RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN (RSV-IVIG)

RESPIRATORY SYNCYTIAL VIRUS IMMUNe GLOBULIN (RSV-IVIG)
(res-pir'a-tory sin-cy'ti-al)
RespiGam
Classifications: biologic response modifier; immunoglobulin;
Therapeutic: immunoglobulin

Prototype: Immune globulin
Pregnancy Category: C

Availability

2500 mg/50 mL vial

Action

Contains IgG immune globulin antibodies from human plasma.

Therapeutic Effect

The preparation contains large amounts of RSV-neutralizing antibodies.

Uses

Prevention of serious lower respiratory tract infection caused by RSV in children <24 mo with bronchopulmonary dysplasia or history of premature birth; hypervolemia.

Contraindications

Previous severe reaction to RespiGam or other human immunoglobulin preparation, selective Iga deficiency; congenital heart disease, fluid overload; hepatic disease, pregnancy (category C).

Cautious Use

Immunodeficiency, AIDS, pulmonary disease; CHF; renal failure.

Route & Dosage

RSV
Child/Infant/Neonate: IV 750 mg/kg infused at 1.5 mL/kg/h for first 15 min, then 3 mL/kg/h for next 15 min, then 6 mL/kg/h  for rest of infusion, may repeat monthly as needed

Administration

Intravenous

PREPARE: IV Infusion: Give undiluted.  

ADMINISTER: IV Infusion: Do not shake vial; infuse vial contents undiluted through a separate IV line if possible; if "piggyback" must be used, see manufacturer's directions. DO NOT EXCEED IV INFUSION RATES given in Route & Dosage table! Use a constant infusion pump.  

INCOMPATIBILITIES Solution/additive or Y-site: Do not mix with other drugs.

  • Store vials at 2°–8° C (35°–46° F). Begin infusion within 6 h after vial is entered and complete within 12 h.

Adverse Effects (≥1%)

Body as a Whole: Fever, pyrexia, fluid overload. CV: Tachycardia, hypertension. GI: Vomiting, diarrhea, gastroenteritis. Respiratory: Respiratory distress, wheezing, rales, hypoxia, hypoxemia, tachypnea. Skin: Injection site inflammation.

Interactions

Drug: May interfere with immune response to live virus vaccines (mumps, rubella, measles), may need to repeat vaccine if given within 10 mo of RespiGam.

Pharmacokinetics

Half-Life: 22–28 d.

Nursing Implications

Assessment & Drug Effects

  • Monitor closely during and after each IV rate change.
  • Assess vital signs and respiratory status prior to infusion, during and after each rate change, and at 30-min intervals until 30 min after infusion is completed, and periodically thereafter for 24 h.
  • Slow infusion immediately if S&S of fluid overload appear and report to physician.
  • Lab tests: Monitor routine blood chemistry, serum electrolytes, blood gases, osmolality.
  • Monitor for aseptic meningitis syndrome, which may begin up to 2 d after infusion.

Patient & Family Education

  • Be aware of the possibility of aseptic meningitis syndrome; learn S&S to report (headache, drowsiness, fever, photophobia, painful eye movements, muscle rigidity, nausea, vomiting).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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