IVIG Therapy: Uses, Benefits, Side Effects, and Costs

Summary of Key Points

Intravenous immunoglobulin (IVIG) is a treatment made from donated blood that contains healthy antibodies. It is used to manage a variety of immune system-related conditions, including primary immunodeficiency, autoimmune diseases, and certain neurological disorders. IVIG therapy works by either boosting or regulating the immune system. Always consult your healthcare provider before starting or adjusting your IVIG treatment. Our telemedicine providers are available to assist with any questions you may have.

Names of IVIG Medications

Gammagard (Intravenous immunoglobulin)

Gamunex-C (Intravenous immunoglobulin)

Privigen (Intravenous immunoglobulin)

Carimune NF (Intravenous immunoglobulin)

Flebogamma (Intravenous immunoglobulin)

Octagam (Intravenous immunoglobulin)

The generic name is the standard name of the medication, while brand names are specific to the manufacturer. The generic name for these medications is listed in parentheses.

Pharmacologic Category

Immune Globulin

Plasma Protein Fraction

IVIG Dosing Guidelines

Intravenous immunoglobulin (IVIG) is used to treat several conditions, and the dosing varies depending on the specific condition being treated. Always follow your doctor’s instructions and consult with our telemedicine providers before making any changes to your dose.

Primary Immunodeficiency

Adults with primary immunodeficiency typically receive an IVIG dose of 300-600 mg/kg every 3 to 4 weeks. The exact dose and frequency may vary based on your response to treatment and overall health.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

The standard dose for CIDP is 2 g/kg, administered over 2 to 5 days, followed by maintenance doses of 1 g/kg every 3 weeks.

Guillain-Barré Syndrome

The recommended dose for Guillain-Barré syndrome is 2 g/kg, given over 2 to 5 days. Treatment is usually short-term but may be repeated based on your doctor’s evaluation.

Myasthenia Gravis

For patients with myasthenia gravis, IVIG is typically given at a dose of 2 g/kg over 2 to 5 days. This is often used during a myasthenic crisis or when other treatments are not effective.

Kawasaki Disease

In Kawasaki disease, IVIG is administered at a dose of 2 g/kg as a single infusion. This is usually given alongside aspirin to reduce inflammation and prevent heart complications.

Immune Thrombocytopenic Purpura (ITP)

For ITP, the dose is 1 g/kg daily for 2 days or 0.4 g/kg daily for 2 to 5 days. This helps increase platelet counts in patients with low platelet levels.

Multifocal Motor Neuropathy

The typical dose for multifocal motor neuropathy is 2 g/kg over 2 to 5 days, followed by maintenance doses of 1 g/kg every 2 to 4 weeks.

Hepatitis B

For hepatitis B, IVIG is used as part of post-exposure prophylaxis. The dose is typically 0.06 mL/kg, given as soon as possible after exposure and repeated every month for up to 6 months.

Bone Marrow Disorders

IVIG is used in bone marrow disorders to prevent infections. The dose is usually 500 mg/kg every 4 weeks, but this may vary depending on your specific condition.

Systemic Lupus Erythematosus (SLE)

For lupus, IVIG is used in cases of severe disease or when other treatments have failed. The dose is typically 400 mg/kg daily for 5 days.

Dosage Forms and Strengths of IVIG

Intravenous solution: 5% (50 mg/mL)

Intravenous solution: 10% (100 mg/mL)

Administration Instructions for IVIG Therapy

IVIG is administered intravenously by a healthcare professional. The infusion can take several hours, depending on the dose. Staying well-hydrated before and after the infusion can help reduce the risk of side effects. Your doctor may recommend pre-medications, such as antihistamines or steroids, to prevent allergic reactions. If you experience any discomfort during the infusion, notify your healthcare provider immediately.

IVIG Side Effects and Adverse Reactions

Like all medications, IVIG can cause side effects. Some are mild, while others may be more serious. It is important to monitor for any changes and report them to your healthcare provider.

Common side effects (affecting more than 1 in 10 patients):

Headache: A common side effect, often mild but can sometimes be severe.

Fatigue: Feeling unusually tired after the infusion is common and usually temporary.

Less common side effects (affecting 1 in 100 to 1 in 1,000 patients):

Nausea: Some patients may feel nauseous during or after the infusion.

Fever: A mild fever may occur after treatment.

Chills: Some patients experience chills during the infusion, which can be managed with pre-medications.

Serious side effects (affecting fewer than 1 in 1,000 patients):

Allergic reactions: Symptoms like rash, itching, or difficulty breathing may indicate an allergic reaction. Seek immediate medical attention if this occurs.

Kidney problems: IVIG can sometimes affect kidney function, especially in patients with pre-existing kidney disease.

Blood clots: Rarely, IVIG can increase the risk of blood clots, particularly in patients with other risk factors.

Contraindications for IVIG Treatment

A contraindication is a specific situation or condition where a particular medication should not be used because it may cause harm to the patient. In the case of Intravenous Immunoglobulin (IVIG), there are certain conditions where taking this medication could be dangerous.

Severe Allergies to Immunoglobulins: If you have had a severe allergic reaction to immunoglobulins in the past, IVIG is contraindicated. This is because the immune system may react strongly, leading to life-threatening allergic reactions like anaphylaxis.

IgA Deficiency with Anti-IgA Antibodies: Patients with IgA deficiency who have developed antibodies against IgA are at risk for severe allergic reactions if given IVIG, as the body may attack the immunoglobulin as a foreign substance.

Thrombosis Risk: IVIG can increase the risk of blood clots (thrombosis). If you have a history of blood clots, heart disease, or other conditions that increase your risk of thrombosis, IVIG may not be suitable for you.

Kidney Disease: IVIG can cause kidney problems, especially in patients with pre-existing kidney disease. If you have kidney issues, your healthcare provider may recommend avoiding IVIG or using it with extreme caution.

Drug to Drug Interactions with Intravenous Immunoglobulin (IVIG)

IVIG therapy can interact with other medications, potentially increasing the risk of side effects or reducing the effectiveness of either IVIG or the other drug. It is essential to inform your healthcare provider about all medications you are taking, including prescription drugs, over-the-counter medications, and herbal supplements.

Live Vaccines

IVIG can interfere with the effectiveness of live vaccines, such as the MMR (measles, mumps, rubella) or varicella (chickenpox) vaccines. It is generally recommended to wait at least three months after receiving IVIG before getting a live vaccine to ensure the vaccine works as intended.

Warfarin (Coumadin)

IVIG may increase the risk of bleeding when taken with blood thinners like warfarin. Your healthcare provider may need to monitor your blood clotting levels more closely during IVIG treatment to prevent complications.

Aminoglycoside Antibiotics (e.g., Gentamicin)

These antibiotics can increase the risk of kidney damage when used with IVIG, particularly in patients with pre-existing kidney conditions. Close monitoring of kidney function is recommended if these medications are used together.

Cyclosporine (Gengraf, Neoral, Sandimmune)

This immunosuppressant can heighten the risk of kidney damage when combined with IVIG. Your healthcare provider may need to adjust your treatment plan to minimize this risk.

Intravenous Immunoglobulin in Pregnancy

Is it safe to take IVIG during pregnancy? The safety of IVIG therapy during pregnancy depends on the specific condition being treated and the individual patient. IVIG is often used to manage certain autoimmune diseases or immune deficiencies during pregnancy, and in many cases, it is considered safe. However, it should only be used if the potential benefits outweigh the risks. Always consult with your healthcare provider before starting or continuing IVIG during pregnancy. If you are pregnant or planning to become pregnant, our telemedicine providers can help you assess your treatment options.

Intravenous Immunoglobulin while Breastfeeding

Is it safe to take IVIG while breastfeeding? IVIG is generally considered safe during breastfeeding. Immunoglobulins are naturally present in breast milk, and there is no evidence to suggest that IVIG poses a risk to a breastfeeding infant. However, it is important to discuss your specific situation with your healthcare provider to ensure that IVIG is the right choice for you while breastfeeding. Our telemedicine team is available to help you make an informed decision.

Estimated Cost of IVIG Treatment

The cost of IVIG treatment can vary significantly depending on the dosage and brand. Without insurance, the estimated cost of a 30-day supply of IVIG using a GoodRX coupon can range from $5,000 to $10,000 or more. The exact price will depend on the specific product and dosage prescribed. Be sure to discuss cost-saving options with your healthcare provider or pharmacist to help manage the cost of IVIG therapy.

Possible Alternatives to IVIG Therapy

If IVIG therapy is not suitable for you, there may be alternative treatments or lifestyle changes that can help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these options.

Primary Immunodeficiency

Alternatives may include prophylactic antibiotics to prevent infections or other immune-modulating therapies. Lifestyle changes, such as avoiding exposure to infections and maintaining a healthy diet, can also help manage the condition.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Alternatives to IVIG treatment for CIDP include corticosteroids, plasma exchange (plasmapheresis), or immunosuppressive drugs like azathioprine. Physical therapy may also help improve muscle strength and function.

Guillain-Barré Syndrome

Plasma exchange or corticosteroids are potential alternatives to IVIG therapy for Guillain-Barré Syndrome. Early treatment is crucial for reducing the severity of symptoms and improving outcomes.

Myasthenia Gravis

Alternatives to IVIG infusion for Myasthenia Gravis include anticholinesterase medications like pyridostigmine (Mestinon) or immunosuppressive drugs like prednisone. Lifestyle changes, such as managing stress and avoiding triggers, may also help manage symptoms.

Kawasaki Disease

High-dose aspirin and corticosteroids are commonly used as alternatives to IVIG in treating Kawasaki Disease. Early treatment is essential to prevent heart complications.

Immune Thrombocytopenic Purpura (ITP)

Alternatives to IVIG therapy for ITP include corticosteroids, rituximab (Rituxan), or thrombopoietin receptor agonists like eltrombopag (Promacta). In some cases, splenectomy (removal of the spleen) may be considered.

Multifocal Motor Neuropathy (MMN)

Alternatives to IVIG infusion for MMN include immunosuppressive drugs like cyclophosphamide. Physical therapy may also help maintain muscle strength and function.

Hepatitis B

Antiviral medications like tenofovir (Viread) or entecavir (Baraclude) are commonly used to treat chronic hepatitis B. Lifestyle changes, such as avoiding alcohol and maintaining a liver-healthy diet, can also help manage the condition.

Bone Marrow Disorders

Treatment for bone marrow disorders depends on the specific disorder but may include chemotherapy, radiation therapy, or bone marrow transplants. Discuss with your healthcare provider to determine the best treatment plan for your condition.

Systemic Lupus Erythematosus (SLE)

Alternatives to IVIG therapy for SLE include corticosteroids, hydroxychloroquine (Plaquenil), and immunosuppressive drugs like methotrexate. Lifestyle changes, such as avoiding sun exposure and managing stress, can also help manage symptoms.

Recent Updates on Intravenous Immunoglobulin Research

Recent studies have explored the use of IVIG in treating COVID-19-related complications, particularly in patients with severe immune responses. While research is ongoing, early results suggest that IVIG may help modulate the immune system and reduce inflammation in these patients. Additionally, new studies are investigating the use of IVIG in treating neurological conditions like Alzheimer’s disease, though more research is needed to confirm its effectiveness. As always, consult with your healthcare provider to understand how the latest research may impact your treatment options. Our telemedicine providers are available to discuss any new developments in IVIG therapy with you.

James Kingsley

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