IV. Contraindications

  1. IgA Deficiency
  2. Caution in conditions with higher risk of adverse effects
    1. Thrombotic conditions (including Thrombophilia)
    2. Congestive Heart Failure
    3. Renal Insufficiency

V. Mechanism

  1. Pooled donor plasma extracted for IgG antibodies and administered as an intravenous Blood Product

VI. Dosing

  1. Precautions
    1. Caution in patients with thrombotic conditions, Congestive Heart Failure and Renal Insufficiency
    2. Consider pretreatment with Acetaminophen, Diphenhydramine to reduce infusion reaction symptoms
    3. Infuse at lowest possible rate of the lowest available concentration (minimize risk of adverse effects)
      1. Initial Infusion Rate at 0.5 mg/kg/min (0.005 mL/kg/min)
      2. Subsequent infusion rates as tolerated up to 4 to 8 mg/kg/min (0.04 to 0.08 mL/kg/min)
  2. Primary Humoral Immunodeficiency
    1. Adult or Child: 200 to 300 mg/kg (up to 400 to 800 mg) IV monthly
  3. Idiopathic Thrombocytopenic Purpura (Induction Dose)
    1. Adult or Child: 400 mg/kg IV daily for 5 days (or 1000 mg/kg IV daily for 1-2 days)
  4. Bone Marrow Transplant (BMT, age >=20 years)
    1. Adult Pre-BMT: 500 mg/kg IV on day 7 and day 2 before BMT
    2. Adult: Post: BMT: 500 mg/kg IV weekly for 90 days after BMT
  5. Kawasaki Disease
    1. Infuse 400 mg/kg IV daily for 4 days (or 2000 mg/kg IV once over 10 hours)
  6. Other dosing regimens vary by indication
    1. See other references and specific condition guidelines for up to date dosing regimens

VII. Adverse Effects

  1. Thrombosis (black box warning)
    1. Caution in Hypercoagulable states and cardiovascular disease
    2. Infuse at lowest possible rate of the lowest available concentration
  2. Acute Kidney Injury or Renal Failure (Black Box warning)
    1. Kidney injury is more common with sucrose containing solutions
    2. Caution with concurrent Nephrotoxic Drugs, Chronic Kidney Disease
    3. Infuse at lowest possible rate of the lowest available concentration
  3. Fluid and Electrolyte Abnormalities
    1. Hyperproteinemia
    2. Hyponatremia
  4. Hemolytic Anemia
    1. Intravascular Hemolysis or RBC sequestration
    2. Increased risk with high IVIG doses and Non-O Blood Group
  5. Cardiopulmonary
    1. Hypertensive Urgency
    2. Transfusion-Related Acute Lung Injury (TRALI)
  6. Bloodborne Communicable Disease
    1. As with all donor Blood Products, carefully screened in U.S., but risk is not 0%
    2. Potential risk of Creutzfeldt Jakob Disease (or its variant)
  7. Other common effects
    1. Headache
    2. Nausea or Vomiting
    3. Fever or chills

VIII. Safety

  1. Pregnancy Category C
  2. Unlnown safety in Lactation
  3. Monitoring
    1. Renal Function tests
    2. Liver Function Tests

IX. Resources

  1. Arumugham and Rayi (2023) Intravenous Immunoglobulin (IVIG) , StatPearls, Treasure Island, Florida
    1. https://www.ncbi.nlm.nih.gov/books/NBK554446/
  2. Intravenous Immunoglobulin - Privigen (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=7e5649da-75be-4a42-8eeb-4aeba562c401
  3. Intravenous Immunoglobulin - Gamunex (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ade6b84a-e95b-0a49-3296-f56208fdf35b
  4. Intravenous Immunoglobulin - Gammagard (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9d42adca-0dd7-4df7-864d-5a7feee52130
  5. Intravenous Immunoglobulin - Alyglo (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fb97b3ec-29ee-4df1-aa99-c23e57a21228
  6. Intravenous Immunoglobulin - Octagam (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a36a12dc-16be-b135-466f-393954f428a7

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Related Studies

Ontology: Immunoglobulins, Intravenous (C0085297)

Definition (HL7V3.0) <p>immune globulin, intravenous</p>
Definition (MSH) Immunoglobulin preparations used in intravenous infusion, containing primarily IMMUNOGLOBULIN G. They are used to treat a variety of diseases associated with decreased or abnormal immunoglobulin levels including pediatric AIDS; primary HYPERGAMMAGLOBULINEMIA; SCID; CYTOMEGALOVIRUS infections in transplant recipients, LYMPHOCYTIC LEUKEMIA, CHRONIC; Kawasaki syndrome, infection in neonates, and IDIOPATHIC THROMBOCYTOPENIC PURPURA.
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129)
MSH D016756
SnomedCT 34245000, 350344000
HL7 87
English Immune Globulin, Intravenous, Immunoglobulins, IV, Intravenous IG, Intravenous Immune Globulin, Intravenous Immunoglobulins, IV Immunoglobulins, IVIG, Immune Globulin IV, Immune Globulin Intravenous, IV IG, IG IV, immune globulin intravenous, Immunoglobulins, Intravenous [Chemical/Ingredient], intravenous immunoglobulin, IV immunoglobulin, intravenous immunoglobulins, Antibodies, Intravenous, Intravenous Antibodies, immune globulin, intravenous, Immune globulin IV, Immune globulin IV (product), Intravenous immunoglobulin, Intravenous immunoglobulin (product), Immune globulin IV (substance), Intravenous immunoglobulin (substance), Immunoglobulins, Intravenous, IGIV, GLOBULIN,IMMUNE (IV)
Swedish Immunglobuliner, intravenösa
Czech imunoglobuliny pro intravenózní infúzi, imunoglobuliny intravenózní
Finnish Suonensisäiset immunoglobuliinit
Russian VNUTRIVENNYE IMMUNOGLOBULINY, ANTITELA VNUTRIVENNYE, IMMUNOGLOBULINY VNUTRIVENNYE, VNUTRIVENNYE ANTITELA, IVIG, АНТИТЕЛА ВНУТРИВЕННЫЕ, ВНУТРИВЕННЫЕ АНТИТЕЛА, ВНУТРИВЕННЫЕ ИММУНОГЛОБУЛИНЫ, ИММУНОГЛОБУЛИНЫ ВНУТРИВЕННЫЕ
Italian IVIG, Ig per uso endovenoso, Immunoglobuline IV, Immunoglobuline per uso endovenoso
French Immunoglobulines par voie veineuse, Anticorps par voie intraveineuse, Immunoglobulines intraveineuses, Immunoglobulines par voie intraveineuse, Immunoglobulines intra-veineuses, Ig intraveineuses, Anticorps par voie veineuse, IgIV
Croatian IMUNOGLOBULINI, INTRAVENOZNI
Polish Immunoglobuliny dożylne, Immunoglobuliny stosowane dożylnie
Spanish inmunoglobulina endovenosa (producto), IGEV, inmunoglobulina endovenosa, inmunoglobulina EV, inmunoglobulina endovenosa (sustancia), inmunoglobulina intravenosa (producto), inmunoglobulina intravenosa (sustancia), inmunoglobulina intravenosa, IGIV, Anticuerpos Intravenosos, Inmunoglobulinas Intravenosas
German IVIG, Antikörper, intravenös applizierte, Immunglobuline, intravenös applizierte, Intravenös applizierte Antikörper, Intravenös applizierte Immunglobuline
Portuguese IVIG, Anticorpos Endovenosos, Anticorpos Intravenosos, Imunoglobulinas Endovenosas, Imunoglobulinas Intravenosas