Intravenous immunoglobulin

Administration

• Type: Immunologic agent
• Dosage Forms:
• Routes of Administration: IV
• Common Trade Names: Gammagard, Gammar-IV, Gamimune-N, Camunex, Carimune/Panglobulin, Iveegam, Polygam S/D, Sandoglobulin, Venoglobulin, KIOVIG

Note: components of each brand vary

Adult Dosing

Varies depending on formulation

Pediatric Dosing

Varies depending on formulation

Special Populations

• Pregnancy Rating: C
• Lactation risk: Infant risk minimal
• Renal dosing: administer at minimum infusion rate possible
• Hepatic dosing: no adjustment

Indications

• FDA-approved indications:
  • Immune thrombocytopenic purpura
  • Kawasaki
  • Common variable immunodeficiency, primary immunodeficiency associated with humoral imunodeficiency
  • Kidney transplant with high antibody recipient or ABO incompatible donor
• Chronic B-cell leukemia, stem cell transplantation
• Off-label indications
  • TTP, HUS
  • Aplastic anemia, autoimmune hemolytic anemia
  • Myasthenia gravis, Lambert-Eaton myasthenic syndrome
  • Guillain-Barre syndrome
  • Anti-NMDA receptor encephalitis
  • Severe Pyoderma, severe Pemphigus vulgaris
  • Acute GVHD
  • Immune-mediated neutropenia
  • Recurrent C. diff

Contraindications

• Allergy to class/drug
• Hereditary intolerance to sucrose or fructose
• Hyperprolinemia
• IgA deficiency with antibodies
  • all IVIG contain trace IgA
  • Gammagard and Polygram have the least

Adverse Reactions

Serious

• MI, chest pain
• Tachycardia
• Hemolytic anemia
• Thrombosis, PE
• Acute renal failure
• Hyponatremia
• Aseptic meningitis
• Transfusion related acute lung injury

Common

• Hypertension, hypotension
• Peripheral edema
• Pruritus, rash, injection site reaction
• Hyperthermia
• Nausea, vomiting, diarrhea, abdominal pain
• Aphthous ulcer
• Arthralgia, myalgia, backache, headache
• Dizziness, fatigue
• Otalgia
• Asthma, nasal congestion, wheezing, pharyngitis
• Fever, rigors, shivering
• Infusion reaction

Pharmacology

• Half-life: 5-37 days
• Metabolism:
• Excretion:

Mechanism of Action

• Interference with Fc receptors on the cells of the reticuloendothelial system for autoimmune cytopenias and ITP

References

Authors

Claire