Immune Globulin Intramuscular (IGIM; IG; Gamma Globulin; ISG)

A to Z Drug Facts

 Action Replaces normal human IgG antibodies.

 Indications Passive immunization against or modification of hepatitis A. Prevention or modification of measles in susceptible persons exposed < 6 days previously. Passive immunization against varicella in immunocompromised patients if varicellazoster immune globulin (VZIG) is not available and IGIM can be given promptly. IgG replacement therapy in certain persons with hypoglobulinemia or agammaglobulinemia.

 Contraindications Immediate hypersensitivity to human antibody product or thimerosal; circulating anti-IgA antibodies; thrombocytopenia or any coagulation disorder.

 Route/Dosage

Preexposure and Postexposure Hepatitis A Prophylaxis

ADULTS & CHILDREN: IM 0.02 ml/kg. Pre-exposure hepatitis A prophylaxis for travelers to developing countries who will stay < 3 mo. IM 0.06 mg/kg with booster doses q 4–6 mo throughout their stay.

Postexposure Measles Prophylaxis

ADULTS & CHILDREN: IM 0.25 ml/kg. SUSCEPTIBLE IMMUNOCOMPROMISED CHILDREN: IM 0.5 ml/kg (max 15 ml).

Postexposure Varicella Prophylaxis

ADULTS & CHILDREN: If VZIG is unavailable, IM 0.6 to 1.2 ml/kg.

Immunoglobulin Deficiency

ADULTS & CHILDREN: IM 0.66 ml/kg (100 mg/kg) q 3 to 4 wk. Larger initial dose (eg, 1.2 ml/kg) is often given at onset of therapy. Patients who rapidly metabolize may require more frequent or larger doses.

 Interactions Live vaccines: To avoid inactivating vaccines containing live viruses or bacteria, give live vaccines 2 to 4 wk before or 3 to 6 mo after IGIU, depending on dose.

 Lab Test Interferences None well documented.

 Adverse Reactions

OTHER: Local pain and tenderness at injection site; urticaria; angioedema; anaphylactic reactions.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Special risk patients: Give drug cautiously to persons receiving anticoagulant therapy because of IM administration. Hypersensitivity: Hypersensitivity, including anaphylaxis, may occur. Administer drug with caution in patients with prior systemic allergic reactions to human immunoglobulins.

 Administration/Storage

• Administer via IM injection only; do not give by IV route.
• In adults, administer via IM injection, preferably in upper outer quadrant of gluteal region.
• In infants and children < 3 yr, administer IM in anterolateral thigh.
• Divide doses > 10 ml and inject into several muscle sites to reduce local pain and discomfort.
• It is better not to inject > 3 ml per injection site.
• Always record manufacturer's name and lot number of immune globulin in patient's permanent record file along with date of administration, name, address and title of person administering injection.
• Refrigerate vials. Do not freeze.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Monitor for hypersensitivity and/or anaphylaxis. Epinephrine should always be available to counteract any possible reactions.

 Patient/Family Education

• Instruct patient to take analgesics (eg, acetaminophen) for local pain and tenderness at injection site if necessary.
• Provide patient or parent with immunization history record and record this injection in patient's medical records.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts