Thymoglobulin® Anti-thymocyte Globulin (Rabbit) for Injection

The Right Dose of Thymoglobulin^® [Anti-thymocyte Globulin (Rabbit)] Offers Clinically Demonstrated Protection for Your Patient's New Kidney

Appropriate dosing for Thymoglobulin is different from dosing for other anti-thymocyte globulin (ATG) products, as protein composition and concentrations vary depending on the source of ATG used. Physicians should therefore exercise care to ensure that the dose prescribed is appropriate for the ATG product being administered.¹

Table showing Thymoglobulin dosing¹ information for intravenous use only, including indication, dose, duration, and cumulative dose. For prophylaxis of acute rejection, 1.5 mg/kg of body weight is administered daily for 4 to 7 days, starting before reperfusion of the donor kidney, with a cumulative dose of 6 to 10.5 mg/kg. For treatment of acute rejection, 1.5 mg/kg of body weight is administered daily for 7 to 14 days, with a cumulative dose of 10.5 to 21 mg/kg. — Dosing for THYMOGLOBULIN is different from dosing for other anti-thymocyte globulin (ATG) products, because protein composition and concentrations vary depending on the source of ATG. The prescribing physician must ensure that the dose prescribed is appropriate for the ATG product being administered.

Total WBC and platelet counts should be monitored to determine the need for any dose modifications¹

Reduce the Thymoglobulin dose by one-half if the WBC count is between 2,000 and 3,000 cells/mm³ or if the platelet count is between 50,000 and 75,000 cells/mm³
Consider stopping treatment with Thymoglobulin if the WBC count falls below 2,000 cells/mm³ or if the platelet count falls below 50,000 cells/mm³
Cytopenias including anemia, neutropenia, and thrombocytopenia have occurred with Thymoglobulin administration and require monitoring of blood counts. Adjust dose accordingly to reverse cytopenias.

Thymoglobulin is used with concomitant immunosuppression. To prevent over-immunosuppression, physicians may wish to decrease the dose of the maintenance immunosuppression regimen during the period of Thymoglobulin use¹
Thymoglobulin overdosage may result in leukopenia, including lymphopenia and neutropenia and/or thrombocytopenia, which can be managed with dose reductions¹

Example Dose: 70 kg (154 lb) patient

The indicated dose of Thymoglobulin is 1.5 mg/kg of body weight administered daily for 4 to 7 days.

For this patient, 105 mg of Thymoglobulin would be administered per day, which would require 5 vials each day.

Over 4 to 7 days, this would equate to a cumulative dose of 420-735 mg or 20-35 vials.

Human icon on a rectangular green card with white text reading “Patient 70 kg (154 lb) 105 mg/day of Thymoglobulin,” on a light green background with a fingerprint pattern.

Dosing Adjustments and Considerations

The immunodeficiency that results from immunosuppression predisposes patients to disorders of immune surveillance and response, including infection and malignancy. The increased risk of infection and malignancy are related more to the overall intensity of immunosuppression than to any specific agent.^2,3

To prevent over-immunosuppression, physicians may wish to decrease the dose of maintenance immunosuppression regimen during the period of Thymoglobulin use¹

During Thymoglobulin therapy, monitoring total lymphocyte count may help assess the degree of T-cell depletion.¹

WBC and platelet counts should be monitored during and after therapy to assess the degree of neutropenia and thrombocytopenia, respectively¹

Personalizing Thymoglobulin dose can help manage your patient’s overall immunosuppression

In all appropriate patients, the Thymoglobulin dose should be reduced to prevent over-immunosuppression^1,*

Full dose of Thymoglobulin

If WBC count is >3,000 cells/mm³
If platelet count is >75,00 cells/mm³

Reduce dose of Thymoglobulin by half

If WBC count is 2,000-3,000 cells/mm³
If platelet count is 50,000-75,000 cells/mm³

Consider stopping Thymoglobulin

If WBC count is <2,000 cells/mm³
If platelet count is <50,000 cells/mm³

Cytopenias including anemia, neutropenia, and thrombocytopenia have occurred with Thymoglobulin administration. Monitors blood counts after Thymoglobulin administration. Adjust dose accordingly to reverse cytopenias.¹

* Monitor for adverse reactions and total WBC and platelet counts to help identify appropriate patients.¹

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Important Safety Information

Important Safety Information for Thymoglobulin [Anti-thymocyte Globulin (Rabbit)]:

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 that contraindicate any additional immunosuppression.

WARNINGS AND PRECAUTIONS

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.
Hypersensitivity and Infusion-Related Reactions: Severe hypersensitivity and infusion-related reactions, including fatal anaphylaxis and severe cytokine release syndrome (CRS), have been reported with the use of Thymoglobulin. 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-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.
Cytopenias: Cytopenias including anemia, neutropenia, and thrombocytopenia have occurred with Thymoglobulin administration. Monitor blood counts after Thymoglobulin administration. Adjust dose accordingly to reverse cytopenias.
Infection: Thymoglobulin is routinely used in combination with other immunosuppressive agents. Infections (bacterial, fungal, viral and protozoal), reactivation of infection (particularly cytomegalovirus [CMV]) and sepsis have been reported after Thymoglobulin administration in combination with multiple immunosuppressive agents. These infections can be fatal.
Monitor patients carefully and administer appropriate anti-infective treatment when indicated.
Malignancy: Malignancies with fatal outcomes have been reported in patients treated with Thymoglobulin. Use of immunosuppressive agents, including Thymoglobulin, may increase the risk of malignancies, including lymphoma or lymphoproliferative disorders.
Immunizations: 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.
Laboratory Tests: Thymoglobulin may interfere with rabbit antibody–based immunoassays and with cross-match or panel-reactive antibody cytotoxicity assays. Thymoglobulin has not been shown to interfere with any routine clinical laboratory tests that do not use immunoglobulins.

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.

The following postmarketing adverse reactions have been reported:

Hepatobiliary Disorders: Hepatic dysfunction including transient reversible elevations in aminotransferases without any clinical signs or symptoms, hepatic failure, hyperbilirubinemia.
Blood and Lymphatic System Disorders: Febrile neutropenia, coagulopathy without clinical signs or symptoms of bleeding, disseminated intravascular coagulopathy, anemia including hemolytic anemia, thrombotic microangiopathy.
Immune System Disorders: Hypersensitivity reactions including anaphylaxis, CRS.

OVERDOSAGE

Thymoglobulin overdosage may result in leukopenia (including lymphopenia and neutropenia) and/ or thrombocytopenia, which can be managed with dose reduction.

INDICATION

Thymoglobulin^®(anti-thymocyte globulin (rabbit)) is indicated for the prophylaxis and treatment of acute rejection in adult and pediatric patients receiving a kidney transplant in conjunction with concomitant immunosuppression.

Click here for full Prescribing Information.

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Important Safety Information

INDICATION

WBC, white blood cells.

References:

1. Thymoglobulin [prescribing information]. Cambridge, MA: Genzyme Corporation; 2026.
2. Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med. 2004;351(26):2715-2729.
3. Kahan BD. Individuality: the barrier to optimal immunosuppression. Nat Rev Immunol. 2003;3(10):831-838.

Dosing & Administration: Dosing

The Right Dose of Thymoglobulin® [Anti-thymocyte Globulin (Rabbit)] Offers Clinically Demonstrated Protection for Your Patient's New Kidney