286
P A R T 3
Drugs acting on the immune system
TABLE 18.2
DRUGS IN FOCUS Immune sera
Drug name
Dosage/route
Usual indications
Immune sera
Anti Rh(D)
immunoglobulin
(WinRho SDF)
28 weeks gestation: 1500 IU IM or IV.
Sensitising event in pregnancy: <34 weeks
gestation: 1500 IU every 12 weeks.
>34 weeks 600 IU IM or IV. Following birth
or abortion: 600 IU. Must be administered
within 72 hours of sensitising event
Prevention of sensitisation to the Rh factor
antithymocyte globulin
(Atgam)
10–15 mg/kg/day × 14 days, then alternate
days for 14 days to total 21 doses in 28 days
Treatment of renal transplant acute
rejection in conjunction with
immunosuppression
cytomegalovirus
immunoglobulin (CMV
Immuno-globulin-VF)
Prophylaxis: 25,000 U/kg IV days –4, –2 and
day of surgery.
Treatment: 50,000 U/kg IV repeated in
4–5 days, then every 10–14 days as needed
Attenuation of primary cytomegalovirus
disease after renal transplantation
hepatitis B
immunoglobulin
(Hepatitis B
Immunoglobulin-VF)
400 IU deep IM. Babies born to hepatitis B
positive mothers: 100 IU IM at birth
Postexposure prophylaxis against
hepatitis B
immunoglobulin,
normal
(Intragam P, Octagam
and others)
Dose varies with indication and preparation;
always check manufacturer’s instructions
Prophylaxis after exposure to hepatitis
A, measles, varicella or rubella; bone
marrow and other transplants; Kawasaki’s
disease; chronic lymphocytic leukaemia;
treatment of people with immunoglobulin
deficiency
rabies immunoglobulin
(Imogam Rabies)
20 International Units/kg IM
Protection against rabies in non-immunised
people exposed to rabies
tetanus immunoglobulin
(generic)
250–500 IU deep IMI
Passive immunisation against tetanus at
time of injury
zoster immunoglobulin
(Zoster
Immunoglobulin-VF)
<10 kg: 125 IU, 10.1–20 kg: 250 IU, 20.1–30 kg:
375 IU, 30.1–40 kg: 500 IU, >40 kg: 600 IU
by deep IMI within 96 hours of exposure
Passive immunisation against varicella
zoster in immunosuppressed people
exposed to disease
Antitoxins and antivenins
black snake antivenom
(generic)
18,000 U by slow IV infusion diluted in
Hartmann’s solution
Systemic envenoming following bite from
king brown or mulga snake
box jellyfish antivenom
(generic)
20,000 U by slow IV infusion diluted with IV
solution
Systemic envenoming or extreme
pain following box jellyfish sting, not
responding to routine analgesia
brown snake antivenom
(generic)
1000 U by slow IV infusion diluted in
Hartmann’s solution
Systemic envenoming following bite from
snake of genus Pseudonaja
death adder antivenom
(generic)
6000 U by slow IV infusion diluted in
Hartmann’s solution
Systemic envenoming following bite from
death adder
funnel-web spider
antivenom (generic)
2 vials diluted by slow IV injection,
simultaneously given with adrenaline.
Dose repeated in 15 minutes if required
Systemic envenoming following bite from
funnel-web spider
polyvalent snake
antivenom (generic)
40,000 U by slow IV infusion diluted in
Hartmann’s solution
Systemic envenoming following snakebite,
where the snake has not been identified.
Contains antibodies to king brown, tiger,
brown snakes, death adder and taipan.
Not used in Victoria or Tasmania
redback spider antivenom
(generic)
1 vial IM, or IV diluted in Hartmann’s solution.
May be repeated in 2 hours
Systemic envenoming following bite from
redback spider
sea snake antivenom
(generic)
1000 U by slow IV infusion diluted with
Hartmann’s solution or normal saline
Systemic envenoming following bite from
a sea snake
