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Intravenous Immunoglobulin: Comprehensive Guide to IVIG Therapy
Summary of Key Points
Intravenous Immunoglobulin (IVIG) is a treatment derived from donated human blood plasma. It is used to manage various immune system disorders, including primary immunodeficiency, chronic inflammatory demyelinating polyneuropathy (CIDP), and Guillain-Barré syndrome. IVIG therapy helps regulate or support the immune system. It is administered intravenously, typically in a hospital or clinic setting. Always consult your healthcare provider before starting or adjusting any IVIG treatment.
Names of IVIG Medications
Gammagard (Intravenous Immunoglobulin)
Gamunex-C (Intravenous Immunoglobulin)
Privigen (Intravenous Immunoglobulin)
Octagam (Intravenous Immunoglobulin)
The generic name refers to the active ingredient in a medication. In this case, the generic name is listed in parentheses after the brand name.
Pharmacologic Category
Immune Globulin
IVIG Dosing Guidelines
Intravenous Immunoglobulin (IVIG) is used to treat a variety of conditions. The dose, frequency, and duration of treatment depend on the specific condition being managed. Always consult your healthcare provider before making any changes to your dose. You can also schedule a telemedicine visit with one of our providers to discuss your IVIG therapy plan.
Primary Immunodeficiency (PI): IVIG is typically administered at a dose of 300 to 600 mg/kg every 3 to 4 weeks, depending on the patient’s clinical response.
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): IVIG is often given at a dose of 2 g/kg over 2 to 5 days, followed by maintenance doses of 1 g/kg every 3 weeks.
Guillain-Barré Syndrome (GBS): IVIG is usually administered at a dose of 2 g/kg over 5 days.
Myasthenia Gravis: IVIG is typically given at a dose of 2 g/kg over 2 to 5 days, depending on the severity of symptoms.
Kawasaki Disease: IVIG is administered as a single dose of 2 g/kg, usually in combination with aspirin.
Immune Thrombocytopenic Purpura (ITP): IVIG is given at a dose of 1 g/kg for 1 to 2 days.
Multifocal Motor Neuropathy (MMN): IVIG is administered at a dose of 2 g/kg over 2 to 5 days, followed by maintenance doses of 1 g/kg every 2 to 4 weeks.
Hepatitis B: IVIG is given at a dose of 0.06 mL/kg every month to prevent reinfection after liver transplantation.
Bone Marrow Disorders: IVIG is typically administered at a dose of 500 mg/kg every 2 to 4 weeks.
Systemic Lupus Erythematosus (SLE): IVIG is usually given at a dose of 400 mg/kg daily for 5 days.
Dosage Forms and Strengths of IVIG
Intravenous Immunoglobulin (IVIG) is available in the following forms and strengths:
- Solution for injection: 5%, 10% concentrations
- Vials: 1 g, 2.5 g, 5 g, 10 g, and 20 g
IVIG Administration Instructions
IVIG is administered intravenously by a healthcare professional, typically in a hospital or clinic. The infusion rate may be adjusted based on your tolerance. Staying well-hydrated before and after the infusion can help reduce the risk of side effects. Your healthcare provider will monitor you during the infusion for any adverse reactions.
Contraindications for IVIG Therapy
A contraindication is a condition where a medication should not be used due to potential harm. If you have any of the following conditions, you should avoid Intravenous Immunoglobulin (IVIG) or use it under close medical supervision.
Severe allergic reactions to immunoglobulins: If you have experienced a severe allergic reaction (anaphylaxis) to immunoglobulins, IVIG may not be safe for you, as your body could have a similar or more severe reaction.
IgA deficiency with antibodies against IgA: Individuals with IgA deficiency who have developed antibodies against IgA are at risk of severe allergic reactions when receiving IVIG, as it contains small amounts of IgA that can trigger an immune response.
Kidney disease: IVIG can sometimes cause kidney problems, especially in those with pre-existing kidney conditions. If you have a history of kidney issues, your doctor may recommend avoiding IVIG or using it cautiously.
Blood clotting disorders: IVIG can increase the risk of blood clots, particularly in individuals with a history of clotting disorders, heart disease, or prolonged immobility. If you have any of these conditions, IVIG may not be the best option for you.
Drug Interactions with IVIG
Certain medications can interact with IVIG, potentially causing harmful side effects or reducing the effectiveness of either drug. Inform your healthcare provider if you are taking any of the following medications:
Live vaccines: IVIG can interfere with the effectiveness of live vaccines, such as the measles, mumps, and rubella (MMR) vaccine or the varicella (chickenpox) vaccine. If you have recently received a live vaccine, your doctor may recommend delaying IVIG treatment.
Nephrotoxic drugs: Medications that can harm the kidneys, such as certain antibiotics (e.g., gentamicin) or nonsteroidal anti-inflammatory drugs (NSAIDs), may increase the risk of kidney damage when used with IVIG.
Anticoagulants: Blood thinners like warfarin (Coumadin) or heparin may interact with IVIG, increasing the risk of bleeding or clotting complications. Your doctor may need to monitor your blood clotting levels closely.
Intravenous Immunoglobulin in Pregnancy
Is it safe to take intravenous immunoglobulin (IVIG) during pregnancy? In most cases, yes, but it depends on your individual circumstances. IVIG is commonly prescribed for pregnant women with autoimmune or immune-related conditions and is generally considered safe. However, as with any treatment, the potential risks and benefits should be carefully weighed. If you’re pregnant or planning to become pregnant, it’s essential to consult your healthcare provider to determine whether IVIG is appropriate for you. You can also schedule a telemedicine appointment with one of our providers to explore your options.
Intravenous Immunoglobulin while Breastfeeding
Is IVIG safe to use while breastfeeding? Yes, IVIG is typically regarded as safe during breastfeeding. Immunoglobulins are naturally present in breast milk, and there is no evidence to suggest that IVIG poses any harm to nursing infants. However, it’s always a good idea to discuss any medications with your healthcare provider, especially if you’re breastfeeding. Our telemedicine providers are available to help you make the best decision for both you and your baby.
Estimated Cost of IVIG Therapy
The cost of IVIG therapy can vary significantly depending on the dosage and the specific product used. Without insurance, a 30-day supply of IVIG, even with a GoodRx coupon, can range from $5,000 to $10,000 or more. This high cost is largely due to the complex process of manufacturing IVIG, which is derived from human plasma. If you’re concerned about the expense of IVIG treatment, speak with your healthcare provider about potential financial assistance programs or alternative treatment options.
Possible Alternatives to IVIG Therapy
Depending on your condition, there may be alternative treatments or lifestyle changes that can help manage your symptoms. Always consult your healthcare provider before making any adjustments to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss these alternatives.
- Primary immunodeficiency: Alternatives may include prophylactic antibiotics to prevent infections or subcutaneous immunoglobulin (SCIG), which can be administered at home.
- Chronic inflammatory demyelinating polyneuropathy (CIDP): Alternatives may include corticosteroids, plasma exchange (plasmapheresis), or immunosuppressive medications such as azathioprine (Imuran).
- Guillain-Barré syndrome: Plasma exchange (plasmapheresis) is another treatment option, particularly in the early stages of the disease.
- Myasthenia gravis: Alternatives include corticosteroids, anticholinesterase medications like pyridostigmine (Mestinon), or immunosuppressive drugs such as azathioprine (Imuran).
- Kawasaki disease: High-dose aspirin and corticosteroids are sometimes used as alternatives to IVIG in treating Kawasaki disease.
- Immune thrombocytopenic purpura (ITP): Corticosteroids, rituximab (Rituxan), or thrombopoietin receptor agonists like eltrombopag (Promacta) may be considered as alternatives.
- Multifocal motor neuropathy (MMN): IVIG is the primary treatment for MMN, but other options may include immunosuppressive drugs like cyclophosphamide.
- Hepatitis B: Antiviral medications such as tenofovir (Viread) or entecavir (Baraclude) are commonly used to treat chronic hepatitis B.
- Bone marrow disorders: Treatment options vary depending on the specific disorder but may include chemotherapy, radiation therapy, or stem cell transplants.
- Systemic lupus erythematosus (SLE): Alternatives may include corticosteroids, hydroxychloroquine (Plaquenil), or immunosuppressive drugs like methotrexate.
Recent Updates on Intravenous Immunoglobulin Research
Recent research on intravenous immunoglobulin continues to explore its potential uses and effectiveness in treating a variety of conditions. Some studies are investigating its role in managing complications related to COVID-19, particularly in patients with severe immune responses. Additionally, ongoing research is examining IVIG’s potential in treating neurological conditions such as Alzheimer’s disease and multiple sclerosis. While these studies are still in their early stages, they offer promising insights into the broader applications of IVIG therapy.
Staying informed about the latest research is important, and discussing new findings with your healthcare provider can help you make the best decisions for your health. If you have questions about IVIG or are considering it as part of your treatment plan, schedule a telemedicine appointment with one of our providers today.
