Immukin

Action

Enhances cellular toxicity and killer cell activity and promotes generation of oxygen metabolites in phagocytes, resulting in destruction of microorganisms.

Availability

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

Contraindications

• Hypersensitivity to drug, its components, or Escherichia coli-derived products

Precautions

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.

Administration

• Administer into deltoid muscle by subcutaneous route only.

• Give at bedtime if flulike symptoms occur.

• Provide antiemetics to ease nausea and vomiting, as prescribed.

Adverse reactions

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

GU: proteinuria

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

Interactions

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

Patient monitoring

See 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.

See 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.

Patient teaching

• Teach patient or caregiver how to administer drug subcutaneously, rotate injection sites, and track dosing schedule and injection sites on calendar.

See 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.