Palivizumab

 Action Neutralizing and fusion-inhibitory activity ag!inst recpirator) syncytial virus (RSV), inhibiting RSV replication.

 Indications Prevention of serious lower respiratory tract disease due to RSV in pediatric patients at high risk of RSV disease.

 Contraindications Standard considerations.

 Route/Dosage

PEDIATRICS: IM 15 mg/kg, preferably in anterolateral aspect of thigh. Give doses > 1 ml in divided doses.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

DERM: Rash. EENT: Otitis media; rhinitis; pharyngitis. HEPA: Increased AST. RESP: Upper respiratory tract infection. OTHER: Pain; hernia.

 Precautions

Pregnancy: Category C. Adults: Not indicated for adult use.

 Administration/Storage

• Store in original container between 2° and 8° C (35.6° and 46.4°F). Do not freeze.
• Reconstitute by first removing the tab portion of the vial cap and cleaning the rubber stopper with 70% ethanol or equivalent. Slowly add 1 ml of Sterile Water for Injection to a 100 mg vial. Gently swirl the vial for 30 sec to avoid foaming. Do not shake vial. After reconstitution let stand at room temperature for a minimum of 20 min until the solution clarifies.
• Follow strict aseptic technique. Use disposable syringes and needles; do not reuse syringes or needles.
• Do not use the gluteal muscle because of risk of damage to the sciatic nerve.
• Administer within 6 hr after reconstitution as palivizumab does not contain a preservative.
• Administer with caution to a patient with thrombocytopenia or any other bleeding or coagulation disorder.

 Assessment/Interventions

• Obtain a complete health history, drug history, and history of allergies.
• Monitor patients at high risk for RSV disease such as pediatric patients with a history of bronchopulmonary dysplasia (BPD) or prematurity.
• Have epinephrine (1:1000) available for immediate use if anaphylaxis or severe allergic reaction occurs.
• Monitor patient for adverse reactions including erythema, vomiting, diarrhea, injection site induration, or inflammation.

 Patient/Family Education

• Instruct family that palivizumab is given for the prevention of serious lower respiratory tract disease caused by RSV in pediatric patients at high risk for complications of RSV infections.
• Instruct parent or family that the child should receive a monthly palivizumab dose throughout the RSV season to maintain a protective level of antibodies against the virus in the blood.
• Instruct parent or family concerning other nonpharmacological methods of infection prevention (ie, preventing exposure to secondhand cigarette smoke and other environmental dangers) and ensuring adequate hydration and rest, humidified air, and proper ventilation.
• Instruct family to report any adverse events that include, but are not limited to, upper respiratory infections, signs and symptoms of otitis media (eg, ear tugging, tenderness), fever, rhinitis, rash, sore throat, or hoarseness immediately to their primary caregiver.