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RHo (D) immune globulin

Generic Name: RHo (D) immune globulin (ROE D im MYOON GLOB yoo lin)
Brand Name: HyperRHO S/D Full Dose, HyperRHO S/D Mini Dose, MicRhoGAM, MicRhoGAM Ultra-Filtered Plus, RhoGAM, RhoGAM Ultra-Filtered Plus, Rhophylac, WinRho SDF, ...show all 19 brand names

What is RHo (D) immune globulin?

RHo (D) immune globulin is a sterilized solution made from human blood. Rh is a substance that most people have in their blood (Rh positive) but some people don't (Rh negative). A person who is Rh negative can be exposed to Rh positive blood through a mismatched blood transfusion or during pregnancy when the baby has the opposite blood type. When this exposure happens, the Rh negative blood will respond by making antibodies that will try to destroy the Rh positive blood cells. This can cause medical problems such as anemia (low red blood cells), kidney failure, or shock.

RHo (D) immune globulin is used to prevent an immune response to Rh positive blood in people with an Rh negative blood type. RHo (D) immune globulin may also be used in the treatment of immune thrombocytopenic purpura (ITP).

RHo (D) immune globulin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about RHo (D) immune globulin?

You should not receive this medicine if you have immune globulin A (IgA) deficiency with antibody to IgA, or if you have hemolytic anemia (a lack of red blood cells).

RHo(D) immune globulin can cause an abnormal breakdown of red blood cells. This effect can lead to life-threatening blood clots or organ failure.

Call your doctor right away if you have any of the following symptoms: fever, chills, back pain, unusual weakness, red or pink urine, pale skin, feeling short of breath, little or no urinating, rapid weight gain, sudden numbness or weakness, slurred speech, problems with vision or balance, coughing up blood, or swelling or warmth in your leg.

What should I discuss with my healthcare provider before I receive RHo (D) immune globulin?

You should not receive this medicine if you have ever had an allergic reaction to an immune globulin, or if you have:

  • immune globulin A (IgA) deficiency with antibody to IgA; or

  • hemolytic anemia (a lack of red blood cells).

To make sure RHo (D) immune globulin is safe for you, tell your doctor if you have:

  • a history of anemia;

  • heart disease or a history of coronary artery disease (hardened arteries);

  • a bleeding disorder (such as hemophilia);

  • high triglycerides (a type of fat in the blood);

  • kidney disease; or

  • diabetes.

RHo (D) immune globulin is often used during and after pregnancy. This medicine is not known to be harmful to a baby during pregnancy or while breast-feeding.

If you are receiving this medication to treat a mismatched blood transfusion, tell your doctor if you are pregnant or if you ever plan to become pregnant.

If you are an Rh-negative woman and you become pregnant, you must tell your doctor if you have ever been exposed to Rh-positive blood in your lifetime. This includes exposure from a mismatched blood transfusion, or exposure during your first pregnancy. Your history of exposure and treatment will be extremely important to each and every one of your pregnancies.

RHo (D) immune globulin is made from human plasma (part of the blood) which may contain viruses and other infectious agents. Donated plasma is tested and treated to reduce the risk of it containing infectious agents, but there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

How is RHo (D) immune globulin given?

RHo (D) immune globulin is injected into a muscle or a vein. You will receive this injection in a clinic or hospital setting.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely after you receive immune globulin. Your urine may also need to be tested every 2 to 4 hours for at least 8 hours.

For treatment during pregnancy, this medicine is usually given at regular intervals during the last half of the pregnancy, and again after the baby is born.

For treatment of a mismatched blood transfusion, the medicine is given when symptoms of an immune response appear (when the body starts making Rh antibodies).

To be sure this medicine is helping your condition, you may need frequent blood tests. You may not notice any change in your symptoms, but your blood work will help your doctor determine how long to treat you with RHo (D) immune globulin.

RHo (D) immune globulin can cause false results with certain lab tests for glucose (sugar) in the blood. Tell any doctor who treats you that you are using this medicine.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your RHo (D) immune globulin injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while receiving RHo (D) immune globulin?

Do not receive a "live" vaccine for at least 3 months after treatment with RHo (D) immune globulin. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

RHo (D) immune globulin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: rash or hives; feeling light-headed, chest tightness, difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • fever, chills, shaking, back pain, unusual weakness, red or pink urine;

  • pale or yellowed skin, dark colored urine;

  • rapid breathing, rapid heart rate, confusion, feeling short of breath;

  • signs of kidney failure--little or no urinating, swelling, rapid weight gain; or

  • signs of a blood clot--sudden numbness or weakness, slurred speech, problems with vision or balance, chest pain, coughing up blood, swelling with redness and warmth in one or both legs.

Common side effects may include:

  • nausea, diarrhea, vomiting, stomach pain;

  • headache, dizziness;

  • drowsiness, weakness, general ill feeling;

  • joint or muscle pain;

  • flushing (warmth, redness, or tingly feeling);

  • mild itching or skin rash;

  • increased sweating; or

  • pain or tenderness where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

RHo (D) immune globulin dosing information

Usual Adult Dose for Idiopathic (Immune) Thrombocytopenic Purpura:

Rhophylac(R): 250 international units (50 mcg) per kg, IV, at 2 mL per 15 to 60 seconds
WinRho(R):
-Initial dose: 250 international units (50 mcg) per kg, IV, over 3 to 5 minutes; may be divided into 2 doses on separate days if desired.
-Maintenance dose: 125 to 300 international units/kg (25 to 60 mcg/kg), IV, over 3 to 5 minutes

Use: Immune thrombocytopenic purpura (ITP):
-Raising platelet counts in Rho (D)-positive, non-splenectomized chronic ITP

Usual Adult Dose for Rh-Isoimmunization:

Dose and route varies for each product.

Rh-incompatible pregnancy:
RhoGAM(R): 1500 international units (300 mcg), IM, at gestational week 26 to 28, or within 72 hours of birth of an RHo (D) positive baby.
Rhophylac(R): 1500 international units (300 mcg), IV or IM, at gestational week 29 to 30; repeat dose within 72 hours of birth of an RHo (D) positive baby.
WinRho(R): 1500 international units (300 mcg), IV or IM, at gestational week 28; give an additional 600 international units (120 mcg) dose within 72 hours of birth of an RHo (D) positive baby.

Comments:
-If RhoGAM(R) or WinRho(R) are administered early in pregnancy, administer at 12 week intervals to maintain adequate anti-Rh levels.
-If the Rh status of the baby is not known at 72 hours, administer WinRho(R).

Amniocentesis and chorionic villus sampling before 34 weeks gestation:
RhoGAM(R): 1500 international units (300 mcg), IM
WinRho(R): 1500 international units (300 mcg), IV or IM, immediately after the procedure

Abortion or miscarriage of up to 12 weeks gestation:
BayRho-D Mini-Dose(R): 1 syringe, IM, within 3 hours, or as soon as possible (within 72 hours of pregnancy termination).
HyperRHO S/D Mini-Dose(R): 1 syringe, IM, within 3 hours, or as soon as possible (within 72 hours of pregnancy termination).
MICRhoGAM(R) or RhoGAM(R): 250 international units (50 mcg), IM, within 72 hours of actual or threatened pregnancy termination.

Abortion or miscarriage after 12 weeks gestation:
RhoGAM(R): 1500 international units (300 mcg), IM

Abortion, amniocentesis, or any other manipulation after 34 weeks gestation:
WinRho(R): 600 international units (120 mcg), IV or IM, within 72 hours

Ectopic pregnancy:
RhoGAM(R): 1500 international units (300 mcg), IM

Excessive fetomaternal hemorrhage:
Rhophylac(R): 1500 international units (300 mcg), IV or IM, within 72 hours of complication, plus:
-100 international units (20 mcg) per mL fetal red blood cells in excess of 15 mL if transplacental bleeding is quantified
OR
-an additional 1500 international units (300 mcg) dose if transplacental bleeding cannot be quantified

Obstetric complications/invasive procedures:
RhoGAM(R): 1500 international units (300 mcg), IM
Rhophylac(R): 1500 international units (300 mcg), IV or IM, within 72 hours of the at-risk event.

Threatened abortion at any time:
WinRho(R): 1500 international units (300 mcg), IV or IM, immediately

Threatened pregnancy loss after 12 weeks gestation with continuation of pregnancy:
RhoGAM(R): 1500 international units (300 mcg), IM

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Incompatible transfusions:
MICRhoGAM(R) or RhoGAM(R):
-Transfusion of less than 2.5 mL of incompatible blood: 250 international units (50 mcg), IM, within 72 hours of exposure
RhoGAM(R):
-Transfusion of 2.5 to 15 mL incompatible blood: 1500 international units (300 mcg), IM, within 72 hours of exposure.
-Transfusion of over 15 mL incompatible blood: 20 mcg per mL transfused blood, IM, within 72 hours of exposure. May be given as a single dose or at spaced intervals within 72 hours of exposure.

Rhophylac(R): 100 international units (20 mcg) per 2 mL transfused blood (or per 1 mL erythrocyte concentrate), IM or IV, within 72 hours of exposure.
WinRho(R):
IV administration:
45 international units (9 mcg) per mL whole blood
90 international units (18 mcg) per mL red blood cells
-Administer 3,000 international units (600 mcg) IV every 8 hours until the total dose (calculated from the above doses) is administered.
IM administration:
60 international units (12 mcg) per mL whole blood
120 international units (24 mcg) per mL red blood cells
-Administer 6000 international units (1200 mcg) IM every 12 hours until the total dose (calculated from the above doses) is administered.

Uses:
Suppression of Rh isoimmunization in:
-Pregnancy and obstetric conditions in non-sensitized, Rho (D)-negative women with an Rh-incompatible pregnancy
-Routine antepartum and postpartum Rh prophylaxis
-Rh prophylaxis in obstetric complications or invasive procedures
-Incompatible transfusions in Rho (D)-negative individuals (given Rho (D)-positive blood cells)

Usual Pediatric Dose for Idiopathic (Immune) Thrombocytopenic Purpura:

Rhophylac(R): 250 international units (50 mcg) per kg, IV, at 2 mL per 15 to 60 seconds
WinRho(R):
-Initial dose: 250 international units (50 mcg) per kg, IV, over 3 to 5 minutes; may be divided into 2 doses on separate days if desired.
-Maintenance dose: 125 to 300 international units/kg (25 to 60 mcg/kg), IV, over 3 to 5 minutes

Use: Immune thrombocytopenic purpura (ITP):
-Raising platelet counts in Rho (D)-positive, non-splenectomized acute or chronic ITP

What other drugs will affect RHo (D) immune globulin?

Other drugs may interact with RHo (D) immune globulin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about RHo (D) immune globulin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.01. Revision Date: 2014-02-12, 9:06:39 AM.

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