VACCINIA IMMUNE GLOBULIN (VIG-IV)
| Vaccinia Immune Globulin (VIG-IV) (vac-cin'i-a) Classifications: biologic response modifier; immunoglobulin; Therapeutic: immunoglobulin Prototype: Immune globulin intravenous Pregnancy Category: C |
Availability
50 mg/mL injection
Action
Vaccinia immune globulin, VIG (VIG-IV) is a purified human immunoglobulin G (IgG) with trace amounts of IgA and IgM. It is derived from adult human plasma collected from donors who received booster immunizations with the smallpox vaccine. VIG (VIG-IV) contains high titers of antivaccinia antibodies.
Therapeutic Effect
VIG is effective in the treatment of smallpox vaccine adverse reactions secondary to continued vaccinia virus replication after vaccination.
Uses
Prevention of serious complications of smallpox vaccine; treatment of progressive vaccinia; severe generalized vaccinia; eczema vaccinatum; vaccinia infection in patients with skin conditions (e.g., burns, impetigo, varicella-zoster, poison ivy, or eczematous skin lesions); treatment or modification of aberrant infections induced by vaccinia virus.
Contraindications
Predisposition to acute renal failure (i.e., preexisting renal insufficiency, diabetes mellitus, volume depletion, sepsis, patients >65 y); AIDS; chronic skin conditions (e.g., burn, atopy); bone marrow suppression; chemotherapy; radiation therapy; corticosteroid therapy, eczema; hematologic disease; herpes infection; postvaccinal encephalitis; pregnancy (category C); lactation; infants <12 mo.
Cautious Use
Concurrent administration of known nephrotoxic drugs; autoimmune disease; cardiomyopathy, cardiac disease.
Route & Dosage
| Vaccinia Adults: IV 100–500 mg/kg Renal Impairment Maximum dose: 400 mg/kg |
Administration
| Intravenous PREPARE: IV Infusion: No dilution required. Use solution as supplied. ADMINISTER: IV Infusion: Begin infusion within 6 h of entering the vial. Complete infusion within 12 h of entering the vial. Use in-line filter (0.22 microns), infusion pump, and dedicated IV line [may infuse into a preexisting catheter if it contains NS, D2.5W, D5W, D10W, or D20W (or any combination of these)]. Infuse at 1.0 mL/kg/h the first 30 min, increase to 2.0 mL/kg/h the next 30 min, and then increase to 3.0 mL/kg/h until infused. |
Adverse Effects (≥1%)
Body as a Whole: Injection site reaction. CNS: Dizziness, headache. GI: Abdominal pain, nausea, vomiting. Musculoskeletal: Arthralgia, back pain. Respiratory: Upper respiratory infection. Skin: Erythema, flushing.Interactions
Drug: May interfere with the immune response to live virus vaccines. Vaccination with live virus vaccines should be deferred until approximately 6 mo after administration of VIG-IV.Pharmacokinetics
Half-Life: 22 d.Nursing Implications
Assessment & Drug Effects
- Monitor vital signs continuously during infusion, especially after infusion rate changes.
- Slow infusion rate for any of the following: flushing, chills, muscle cramps, back pain, fever, nausea, vomiting, arthralgia, and wheezing.
- DC infusion, institute supportive measures, and notify physician for any of the following: increase in heart rate, increase in respiratory rate, shortness of breath, rales or other signs of anaphylaxis.
- Have loop diuretic available for management of fluid overload.
Patient & Family Education
- Promptly report any discomfort that develops while drug is being infused.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug