IMMUNE SERA
MECHANISM OF
DRUG NAME
GENERIC NAME
immune globulin, intramuscular
BRAND NAME
BayGam, Gamastan, Gammar
AVAILABLE FORM
IGIM 2 mL, 10 mL vials
DOSAGES
Hepatitis A Exposure
Adult/Child: IM 0.02 mL/kg as
soon as possible after exposure;
if period of exposure will be 3
mo, give 0.05–0.06 mL/kg once
q4–6mo
Hepatitis B Exposure
Adult/Child: IM 0.02–0.06
mL/kg as soon as possible after
exposure if H-BIG is unavailable
Rubella Exposure
Adult: IM 20 mL as single dose
in susceptible pregnant women
Rubeola Exposure
Adult/Child: IM 0.25 mL/kg
within 6 d of exposure
Varicella-zoster Exposure
Adult/Child: IM 0.6–1.2 mL/kg
promptly
SIDE EFFECT/
INDICATION CONTRAINDICATION NURSING CONSIDERATION
ACTION ADVERSE EFFECT
Sterile concentrated In susceptible persons History of anaphylaxis or ADVERSE EFFECT BEFORE
solution containing to provide passive severe reaction to human (>1%) 1. Screen for the following, which may
globulin (primarily immunity or to modify immune serum globulin  Pain be contraindications or cautions to
IgG) prepared from severity of certain (IG) or to any ingredient  Tenderness the use of the drug: any known
large pools of infectious diseases, in the formulation such as  muscle stiffness at allergies to any of these drugs or
normal human e.g., rubeola (measles), thimerosal (mercury IM site; local their components; pregnancy;
plasma of either rubella (German derivative) preservative in inflammatory previous exposure to serum being
venous or placental measles), varicella- IM formulations and reaction used; thrombocytopenia;
origin and processed zoster (chickenpox), maltose (stabilizing agent)  erythema coagulation disorders; and
by a special type A (infectious) in IV formulations;  urticaria immunization history.
fractionating hepatitis, and as persons with clinical  angioedema 2. Include screening for baseline status
technique. replacement therapy in hepatitis A; IGIV for before beginning therapy and for
 headache
congenital patients with class- any potential adverse effects:
 malaise
agammaglobulinemia specific anti-IgA presence of any skin lesions;
or IgG deficiency deficiencies; IGIM in  fever temperature; orientation, reflexes;
diseases. May be used severe thrombocytopenia  arthralgia pulse, blood pressure, respirations,
as an alternative to H- or other bleeding  nephrotic and adventitious sounds.
BIG to provide passive disorders; intramuscular syndrome 3. Do not administer to any patient
immunity in hepatitis B injection, pregnancy  hypersensitivity with a history of severe reaction to
infection. Also for (category C), lactation. (fever, chills, immune globulins or to the
postexposure anaphylactic components of the drug being used
prophylaxis of hepatitis shock) because severe immune reactions
non-A, non-B, and  infusion reactions can occur.
nonspecific hepatitis. (nausea, flushing,
chills, headache, DURING
Usual indication: chest tightness, 1. Administer the drug as indicated.
Prophylaxis after wheezing, skeletal Preparation varies with each
exposure to hepatitis A, pain, back pain, product; always check
measles, varicella, or abdominal cramps, manufacturer’s guidelines.
rubella anaphylaxis) 2. Monitor for severe reactions and
 renal dysfunction have emergency equipment ready.
 renal failure 3. Arrange for supportive care and
comfort measures for flu-like
symptoms and for the local reaction
to promote patient comfort.
IMMUNE SERA
Immunoglobulin Deficiency
Adult/Child: IV Gammagard,
100 mg/kg/mo; Sandoglobulin,
200 mg/kg/mo IM 1.2 mL/kg
followed by 0.6 mL/kg q2–4wk
Idiopathic Thrombocytopenia
Purpura
Adult/Child: IV 400 mg/kg/d for
5 consecutive d or 1 g/kg q.o.d.
for up to 3 doses
AFTER
1. Provide thorough patient teaching,
including measures to avoid adverse
effects and warning signs of
problem, to improve patient
compliance.
2. Monitor the patient’s vital signs and
report any side effects observed.
IMMUNE SERA
MECHANISM OF SIDE EFFECT/
DRUG NAME INDICATION CONTRAINDICATION NURSING CONSIDERATION
ACTION ADVERSE EFFECT
GENERIC NAME Sterile solution of Prophylactically to Pregnancy (category C) ADVERSE EFFECT BEFORE
hepatitis B immune globulin immunoglobulins provide passive - adverse effect on (>1%) 4. Screen for the following, which may
[immunoglobulin G immunity to hepatitis the fetus and Body as a Whole: be contraindications or cautions to
BRAND NAME (IgG)] prepared by a B infection in there are no  Muscle stiffness the use of the drug: any known
BayHep B Nabi-HB special process using individuals exposed to adequate and  Pain allergies to any of these drugs or
pooled human HBV or HBsAg- well-controlled  Tenderness their components; pregnancy;
AVAILABLE FORM plasma. Serum has positive materials studies in  Swelling previous exposure to serum being
1 mL, 4 mL, 5 mL vials also been tested for (blood plasma, serum). humans, but  erythema of used; thrombocytopenia;
and found free of Also as postexposure potential benefits injection site coagulation disorders; and
DOSAGES antibody to HIV. prophylaxis after bite may warrant use  nausea immunization history.
Hepatitis B Prophylaxis The possibility of or percutaneous of the drug in 5. Include screening for baseline status
 faintness
Adult/Child: IM 0.06 mL/kg as transmission of exposure, ingestion, pregnant women before beginning therapy and for
 fever
soon as possible after exposure, hepatitis infection or direct mucous despite potential any potential adverse effects:
preferably within 24 h, but no AIDS from H-BIG is membrane contact, risks  dizziness presence of any skin lesions;
later than 7 d, repeat 28–30 d remote. sexual or intimate  malaise temperature; orientation, reflexes;
after exposure contact, and in  lassitude pulse, blood pressure, respirations,
neonates born to  body and joint pain and adventitious sounds.
Newborn Exposure HBsAg-positive  leg cramps 6. Do not administer to any patient
Child: IM 0.5 mL as soon as women. with a history of severe reaction to
possible after birth, but no later Skin: immune globulins or to the
than 24 h, repeat dose 3 and 6 Usual Indication:  Urticaria components of the drug being used
mo later Postexposure  Rash because severe immune reactions
prophylaxis against  Angioedema can occur.
hepatitis B  Pruritus
 Erythema DURING
 sensitization 4. Administer the drug as indicated.
(following large or Preparation varies with each
repeated doses) product; always check
 anaphylaxis (rare) manufacturer’s guidelines.
 Urticaria 5. Monitor for severe reactions and
 Rash have emergency equipment ready.
6. Arrange for supportive care and
 Angioedema
comfort measures for flu-like
 Pruritus
symptoms and for the local reaction
 Erythema to promote patient comfort.
IMMUNE SERA
 sensitization (following large or repeated doses)
 anaphylaxis (rare) AFTER
3. Provide thorough patient teaching,
including measures to avoid adverse
effects and warning signs of
problem, to improve patient
compliance.
4. Monitor the patient’s vital signs and
report any side effects observed.
ANTITOXINS AND ANTIVENINS
DRUG NAME
GENERIC NAME
crotalidae polyvalent immune
fab
BRAND NAME
CROFAB
AVAILABLE FORM
intravenous administration
after reconstitution with 18
mL of 0.9% Saline
DOSAGES
CROFAB was shown in
clinical studies to be effective
when given within 6 hours of
snakebite. Based on clinical
experience with CROFAB, the
recommended initial dose is 4
to 6 vials; however, the
starting dose may vary from a
minimum of 4 vials to a
maximum of 12 vials based on
clinical judgement and
severity of envenomation.
The patient should be
observed for up to 1 hour
following the completion of
this first dose to determine if
initial control of the
envenomation has been
achieved. Initial control is
MECHANISM OF SIDE EFFECT/
INDICATION CONTRAINDICATION NURSING CONSIDERATION
ACTION ADVERSE EFFECT
binding and Usual indications: CROFAB should not be ADVERSE EFFECT BEFORE
neutralizing venom Neutralizes the venom administered to patients Adverse reactions that 1. Screen for the following, which
toxins, facilitating their and treats the with a known history of occurred in ≥5% of may be contraindications or
redistribution away envenomation caused hypersensitivity to subjects were: cautions to the use of the drug:
from target tissues and by of pit vipers, papaya or papain unless  urticaria, any known allergies to any of
their elimination from rattlesnakes, the benefits outweigh  rash these drugs or their components;
the body cottonmouths, and the risks and appropriate  nausea pregnancy; previous exposure to
copperheads. management for  pruritus serum being used;
anaphylactic reactions is  back pain thrombocytopenia; coagulation
readily available. disorders; and immunization
history.
This should never be 2. Include screening for baseline
administered status before beginning therapy
prophylactically to and for any potential adverse
asymptomatic patients. effects: presence of any skin
lesions; temperature; orientation,
reflexes; pulse, blood pressure,
respirations, and adventitious
sounds.
3. Do not administer to any patient
with a history of severe reaction
to immune globulins or to the
components of the drug being
used because severe immune
reactions can occur.
DURING
1. Administer the drug as indicated.
Preparation varies with each
product; always check
manufacturer’s guidelines.
2. Monitor for severe reactions and
have emergency equipment ready.
ANTITOXINS AND ANTIVENINS
achieved when local signs of 3. Arrange for supportive care and
envenomation are arrested. comfort measures for flu-like
symptoms and for the local
If initial control is not reaction to promote patient
achieved by the first dose, an comfort.
additional dose of 4 to 6 vials
should be repeated until initial AFTER
control of the envenomation 1. Provide thorough patient teaching,
syndrome has been achieved. including measures to avoid
adverse effects and warning signs
After initial control has been of problem, to improve patient
established, additional 2-vial compliance.
doses of CROFAB every 6 2. Monitor the patient’s vital signs
hours for up to 18 hours (3 and report any side effects
doses) is recommended. observed.
Optimal dosing following the
18-hour scheduled dose of
CROFAB has not been
determined. Additional 2-vial
doses may be administered as
deemed necessary by the
treating physician, based on
the patient’s clinical course.
ANTITOXINS AND ANTIVENINS

MECHANISM OF SIDE EFFECT/

DRUG NAME INDICATION CONTRAINDICATION NURSING CONSIDERATION
ACTION ADVERSE EFFECT
GENERIC NAME The pharmacological Usual indications: No information ADVERSE EFFECT BEFORE
black widow spider antivenin mode of action is Treatment of provided.  Hypersensitivity 7. Screen for the following, which
unknown and symptoms of black reactions including may be contraindications or
BRAND NAME metabolic and widow spider bites anaphylaxis and cautions to the use of the drug:
Antivenin pharmacokinetic data serum sickness. any known allergies to any of
in humans  Muscle cramps have these drugs or their components;
AVAILABLE FORM are unavailable. also been reported. pregnancy; previous exposure to
vial (2.5 mL) of Antivenin serum being used;
thrombocytopenia; coagulation
DOSAGES disorders; and immunization
Using a sterile syringe, inject 2.5 mL history.
of Sterile Water for Injection into the 8. Include screening for baseline
vial of Antivenin. With the needle
still in the rubber stopper, shake the
status before beginning therapy
vial to dissolve the contents and for any potential adverse
completely. effects: presence of any skin
lesions; temperature; orientation,
The dose for adults and children is reflexes; pulse, blood pressure,
the entire contents of a restored vial
(2.5 mL) of Antivenin. It may be
respirations, and adventitious
given intramuscularly, preferably in sounds.
the region of the anterolateral thigh 9. Do not administer to any patient
so that a tourniquet may be applied in with a history of severe reaction
the event of a systemic reaction. to immune globulins or to the
Symptoms usually subside in 1 to 3
hours. Although one dose of
components of the drug being
Antivenin usually is adequate, a used because severe immune
second dose may be necessary in reactions can occur.
some cases.
DURING
Antivenin also may be given
intravenously in 10 to 50 mL of
7. Administer the drug as
saline solution over a 15 minute indicated. Preparation varies
period. It is the preferred route in with each product; always check
severe cases, or when the patient is manufacturer’s guidelines.
under 12, or in shock. One restored 8. Monitor for severe reactions and
vial usually is enough.
have emergency equipment
ANTITOXINS AND ANTIVENINS
ready.
9. Arrange for supportive care and
comfort measures for flu-like
symptoms and for the local
reaction to promote patient
comfort.

AFTER
5. Provide thorough patient
teaching, including measures to
avoid adverse effects and
warning signs of problem, to
improve patient compliance.
6. Monitor the patient’s vital signs
and report any side effects
observed.