periodically during infusion, and postinfusion.
- Notify physician immediately if any of the following occur: flushing, nausea, back pain, fall in BP, other signs of anaphylaxis.
- Emergency drugs should be available for treatment of acute anaphylactic reactions.
- Monitor for CMV-associated syndromes (e.g., leukopenia, thrombocytopenia, hepatitis, pneumonia) and for superinfections.
Patient & Family Education
- Familiarize yourself with potential adverse effects and know which to report to physician.
- Defer vaccination with live viral vaccines for 3 mo after administration of CMVIG.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug