Actimmune

Action

Enhances cellular toxicity and killer cell activity and promotes generation of oxygen metabolites in phagocytes, resulting in destruction of microorganisms.

Availability

Injection: 100 mcg (2 million international units)/0.5-ml vial

Indications and dosages

➣ Chronic granulomatous disease; severe malignant osteoperosis

Adults with body surface area (BSA) above 0.5 m²: 50 mcg/m² (1 million international units/m²) subcutaneously three times weekly

Adults with BSA of 0.5 m² or less: 1.5 mcg/kg subcutaneously three times weekly in deltoid or anterior thigh

Contraindications

• Hypersensitivity to drug, its components, or Escherichia coli-derived products

Precautions

Use cautiously in:

• thyroid disorders, bone marrow depression, hepatic or cardiac disease, seizure disorders, compromised CNS function

• pregnant or breastfeeding patients

• children ages 18 and younger.

Administration

• Administer into deltoid muscle by subcutaneous route only.

• Give at bedtime if flulike symptoms occur.

• Provide antiemetics to ease nausea and vomiting, as prescribed.

Adverse reactions

CNS: dizziness, confusion, paresthesia, lethargy, depression, difficulty thinking or concentrating, insomnia, anxiety, fatigue, amnesia, nervousness, drowsiness, asthenia, malaise

CV: chest pain, hypertension, palpitations, arrhythmias

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, pancreatitis

GU: proteinuria

Hematologic: anemia, leukopenia, thrombocytopenia, neutropenia

Musculoskeletal: joint pain, back pain, myalgia

Skin: flushing, rash, dry skin, erythema

Other: flulike symptoms, weight loss, edema, hypersensitivity reaction

Interactions

Drug-drug. Bone marrow depressants: increased bone marrow depression

Zidovudine: increased zidovudine blood level

Drug-diagnostic tests. Hepatic enzymes: increased levels

Neutrophils, platelets: decreased counts

Patient monitoring

☞ Before and monthly during therapy, assess CBC with white cell differential, glucose and electrolyte levels, and liver and kidney function tests.

• Assess fluid intake and output. Keep patient well hydrated.

• Monitor for GI upset. Provide small, frequent meals or antiemetics to ease severe nausea and vomiting.

☞ Monitor patient for mental status changes and depression.

• Assess for flulike symptoms. If these occur, give drug at bedtime and provide supportive care, such as rest and acetaminophen for headache and fever.

Patient teaching

• Teach patient or caregiver how to administer drug subcutaneously, rotate injection sites, and track dosing schedule and injection sites on calendar.

☞ Tell patient to contact prescriber immediately if depression occurs.

• Advise patient to eat small, frequent meals to combat nausea, vomiting, and appetite loss.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Inform female patient that drug is linked to fetal abnormalities. Advise her not to get pregnant during therapy, and to use barrier contraception.

• Tell female patient to consult prescriber before breastfeeding.

• Tell patient he'll need regular follow-up examinations and blood tests to monitor drug effects.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.