palivizumab

Action

Neutralizes and suppresses activity of syncytial virus in respiratory tract, inhibiting respiratory syncytial virus (RSV) replication

Availability

Injection: 50 mg, 100-mg vial

Indications and dosages

➣ To prevent serious lower respiratory disease caused by RSV in high-risk children

Children: 15 mg/kg I.M. q month throughout RSV season

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• thrombocytopenia, coagulation disorders, established RSV infection.

Administration

See Keep epinephrine 1:1,000 available in case anaphylaxis occurs. (However, drug isn't known to cause anaphylaxis.)

• Dilute in sterile water for injection. Gently swirl for 30 seconds to avoid foaming.

• Keep reconstituted solution at room temperature for at least 20 minutes before administering. Give within 6 hours of reconstitution.

• Inject I.M. into anterolateral thigh. Avoid gluteal injection, which may damage sciatic nerve.

Adverse reactions

CNS: nervousness, pain

EENT: conjunctivitis, otitis media, rhinitis, pharyngitis, sinusitis

GI: vomiting, diarrhea, gastroenteritis, oral moniliasis

Hematologic: anemia

Respiratory: upper respiratory tract infection, cough, wheezing, dyspnea, bronchiolitis, bronchitis, pneumonia, croup, asthma, apnea

Skin: rash, fungal dermatitis, eczema

Other: hernia, pain, fever, injection site reaction, viral infection, flulike symptoms, failure to thrive

Interactions

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase: increased levels

Hemoglobin: decreased level Immunological-based RSV diagnostic tests: interference, possibly leading to false-negative test results

Patient monitoring

See Watch closely for signs and symptoms of anaphylaxis immediately after dosing.

• Assess for signs and symptoms of infection, particularly EENT and respiratory infection.

• Monitor liver function tests and CBC.

• Assess patient's weight and hydration status.

Patient teaching

• Tell parent that monthly injections are necessary during RSV season (November through April).

• Inform parent that drug may cause GI symptoms and failure to thrive. Provide dietary consultation as needed.

See Caution parent that EENT and respiratory infections may follow administration. Advise parent to contact pre-scriber immediately if child has fever or other signs or symptoms of infection.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.