|
| |
Guidelines for use of
Intravenous Immune Globulin (IVIG)
05 November 2004
-
Indications:
IVIG is sometimes used in the following neurologic diseases related to
immunologic dysfunction, however, it
is not FDA-approved for use in these diseases. Listed dose is the dose
most commonly reported in the literature.
|
Disease
|
Dose
|
Comment(s)
|
|
chronic
inflammatory demyelinating polyneuropathy
|
0.4g/kg
iv qd x5 days
|
IVIG
is an equivalent alternative to plasma exchange in children and adults
|
|
Guillain-Barre
Syndrome
|
0.4g/kg
iv qd x5 days
|
IVIG
is an equivalent alternative to plasma exchange in children and adults
|
|
myasthenia
gravis
|
0.4g/kg
iv qd x5 days
|
routine
use of IVIG not recommended; IVIG may be considered in pts with severe
MG for whom other treatments have failed or are contraindicated
|
|
neuropathies
associated with vasculitities
|
0.4g/kg
iv qd x5 days
|
routine
use of IVIG not recommended; IVIG may be used in pts with severe active
illness who have failed other tx
|
|
polymyositis
|
1g/kg
x2 days monthly
|
routine
use of IVIG not recommended; IVIG may be used in pts with severe active
illness who have failed other tx
|
| dermatomyositis |
1g/kg
x2 days monthly |
routine
use of IVIG not recommended; IVIG may be used in pts with severe active
illness who have failed other tx (dermatomyositis is more responsive to
IVIG than polymyositis)
|
-
Contraindications:
isolated immunoglobulin A (IgA) deficiency
-
Administration:
|
Initiation:
|
0.01
ml/kg/min, increasing to 0.02 ml/kg/min after 15 to 30 minutes if
tolerated
|
|
Titration:
|
If
no adverse effects (see below) are observed at 30 minutes, gradually
increase infusion rate q15-30 minutes to a maximum rate of 0.06
ml/kg/min
|
|
Maintenance:
|
On
average, patients tolerate a maintenance infusion rate in the 0.03-0.06
ml/kg/min range (2 to 4 ml/min for a 70 kg patient).
|
|
Equipment:
|
Infusion
pump and vented tubing
IVIG is dispensed in glass and, therefore, must be administered through
vented tubing.
|
|
Compatibility:
|
Compatible
with 0.9% Sodium Chloride only. Main line should be primed with normal
saline prior to administration. No other medication or solution should
be administered with IVIG. Line should be flushed with normal saline
after IVIG administration is complete.
|
|
Stability:
|
8
hours at room temperature
|
-
Adverse
effects: Most adverse effects of IVIG are
infusion rate-related and can be managed by reducing the infusion rate or by
interruption of the infusion until symptoms subside. Premedication with
aspirin, acetaminophen and/or diphenhydramine may also be useful.
|
Infusion
rate-related
|
Independent
of infusion rate
|
|
headache
|
fatigue
|
|
backache
|
urticaria
|
|
myalgia
|
anaphylaxis
|
|
pyrexia
|
aseptic
meningitis
|
|
abdominal
pain
|
|
|
chest
tightness
|
|
|
hypotension
or hypertension
|
|
|
flushing
|
|
|
nausea/vomiting
|
|
|
chills
|
|
Monitoring:
Closely monitor the patient for the first five
minutes and each time the administration rate is increased. The most common time
for a transfusion reaction to occur is 30 to 60 minutes after the transfusion is
initiated and each time the rate is increased. Continue to monitor the patient
as appropriate throughout the transfusion for changes in vital signs and
symptoms of adverse reactions.
|
