human cytomegalovirus immunoglobulin (CMVIG): clinical use

Prescribing considerations

• Confirm prophylactic use in an immunosuppressed patient and consider appropriate antiviral prophylaxis.
• Assess hydration, renal function, thrombotic risk, active infection and previous immunoglobulin exposure.
• Use particular caution when switching immunoglobulin products or in immunoglobulin-naive patients.
• Record the product name and batch number for traceability.

Contraindications and cautions

• Hypersensitivity to human CMV immunoglobulin or an excipient.
• Selective IgA deficiency with anti-IgA antibodies because the product contains IgA and may cause anaphylaxis.

Monitoring

• Observe during and after administration for infusion or hypersensitivity reactions.
• Monitor serum creatinine and urine output where renal risk factors are present.
• Remain vigilant for thrombosis, haemolysis, aseptic meningitis and acute lung injury.
• Interpret serology and direct antiglobulin testing cautiously because transferred antibodies can cause misleading results.

Clinical pharmacology

A CMV-specific polyclonal IgG preparation that neutralises circulating CMV and promotes phagocytic and immune-cell responses. It is immediately bioavailable after intravenous administration and is catabolised through the reticuloendothelial system.

Formulation and product differences

• Ready-to-use intravenous infusion made from pooled human plasma.
• Contains glycine and water for injections, without sucrose, glucose or maltose.
• Contains limited amounts of IgA, which is relevant in patients with anti-IgA antibodies.
• Store refrigerated and protected from light; do not freeze. Use immediately after opening and do not mix with other medicines or immunoglobulin products.