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Botulism Immune Globulin (Intravenous-Human)

Medically reviewed by Drugs.com. Last updated on Aug 30, 2019.

Pronunciation

(BOT yoo lism i MYUN GLOB you lin, in tra VEE nus, YU man)

Index Terms

  • BIG-IV

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, powder for reconstitution [preservative free]:

BabyBIG: ~ 100 mg [contains albumin (human), sucrose; supplied with diluent]

Brand Names: U.S.

  • BabyBIG

Pharmacologic Category

  • Blood Product Derivative
  • Immune Globulin

Pharmacology

BIG-IV is purified immunoglobulin derived from the plasma of adults immunized with botulinum toxoid types A and B. BIG-IV provides antibodies to neutralize circulating toxins.

Duration of Action

Protective neutralizing antibody levels: ~6 months

Half-Life Elimination

Infants: 28 days

Use: Labeled Indications

Treatment of infant botulism caused by toxin type A or B

Contraindications

Hypersensitivity to human immune globulin preparations or any component of the formulation; selective immunoglobulin A deficiency

Dosing: Pediatric

Infant botulism: Dosage is specific to the manufactured lot; refer to product-specific labeling.

Infants: IV: 50 mg/kg as a single IV infusion; begin as soon as diagnosis of infant botulism is made.

Storage

Prior to reconstitution, store between 2°C to 8°C (36°F to 46°F). Infusion should begin within 2 hours of reconstitution and be completed within 4 hours of reconstitution.

Drug Interactions

Vaccines (Live): Immune Globulins may diminish the therapeutic effect of Vaccines (Live). Management: Consult full interaction monograph for dose interval recommendations. This interaction does not apply to oral Ty21a typhoid vaccine or others listed as exceptions. Exceptions: Adenovirus (Types 4, 7) Vaccine; Cholera Vaccine; Influenza Virus Vaccine (Live/Attenuated); Poliovirus Vaccine (Live/Bivalent/Oral); Poliovirus Vaccine (Live/Trivalent/Oral); Rotavirus Vaccine; Yellow Fever Vaccine; Zoster Vaccine (Live/Attenuated). Consider therapy modification

Adverse Reactions

Frequency not always defined. Percentages reported in open-label study except where otherwise noted; may reflect pathophysiology of infant botulism.

>10%:

Cardiovascular: Increased blood pressure (transient, 75%), edema (18%), decreased blood pressure (transient, 16%), heart murmur (15%)

Central nervous system: Irritability (41%), decreased body temperature (16%)

Dermatologic: Pallor (28%), contact dermatitis (24%), erythematous rash (22%, reported as 14% vs 8% in placebo-controlled study)

Gastrointestinal: Dysphagia (65%), loose stools (25%), vomiting (20%), abdominal distension (11%)

Otic: Otitis media (11%, reported in placebo-controlled study)

Respiratory: Atelectasis (39%), rhonchi (34%), nasal congestion (18%), oxygen saturation decreased (17%), cough (13%), rales (13%)

Miscellaneous: Fever (17%)

1% to 10%:

Cardiovascular: Cold extremities (7%), tachycardia (7%)

Central nervous system: Agitation (10%), neurologic abnormality (neurogenic bladder)

Endocrine & metabolic: Dehydration (10%), hyponatremia (6%), metabolic acidosis (5%)

Gastrointestinal: Oral candidiasis (8%)

Hematologic & oncologic: Decreased hemoglobin (9%), anemia (5%)

Local: Injection site reaction (7%), erythema at injection site (5%)

Respiratory: Abnormal breath sounds (decreased: 10%), stridor (9%), lower respiratory tract infection (8%), dyspnea (6%), tachypnea (5%)

Miscellaneous: Infusion related reaction (related to rate: <5%, includes back pain, chills, fever, muscle cramps, nausea, vomiting, wheezing)

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis/hypersensitivity reactions: Hypersensitivity and anaphylactic reactions can occur (some severe); patients with known antibodies to IgA are at greater risk; a severe fall in blood pressure may rarely occur with anaphylactic reaction; discontinue therapy and institute immediate treatment (including epinephrine 1 mg/mL) should be available.

• Aseptic meningitis: Aseptic meningitis syndrome (AMS) has been reported with immune globulin administration; may occur with rapid infusion and/or high doses of intravenous immune globulin (IGIV, ≥1 g/kg). Syndrome usually appears within several hours to 2 days following treatment; usually resolves within several days after product is discontinued. Female patients or patients with a migraine history may be at higher risk for AMS.

• Hemolysis: IGIV has been associated with antiglobulin hemolysis (acute or delayed). Cases of hemolysis-related renal impairment/failure or disseminated intravascular coagulation (DIC) have been reported. Risk factors associated with hemolysis include high doses (≥2 g/kg) given either as a single administration or divided over several days, underlying associated inflammatory conditions, and non-O blood type (FDA 2012). An underlying inflammatory state (eg, elevated C-reactive protein or erythrocyte sedimentation rate) may also increase the risk. Closely monitor patients for signs of hemolytic anemia, particularly in patients with preexisting anemia and/or cardiovascular or pulmonary compromise.

• Hyperproteinemia: Hyperproteinemia, increased serum viscosity, and hyponatremia may occur; distinguish hyponatremia from pseudohyponatremia to prevent volume depletion, a further increase in serum viscosity and a higher risk of thrombotic events.

• Infusion reactions: Patients should be monitored for adverse events during and after the infusion. Stop administration with signs of infusion reaction (fever, chills, nausea, vomiting, and rarely shock). With other immune globulin products, risk may be increased with initial treatment, when switching brands of immune globulin, and with treatment interruptions of >8 weeks.

• Pulmonary edema: Monitor for transfusion-related acute lung injury (TRALI); noncardiogenic pulmonary edema has been reported with IGIV use. TRALI is characterized by severe respiratory distress, pulmonary edema, hypoxemia, and fever in the presence of normal left ventricular function. Usually occurs within 1 to 6 hours after infusion.

• Renal impairment: Acute renal dysfunction (increased serum creatinine, oliguria, acute renal failure, osmotic nephrosis) can rarely occur and has been associated with fatalities in predisposed patients. Patients predisposed to renal dysfunction include patients with renal disease, diabetes mellitus, hypovolemia, volume depletion, sepsis, paraproteinemia, and nephrotoxic medications due to risk of renal dysfunction. Renal dysfunction and acute renal failure occur more commonly in patients receiving IGIV products containing sucrose. In patients at risk of renal dysfunction or acute renal failure, ensure adequate hydration prior to administration; the dose, rate of infusion, and concentration of solution should be minimized. Assess renal function prior to treatment and periodically thereafter. Discontinue if renal function deteriorates.

• Thrombotic events: Thrombosis may occur with immune globulin products even in the absence of risk factors for thrombosis. For patients at risk of thrombosis (eg, hypercoagulable conditions, history of venous or arterial thrombosis, indwelling central vascular catheters, hyperviscosity, cardiovascular risk factors, use of estrogens, prolonged immobilization, and advanced age), administer at the minimum dose and infusion rate practicable. Ensure adequate hydration before administration. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity, such as those with cryoglobulins, fasting chylomicronemia/severe hypertriglyceridemia, or monoclonal gammopathies.

Disease-related concerns:

• Renal impairment: Use with caution; ensure adequate hydration prior to administration; the rate of infusion and concentration of solution should be minimized.

Special populations:

• Adults: Not indicated for use in adults.

Dosage form specific issues:

• Human plasma: Product of human plasma; may potentially contain infectious agents (eg, viruses, the variant Creutzfeldt Jakob disease [vCJD] agent and, theoretically, the Creutzfeldt Jakob disease [CJD] agent) that could transmit disease, including unknown or emerging viruses and other pathogens. Screening of donors, as well as testing and/or inactivation or removal of certain viruses, reduces the risk. Infections thought to be transmitted by this product should be reported to the manufacturer.

Other warnings/precautions:

• Administration: For IV infusion only; do not exceed recommended rate of administration.

Monitoring Parameters

Renal function (BUN, serum creatinine, urinary output); vital signs (continuously during infusion); signs and/or symptoms of allergic reaction (continuously during infusion); aseptic meningitis syndrome (may occur hours to days following IGIV therapy); signs of relapse (may occur up to 1 month following recovery)

Pregnancy Considerations

Botulism immune globulin is only indicated for use in infants <1 year of age.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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