Live Vaccines
Contraindicated
Database
Profound immunosuppression
Avoid live vaccines pre-/post-treatment per immune-reconstitution timing
Source: Kimi deep-research + Cla
Drug reference
Antithymocyte immunoglobulin (rabbit)
Polyclonal rabbit IgG immunosuppressant (anti-T-cell) · Immunosuppressive agent
Also known as Thymoglobulin, Thymoglobuline, ATG
START
1–1.5 mg/kg/day IV ×7–14 d (transplant); 3.5 mg/kg/day ×5 d (AA)
TYPICAL MAX
3.5 mg/kg/day (aplastic anaemia protocols)
STOP IF
Severe anaphylaxis, serum sickness, or refractory profound cytopenia
WATCH
CBC daily, infusion reactions, infection signs, post-treatment PTLD surveillance
CDSCO approvedSchedule HATC L04AA04
KDIGO 2024 + manufacturer label
- ONSET
- 6min · infusion start
- PEAK
- 6h · end infusion
- t½
- 4.3w · t½ ~30 d
- DURATION
- 4.3w · lymphopenia
EXCRETION
Proteolytic catabolism; not excreted intact
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Use only if benefit outweighs risk; transplant indication usually drives use.
FDA category + note
Top interactionssee all 12 →
- Live VaccinesContraindicatedDatabaseKimi deep-research + Cla
- AdalimumabSevereDatabaseDDInter
- BaricitinibSevereDatabaseDDInter
- CertolizumabSevereDatabaseDDInter
Mechanism
Polyclonal rabbit IgG raised against human thymocytes binds multiple T-cell-surface antigens (CD2, CD3, CD4, CD8, CD11a, CD18, CD25, etc.) — depletes circulating T-lymphocytes by complement-dependent lysis, apoptosis, and Fc-mediated clearance.
Indications
Prophylaxis of acute solid-organ transplant rejectionTreatment of steroid-resistant acute rejectionAplastic anaemiaConditioning for allogeneic HSCT (selected)
Dosing
- Adult
- Rejection prophylaxis: 1–1.5 mg/kg/day IV for 7–14 days. Rejection treatment: 1.5 mg/kg/day IV for 7–14 days. Aplastic anaemia: 3.5 mg/kg/day IV for 5 days (with ciclosporin).
- Pediatric
- Same weight-based dosing (specialist).
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- No specific adjustment.
- Geriatric
- Higher infection risk; monitor closely.
- Max dose
- 3.5 mg/kg/day (aplastic anaemia protocols)
Pharmacokinetics
Onset
T-cell depletion within hours
Peak effect
End of infusion (serum)
Duration
Lymphopenia for weeks-months
Half-life
~30 days
Bioavailability
IV 100%
Protein binding
Not applicable (IgG)
Metabolism
Proteolytic catabolism
Excretion
Catabolised (not excreted intact)
Contraindications
- Active acute infection (bacterial / viral / fungal)
- Severe hypersensitivity to rabbit proteins
- Caution: prior severe infusion reaction to ATG
Side effects
Common
Fever / chills (infusion-related)HeadacheThrombocytopenia / leukopeniaDiarrhoeaSkin reactions
Serious
- Severe infusion reactions / cytokine release / anaphylaxis
- Severe and prolonged immunosuppression / serious infection
- Lymphoproliferative disease (post-transplant)
- Serum sickness (delayed type III)
- Thrombocytopenia
Pregnancy & lactation
Pregnancy
Use only if benefit outweighs risk; transplant indication usually drives use.
Lactation
Avoid (limited data; immunosuppression effects).
Drug interactions
Adalimumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Baricitinib
Severe
Database
Drug interaction classified as: others
Source: DDInter
Certolizumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cladribine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Deferiprone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Etanercept
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Fingolimod
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Golimumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Infliximab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Leflunomide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Measles Virus Vaccine Live Attenuated
Severe
Database
Drug interaction classified as: others
Source: DDInter
Related guidelines
Iron deficiency anaemia in adults
ICMR · Hematology · 2023
Iron deficiency anaemia in pregnancy
ICMR · Obstetrics & Gynaecology · 2022
Iron deficiency anaemia in pregnancy
FOGSI · Obstetrics & Gynaecology · 2017
Venous thromboembolism prophylaxis
ASH · Haematology · 2018
Drug-resistant tuberculosis
RNTCP · Pulmonology · 2025
Ask House about Antithymocyte immunoglobulin (rabbit)
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: BNF·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20