CLINICAL USE


Steroid resistant acute transplant rejection Prophylaxis of rejection in sensitised patients

DOSE IN NORMAL RENAL FUNCTION

5 mg daily for 10–14 days (10 days most common)

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :50 000 (Heavy chain) + 25 000 (Light chain)
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :No data
  • %Excreted unchanged in urine &nbsp &nbsp : No data

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.093

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :18–36/–

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in normal renal function

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in normal renal function
  • HDF/high flux &nbsp :Unknown dialysability. Dose as in normal renal function
  • CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Ciclosporin: increases ciclosporin plasma levelsIndometacin: may increase risk of encephalopathyVolatile anaesthetics/drugs that decrease cardiac contractility: increase risk of developing cardiovascular problems

    ADMINISTRATION

    Reconstition

    –

    Route

    IV

    Rate of Administration

    FAST over less than 1 minute

    Comments

    NB Doctor administration recommended

    OTHER INFORMATION

    Ensure patient is not fluid overloaded prior to administration Possible future scope for dose titration according to CD3 or absolute T-cell countReduce or stop other immunosuppressant therapy during treatment, and resume 3 days prior to cessation of OKT3IV methylprednisolone sodium succinate (8 mg/kg given 1–4 hours prior to the first dose of OKT3) is strongly recommended to decrease the incidence and severity of reactions to the first dose. Paracetamol and antihistamines given concomitantly with OKT3 may also help to reduce some early reactions
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