Anthrax Immune Globulin

Anthrax immune globulin is used to treat inhalational anthrax in combination with appropriate antibacterial drugs.

Anthrax immune globulin is available under the following different brand names: Anthrasil.

Dosages of Anthrax Immune Globulin:

Dosage Forms and Strengths

Intravenous Solution

• 40-70mg/vial; variable fill volume per vial of total protein concentrate

Dosage Considerations – Should be Given as Follows:

Anthrax Exposure

• Indicated for the treatment of inhalational anthrax in combination with appropriate antibacterial drugs
• Adults and children 17 years and older: 420 units (7 vials) intravenously (IV); initiate IV infusion at 0.5 mL/minute for 30 minutes; if tolerated, may increase infusion rate by 0.5 mL/minute every 30 minutes; not to exceed 2 mL/minute
• Children 16 years and younger: 60-420 units (1-7 vials) IV; initiate IV infusion at 0.01 mL/kg/minute for 30 minutes; if tolerated, may increase infusion rate by 0.02 mL/kg/minute every 30 minutes; not to exceed 0.04 mL/kg/minute
• Do not exceed adult infusion rate when initiating (i.e., 0.5 mL/minute) or for maximum infusion rate (i.e., 2 mL/minute)

Vials needed by weight

• Less than 10 kg: 1 vial
• 10 to less than 18 kg: 2 vials
• 18 to less than 25 kg: 3 vials
• 25 to less than 35 kg: 4 vials
• 35 to less than 50 kg: 5 vials
• 50 to less than 60 kg: 6 vials
• 60 kg and greater: 7 vials
• Select initial dose based on clinical severity; severe cases may warrant use of 14 vials (840 units) in adults

Dosage Considerations

• Effectiveness is based solely on efficacy studies conducted in animal models of inhalational anthrax
• Does not cross the blood-brain barrier and does not prevent or treat meningitis
• Does not have direct antibacterial activity
• Adult dosage of 420 units (7 vials) contains up to 0.368 g protein per kg body weight
• Adult dosage of 840 units (14 vials) contains up to 0.736 g protein per kg body weight

Common side effects of anthrax immune globulin include:

• Headache
• Nausea
• Infusion site pain
• Infusion site swelling
• Back pain

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Anthrax immune globulin has no listed severe interactions with other drugs.
Anthrax immune globulin has no listed serious interactions with other drugs.
 

Moderate interactions of anthrax immune globulin include:

• adenovirus types 4 and 7 live, oral
• BCG vaccine live
• influenza virus vaccine quadrivalent, intranasal
• measles mumps and rubella vaccine, live
• measles, mumps, rubella and varicella vaccine, live
• rotavirus oral vaccine, live
• smallpox (vaccinia) vaccine, live
• typhoid vaccine live
• varicella virus vaccine live
• yellow fever vaccine
• zoster vaccine live
• zoster vaccine recombinant

Anthrax immune globulin has no listed mild interactions with other drugs.
 

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings
 

This medication contains anthrax immune globulin. Do not take Anthrasil if you are allergic to anthrax immune globulin or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Black Box Warnings

Falsely high blood glucose levels

• Maltose in immune globulin products, including anthrax immune globulin, may give falsely high blood glucose levels with some blood point-of-care glucose testing systems (e.g., those based on the GDH-PQQ or glucose-dye-oxidoreductase methods), possibly resulting in inappropriate administration of insulin and life-threatening hypoglycemia
• To avoid interference by maltose, perform blood glucose measurements with a glucose-specific method (monitor and test strips)

Thrombosis

• May occur with immune globulin products
• Risk factors include advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling vascular catheters, hyperviscosity, and cardiovascular risk factors
• Thrombosis may also occur in the absence of known risk factors
• For patients at risk of thrombosis, administer at the minimum infusion rate practicable
• Ensure adequate hydration in patients before administration
• Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk of hyperviscosity

Contraindications

• History of anaphylaxis or prior severe systemic reaction associated with the parenteral administration of this or other human immune globulin preparations
• IgA deficiency with antibodies against IgA and a history of IgA hypersensitivity, as it contains trace amounts of IgA (up to 40 mcg/mL)

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Anthrax Immune Globulin?”

Long-Term Effects

• See "What Are Side Effects Associated with Using Anthrax Immune Globulin?”

Cautions

• Hypersensitivity reactions may occur
• Contains maltose; may interfere with certain types of blood glucose monitoring systems
• Thrombosis may occur following treatment with immune globulin products
• Adverse reactions (e.g., chills, fever, headache, nausea, vomiting) may be related to the rate of infusion; follow closely the recommended infusion rate
• Hemolytic anemia and hemolysis may develop; anthrax immune globulin may contain blood group antibodies that may act as hemolysins and induce in vivo coating of red blood cells with immune globulin, causing a positive direct antiglobulin reaction and hemolysis
• Aseptic meningitis syndrome, noncardiogenic pulmonary edema, and blood-borne infections may occur in association with the administration of immune globulin products

Renal impairment

• Acute renal dysfunction, acute renal failure, osmotic nephropathy, acute tubular necrosis, proximal tubular nephropathy, and death may occur upon use of immune globulin intravenous products
• Caution with any degree of preexisting renal insufficiency and in patients at risk of developing renal insufficiency (including, but not limited to, those with diabetes mellitus, aged over 65 years, volume depletion, paraproteinemia, sepsis, and concurrent nephrotoxic drugs)
• Administer at the minimum rate of infusion if practicable and ensure that patients are not volume depleted before infusion; do not exceed the recommended infusion rate
• Assess renal function, including BUN and serum creatinine, before initiating and at appropriate intervals thereafter If renal function deteriorates, consider discontinuing
• Most cases of renal insufficiency following administration of immune globulin products have occurred in patients receiving total doses containing 400 mg/kg or greater of sucrose; anthrax immune globulin does not contain sucrose

Pregnancy and Lactation

There are no human data to establish the presence or absence of an associated risk using anthrax immune globulin during pregnancy or while breastfeeding. Consult your doctor.