How to Prepare Thymoglobulin^® [Anti-thymocyte Globulin (Rabbit)] for Administration¹

Image of Thymoglobulin® [Anti‑thymocyte Globulin (Rabbit)] 25 mg vial next to its product carton.

Calculate dose based on body weight and determine the number of vials needed

Image of wall mounted thermometer displaying temperature scales in Celsius and Fahrenheit, with an additional circular hygrometer gauge at the bottom, all set against a white brick background.

Bring the appropriate number of vials to room temperature

Image of syringe needle inserted into the rubber stopped medicine vial.

Reconstitute each vial with 5 ml of sterile water for injection using aseptic technique

Image of an open storage containing multiple medicine vials.

Gently rotate vials until all product is dissolved. Inspect solution for particulate matter after reconstitution

Image of clear intravenous infusion bag filled with fluid, with connected tubing and ports, set against a plain white background.

Transfer the contents of the calculated number of Thymoglobulin vials into the bag of infusion solution (saline or dextrose). Mix solution by inverting bag only once or twice

Recommended volume: 50 mL of infusion solution per vial of Thymoglobulin (total volume usually between 50 to 500 mL)¹

Thymoglobulin Administration

Thymoglobulin should be administered under strict medical supervision in a hospital setting and patients should be carefully monitored during the infusion¹

Thymoglobulin is administered by intravenous injection and infused through a 0.22-μm filter into a high-flow vein (follow the manufacturer's instructions for the infusion administration set)¹

Set the flow rate to deliver the dose over a minimum of 6 hours for the first dose and over at least 4 hours for subsequent doses¹

Thymoglobulin is less likely to produce side effects when administered at the recommended flow rate¹

Severe hypersensitivity and infusion-related reactions, including fatal anaphylaxis and severe CRS, have been reported with the use of Thymoglobulin. Severe acute CRS can cause serious cardiorespiratory events and/or death.¹

Close compliance with the recommended dosage and infusion time may reduce the incidence and severity of infusion-related reactions. Slowing the infusion rate may minimize the risk of infusion-related reactions. If a hypersensitivity or infusion-related reaction occurs, terminate the infusion immediately and provide supportive treatment according to clinical practice.¹

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Important Safety Information

WARNING: IMMUNOSUPPRESSION. Thymoglobulin should only be used by physicians experienced in immunosuppressive therapy in transplantation.

Contraindications. Thymoglobulin is contraindicated in patients with a history of allergy or anaphylaxis to rabbit proteins or to any product excipients, or who have active acute or chronic infections which contraindicate any additional immunosuppression.
Management of Immunosuppression. To prevent over-immunosuppression, physicians may wish to decrease the dose of the maintenance immunosuppression regimen during the period of Thymoglobulin use. Dosing for Thymoglobulin is different from dosing for other ATG products, because protein composition and concentrations vary depending on the source of ATG. Thymoglobulin should be used under strict medical supervision in a hospital setting, and patients should be carefully monitored during the infusion.
Immune Mediated Reactions. Serious immune-mediated reactions, including anaphylaxis or severe cytokine release syndrome (CRS), have been reported with the use of Thymoglobulin. Fatal anaphylaxis has been reported. If an anaphylactic reaction occurs, the infusion should be terminated immediately.
Infusion-Associated Reactions. Cases consistent with cytokine release syndrome (CRS) have been reported with rapid infusion rates. CRS is attributed to the release of cytokines by activated monocytes and lymphocytes. Severe acute CRS can cause serious cardiorespiratory events and/or death. Close compliance with the recommended dosage and infusion time may reduce the incidence and severity of infusion-associated reactions (IARs). Slowing the infusion rate may minimize many of these IARs. Reactions at the infusion site may include pain, swelling, and redness of the skin.
Hematologic Effects. Low counts of platelets and white blood cells (including low counts of lymphocytes and neutrophils) have been identified and are reversible following dose adjustments. Total white blood cell and platelet counts should be monitored.
Infection and Malignancy. Infections, reactivation of infection, febrile neutropenia, sepsis, malignancies including lymphoproliferative disorders (LPD) and other lymphomas as well as solid tumors have been reported after Thymoglobulin administration in combination with multiple immunosuppressive agents. These events can be fatal.
Immunization. The safety of immunization with attenuated live vaccines following Thymoglobulin therapy has not been studied; therefore, immunization with attenuated live vaccines is not recommended for patients who have recently received Thymoglobulin.
Overdosage. Thymoglobulin overdosage may result in leukopenia (including lymphopenia and neutropenia) and/ or thrombocytopenia, which can be managed with dose reduction.
Adverse Reactions. The most common adverse reactions and laboratory abnormalities (incidence >5% higher than comparator) are urinary tract infection, abdominal pain, hypertension, nausea, shortness of breath, fever, headache, anxiety, chills, increased potassium levels in the blood, and low counts of platelets and white blood cells.
During post-marketing surveillance, arthralgia/myalgia, lymphadenopathy, proteinuria, and decreased oxygen saturation tend to occur 5 to 15 days after Thymoglobulin infusion and are consistent with serum sickness. Symptoms are manageable with corticosteroid treatment.

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Important Safety Information

CRS, cytokine release syndrome.

Reference:

1. Thymoglobulin [prescribing information]. Cambridge, MA: Genzyme Corporation; 2026.

Dosing & Administration: Administration

How to Prepare Thymoglobulin® [Anti-thymocyte Globulin (Rabbit)] for Administration1

Thymoglobulin Administration

Important Safety Information

Important Safety Information

How to Prepare Thymoglobulin^® [Anti-thymocyte Globulin (Rabbit)] for Administration¹