CytoGam
cytomegalovirus immune globulin
(site-oh-meg-a-loe-vye-rus) cytomegalovirusimmuneglobulin,CMVIG
(trade name),CytoGam
(trade name)Classification
Therapeutic: vaccines immunizing agentsPharmacologic: immune globulins
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (CMV antibody titers)
ROUTE | ONSET | PEAK | DURATION |
IV | rapid | unknown | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- headache
- tremor
- anxiety
- seizures
Hematologic
- pancytopenia
- hemolysis
- leukopenia
Respiratory
- wheezing
- dyspnea
- pulmonary edema
Cardiovascular
- hypotension
- thromboembolism
Gastrointestinal
- nausea
- vomiting
- hepatic dysfunction
Dermatologic
- flushing
- rash
Genitourinary
- oliguria
- anuria
- acute renal failure
Musculoskeletal
- back pain
- muscle cramps
Miscellaneous
- allergic reactions including chills
- fever
- anaphylaxis (life-threatening)
Interactions
Drug-Drug interaction
May interfere with immune response to some live-virus vaccines including measles, mumps, and rubella (MMR ; do not administer within 3 mo of immune globulin).Route/Dosage
Kidney TransplantAvailability
Nursing implications
Nursing assessment
- 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 Diagnoses
Risk for infection (Indications)Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Implementation
Intravenous Administration
- 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.
Patient/Family Teaching
- 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.
Evaluation/Desired Outcomes
- Prevention of serious sequelae of CMV disease, including blindness, associated with transplantation of kidney, lung, liver, pancreas, or heart.