Parenteral Manual

Cytomegalovirus immune globulin, human (BLOOD PRODUCT from TML)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Immune globulin
Original Date: 
August 2005
Revised Date: 
February 2014
  • Prevention or attenuation of CMV disease in kidney, liver, lung, pancreas, heart or bone marrow transplant recipients.
Reconstitution and Stability: 
  • Available as 50 mg/mL injection. Further dilution not recommended
  • Refrigerate. Stable 24 hours in PVC bags.

- Solution Compatible: no information

- Additive/Above Cassette Compatible: no information

- Y-site Compatible: preferably should be administered via a separate infusion line undiluted.  May be piggy-backed into a preexisting line containing: NS injection or up to 20% dextrose injection as long as the dilution of Cytogam: fluid does not exceed 1:2.  Manufacturer recommends cytogam NOT be admixed with other drugs.

- Incompatible: no information



(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct


IV Intermittent Infusion

YES,   Use a 0.2 micron in-line filter
Infusion Rate: 

0.3 mL/kg/hr or 15 mg/kg/hr x 15 min; if tolerated increase to
0.6 mL/kg/hr or 30 mg/kg/hr x 15 min; if tolerated increase to
1.2 mL/kg/hr or 60 mg/kg/hr until done (not to exceed 75 mL/hr)

Flush IV with 25 mL D5W after infusion complete

IV Continuous Infusion NO

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • For prevention or treatment of CMV disease in kidney recipients: 100 to 150 mg/kg/dose IV Q 2 weeks for 16 weeks
  • Treatment must begin within 72 hours of transplant
Potential hazards of parenteral administration: 
  • Infusion rate reactions: flushing, chills, muscle cramps, back pain, fever, nausea, arthralgia, and wheezing;
  • Many adverse reactions are related to infusion rates; therefore, slowing or temporarily stopping the infusion rate may stop the reaction.
  • If anaphylaxis or drop in blood pressure occurs during the infusion, discontinue infusion and use antidote such as diphenhydramine and epinephrine
  • This medication contains albumin or human blood products. Consent (Informed Consent for Transfusion of Blood/Blood Products - form #1084) is required prior to administration to the patient.

Contraindicated in patients who have a severe reaction to CMV-IGIV or any other immune globulin, and in patients with selective IgA deficiency. Cytogam must be administered through a 0.2 micron in-line filter. Monitor vital signs with BP pre-infusion, Q15 MIN for one hour, then hourly during infusion and 30 minutes post-infusion Notify doctor and hold infusion if:
- heart rate 30/minute > baseline
- respiratory rate 10/minute > baseline
- temperature 1.5°C > baseline
- blood pressure changes
- wheezing, chills, rash, urticaria, flushing, myalgia, CNS or behavioural
change, headache or other unusual symptoms Drug interactions: Live virus vaccines (measles, mumps, rubella, varicella) Contains 5 % sucrose and 1%albumin as stabilizing agents Contains 1-1.5 mEq of Na/50 mL 

- Have epinephrine, diphenhydramine and hydrocortisone available at bedside and
in portable kit for patient transport off unit. 
- Dosage guidelines (Administer in sequence listed):

  • Epinephrine (Adrenalin®) (1:1,000 is 1 mg/mL)______ mg = _______mL(0.01 mg/kg/dose = 0.01 mL/kg/dose, Max. 0.5 mg = 0.5 mL) IM in the thigh or alternative large muscle q15 minutes x 2, then Q4H PRN.
  • Diphenhydramine [Benadryl®] __________ mg (1 mg/kg/dose, Max. 50 mg) I.V. x 1, then Q6H PRN.
  • Hydrocortisone [Solu-cortef®] __________ mg (5 mg/kg/dose) I.V. x 1, then Q4H



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